What are the treatment options for chronic pain? An explanation of the sequence from regenerative injections to catheter intervention

A common situation encountered in the outpatient clinic is this: joint or tendon pain has persisted for more than six months, and the patient has also received PRP injections at other clinics. It felt effective the first few times, but the effect became shorter and shorter. The doctor recommended considering surgery, but the patient is still reluctant to undergo an operation.

In times like this, it is worth understanding one thing first: even if the effect of PRP is limited, it does not mean that surgery is the only path left. There are still several steps in between that can be evaluated, provided that the source of the pain is clarified first.

Why should the treatment of chronic pain be observed in several stages?

Because there is more than one stage in the source of pain, and different treatments address different aspects.
The goal of injection therapies like PRP and high-concentration dextrose is to stimulate the repair of damaged tissues, such as tendons, ligaments, and soft tissues around joints. If the pain mainly stems from damage to these tissues, injections have their utility.

However, in areas of long-term chronic pain, in addition to tissue damage, abnormal proliferation of microvessels may also occur, accompanied by newly formed nerve endings that continuously send pain signals. This aspect is not what regenerative injections are designed to treat, which is also one of the reasons why some patients find that "it was effective when injected, but the effect became shorter and shorter."
To understand the individual factors that affect the efficacy of injections (blood quality, injection location, dosage, and precision of image guidance), you can refer to the article on this site regarding Differences in PRP Efficacy.

Therefore, which stage to move toward depends not on switching to a stronger injection, but on first confirming which stage the source of pain is located in.

What are the treatment options, and how should they be ordered?

Pain treatment can be roughly divided into three levels. The actual sequence is determined by the doctor based on the results of exams and evaluations, and not everyone will undergo all treatments.

The first stage is regenerative injection therapy, which involves injecting prolotherapy agents into or near the joint or damaged tissue, with the goal of assisting tissue repair. Common options include high-concentration dextrose, PRP (platelet-rich plasma growth factors), amniotic membrane matrix, BMAC (bone marrow aspirate concentrate), and PLT freeze-dried crystals. This treatment method is quite common in orthopedic and rehabilitation clinics; which type to use and how many injections to administer are determined by the doctor based on the condition, location, and past injection responses.

The second stage is TAME (Transcatheter Arterial Micro-Embolization). It addresses abnormally proliferating microvessels, aiming to reduce the source of pain signals and alleviate local continuous inflammation. When pain recurs and the effect of regenerative injections is limited, and imaging and examinations show that the pain may be related to abnormal blood vessels, TAME will be included in the evaluation list.

The third stage is surgery. When imaging shows clear structural problems or there are signs of neurological impairment, surgery remains a necessary option. This article is not saying that surgery is bad, but rather that before reaching the stage of surgery, there is still room for evaluation and treatment in between.

It is important to emphasize here that these three stages are not upgrade levels. Some people achieve sufficient improvement in the first stage; for some, after evaluation, the source of pain is not suitable for embolization, and at this point, the doctor will suggest other treatment directions; others should consider surgery directly from the beginning. The arrangement of treatment is decided by the doctor based on the medical condition, imaging, and treatment feedback.

How to choose among PRP, Amniotic Membrane Matrix, and C-TAME?

Let's first clarify that the three are not the same type of treatment method.

PRP, amniotic membrane matrix, BMAC, and PLT freeze-dried crystals all belong to regenerative injection therapies, injected into or near the joint or damaged tissue, with the treatment goal of repairing the tissue itself.
The differences lie in their sources and ingredients: PRP is derived from the patient's own blood; BMAC is derived from the patient's own bone marrow, which is extracted, prepared into a formulation by a cell company, and then injected back into the joint; amniotic membrane matrix and PLT freeze-dried crystals are pre-prepared formulations. Which one is suitable depends on the location, the state of the tissue, what has been injected in the past, and the feedback after treatment.

C-TAME, on the other hand, is another type of minimally invasive treatment.
This minimally invasive treatment is non-injection based and is not injected into the joint. Instead, microcatheters are used to deliver embolization agents through the artery to abnormally proliferating microvessels, addressing the source of pain signals rather than tissue repair. Therefore, it follows a different treatment logic than the aforementioned prolotherapy and represents a different stage of treatment.

So, how do we arrange this in practice? For most symptoms, we start with regenerative injections because they are less invasive and do not require catheters or angiography equipment.
If you have had several injections with limited effect, and the pain has lasted for more than six months, and imaging and examinations show that the pain may be related to abnormal blood vessel proliferation, then TAME will be considered for evaluation. It is important to emphasize here that not everyone needs to proceed to this stage, and some people are deemed unsuitable after evaluation.

In addition, there is a practical difference worth noting: regenerative injections are quite common in orthopedic and rehabilitation clinics, whereas C-TAME requires angiography equipment and catheterization techniques.
He-Yi uses the GE OEC 3D mobile C-arm with cone-beam CT (3D tomography) function, performed by Director Lu Bing-sheng.
Whether the symptoms require ultrasound-guided s-TAME or catheter-based C-TAME is evaluated and determined by the doctor based on the depth of the painful area and imaging. For the differences between the two, please see "What is the difference between C-TAME and s-TAME?".

What is TAME? How does it differ from injection therapy?

The difference lies in the target of treatment.
TAME (Transcatheter Arterial Micro-Embolization) selectively addresses pain-related abnormal microvessels using embolic materials, causing these vessels to shrink; regenerative injection therapy targets damaged soft tissue. The two do not replace each other but rather address different aspects of chronic pain.

Having received PRP or hyaluronic acid injections in the past does not affect the evaluation for TAME; the doctor will make a judgment based on current symptoms and imaging.

How to choose between C-TAME and s-TAME?

The choice depends on the depth of the painful area and whether it can be localized using ultrasound.

C-TAME (catheter-based) is guided by angiography equipment with cone-beam CT (3D tomography) function, using microcatheters to deliver embolization agents to target blood vessels for selective embolization, requiring contrast agent injection during the procedure.
The equipment used by He-Yi is the GE OEC 3D mobile C-arm, and the treatment is completed in the clinic's angiography operating room. It is suitable for deeper areas with more complex vascular pathways, such as the knee, hip, and shoulder.

s-TAME (simplified type) is performed using fine-needle injection under ultrasound guidance, without inserting a catheter or requiring contrast agents. It is suitable for superficial areas that can be clearly localized by ultrasound, such as fingers, wrists, and soles of feet. For those allergic to contrast agents or with poor kidney function, s-TAME is one of the treatment options that can be discussed with the doctor.

Both are performed under local anesthesia in the outpatient clinic, without requiring hospitalization. For a complete comparison, please see "What is the difference between C-TAME and s-TAME?".

In what situations should surgery still be considered?

When imaging examinations show significant structural compression or damage, symptoms continue to worsen after conservative and interventional treatments, or signs of neurological impairment appear (such as muscle atrophy or obvious weakness in the lower limbs), these conditions should receive surgical evaluation. If urinary/fecal incontinence or perineal numbness occurs, it is an emergency warning sign; please seek medical attention immediately.

If I want to get evaluated, what should I prepare?

Bringing all imaging and previous medical records can save you a clinic visit.
When coming for a consultation, please bring past imaging data (X-rays, MRI, ultrasound) and treatment records, including the types of injections, frequency, and responses at other clinics. This information will influence the doctor's judgment regarding the source of pain and the next steps.

You can first go through LINE for a pre-evaluation, and then schedule a pain specialty consultation.
He-Yi Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Daan Dist., Taipei City, operating strictly by appointment. Phone: (02) 2366-0186.


Author: Dr. Lu Bing-sheng

Last Updated: August 6, 2026

Disclaimer: This article is for health education information purposes and cannot replace medical diagnosis and treatment advice. Whether any treatment is suitable should be evaluated and decided by a doctor.

Dr. Yuji Okuno's Micro-Embolization Research References:
Okuno Y, Korchi AM, Shinjo T, et al. Midterm clinical outcomes and MR imaging changes after transcatheter arterial embolization as a treatment for mild to moderate radiographic knee osteoarthritis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(7):995-1002. doi:10.1016/j.jvir.2017.02.033

Okuno Y, Iwamoto W, Matsumura N, et al. Clinical outcomes of transcatheter arterial embolization for adhesive capsulitis resistant to conservative treatment. J Vasc Interv Radiol. 2017;28(2):161-167.e1. doi:10.1016/j.jvir.2016.09.028

Iwamoto W, Okuno Y, Matsumura N, et al. Transcatheter arterial embolization of abnormal vessels as a treatment for lateral epicondylitis refractory to conservative treatment: a pilot study with a 2-year follow-up. J Shoulder Elbow Surg. 2017;26(8):1335-1341. doi:10.1016/j.jse.2017.03.026