Injection therapy effective pain relief in physios’ hands - Congress article 6

More than a decade of experience of injection therapy showed it was a safe, cost-effective intervention for pain relief, especially for musculoskeletal conditions, said injection therapy pioneer and member of the CSP prescribing steering group, Stephanie Saunders.

The technique did not stand alone but, in the hands of physiotherapists, when combined with usual rehabilitation modalities, injection therapy could cut the amount of treatment needed and make the effects last longer, Ms Saunders said. However, more evidence was needed. An audit of injections between 1999 and 2008 showed that of a total of 1,263, 76 per cent were upper limb and just under half of these – 345 – were shoulder sites. The audit also found that 34 per cent of shoulder injections were repeated, in most instances only once. One patient, however, ‘a very short bell ringer’, had a total of six injections over two years. Details of adverse reactions were collated as part of the audit. These included two patients who suffered ‘quite frightening’ anaphylactic attacks, Ms Saunders said. She asked physios who inject to inform the Association of Chartered Physiotherapists in Orthopaedic Medicine of any more adverse reactions. Ms Saunders also presented the results of an audit of the injection therapy clinical guideline for physiotherapists. This showed the vast majority of physiotherapists injected in line with the guidelines. However, 11 per cent did not document patient consent and 15 per cent did not record drug information, which Ms Saunders described as ‘worrying’. Delegates also heard from consultant physiotherapists Billy Fashanu and Darryn Marks about a recent controversy over the practice of mixing two drugs – a steroid and a local anaesthetic – in the syringe prior to injection, under a patient group directive. This was seen as making a new substance, which constituted an unlicensed drug and was therefore illegal for physiotherapists to inject, the consultants explained. However, it was permissible if the mixing were done as part of a clinical management plan, where a doctor shared responsibility. ‘This raises lots of issues for us as a profession,’ Mr Marks said. Ms Saunders suggested two ways round the situation: to use a premix or not to use the local anaesthetic. 
Catherine Hill

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