pain-management

Coastal Virginia
Spine and Pain Center

spinal

Reducing PAIN

Returning FUNCTION 

Restoring QUALITY OF LIFE

Coastal Virginia Spine and Pain Center

Dedicated and Skilled Professionals
Evaluating and Treating Spinal and Musculoskeletal Pain
Providing Quality Care
Using Cutting-Edge Technology
Utilizing over 30 Years of Experience
Covering the Coastal Virginia Region
Centrally Located in Virginia Beach

PROLOTHERAPY

regenerative therapy

Regenerative Medicine, (commonly referred to as "Biologic Healing" or "Stem Cell Therapy") describes a process by which an intervention is performed in order to initiate regeneration of injured or damaged sites within the body. This cutting-edge treatment has been shown to improve both pain and function in many painful conditions such as osteoarthritis, tendonitis, partial tendon tears and ligament injuries.

Our provider team at Coastal Virginia Spine and Pain Center will assess the cause of your pain, and then decide which Regenerative Treatment method would be best to heal your condition.

We currently offer Platelet-Rich Plasma and Prolotherapy. 

PROLOTHERAPY

Proliferative Therapy, also known as Prolotherapy, is a method of injecting an anesthetic and an irritant (usually containing dextrose and fish oil) into joints, ligaments or tendons that are weakened, torn or pulled. It is a non-surgical method by which ligaments and tendons are repaired, resulting in strengthening of the weakened connective tissue by using the body’s own healing powers.

Prolotherapy is not a new concept. While treating wounded soldiers by cauterizing the injuries to stop bleeding, Hippocrates noticed the added healing benefits that resulted in the ligaments and tendons.  Prolotherapy was used in the 1800's and was further developed in the 1940s by Dr. George Hackett, and long-term studies were done by Dr. Gustav Hemwall from the 1950s through the 1990s.

Prolotherapy differs from Platelet-Rich Plasma (PRP) in that PRP injections are a totally natural process that stimulates the repair of soft tissue and joints.  It is important to understand that the purpose of this treatment is to strengthen these weakened areas, and not to decrease pain. The decrease in pain usually results from the increased stabilization and ability for the muscles to relax. Prolotherapy is useful in the treatment of:

  • Overuse injuries
  • Ligament or tendon dysfunction (sprain, strain, and tendonitis)
  • Bursitis
  • Arthritis
  • Degenerative discs

What causes the connective tissue to become weakened?

Repetitive use injuries, poor posture, improper stretching, auto accidents, falls, etc., can cause these tissues to become torn and stretched. This can be compared to elastic – it is flexible when it is new, but as it ages it becomes less pliable, more brittle, and loses its elasticity.

As a result of the weakened tissues, joint mobility changes, strength can decrease, and muscles go into spasm, all of which result in more pain and postural/functional limitations. Arthritis is actually the body’s way of trying to strengthen a joint when the connective tissue is torn or lax, resulting in degenerative changes that are permanent. Prolotherapy is helpful in reversing some of these changes.

How Does Prolotherapy Work

With Prolotherapy, an injectate is injected into the lax or torn areas causing a stress inflammation.  This inflammation results in the proliferative cells migrating to the weakened area, allowing for growth of new, strengthened tissues.  This is how Prolotherapy provides a mechanism by which the body can work toward healing itself.

Prolotherapy helps stimulate the body to make collagen.  This is accomplished through a series of injections, not of collagen, but of a mild chemical or a natural irritant such as dextrose (sugar), which stimulates an immune response facilitating the body to produce collagen naturally.  The immune response is facilitated because the procedure causes a stress inflammation (unlike that caused from an infection) and the body responds to this, thereby starting the repair process. The procedure increases the number of fibroblasts, which synthesize collagen.

The making of new collagen facilitates tissue repair, which allows for strengthened and restored tendons, ligaments and joints, and ultimately translates into more significant and/or permanent pain relief.  There is no evidence that this process causes scarring in the area of the injections.  The advantage of Prolotherapy is that it does not interfere with the patient’s activity level during treatment (activity can continue at work, exercise and play), and there is no postoperative recovery time.

How long will the effects of treatment last?

Because the therapy stimulates the body to create new healthy tissue, the effects are considered permanent. Results are not seen immediately, as it takes months for the process to fully mature. Studies have shown that tendon size can increase from this treatment by as much as 35-40%.

Does proliferative therapy work on all areas of the body?

All joints respond to treatment. In fact, the treatment has also been successful in cases involving almost all types of:

  • Back pain - degenerative disc disease
  • Bone fractures and arthritis
  • Unstable joints
  • Heel spurs
  • Tennis elbow
  • Rotator cuff tears
  • Knee-joint problems
prolotherapy

Are there any side effects with Prolotherapy?

Some people may have sensitivity to the proliferative agent and/or the anesthetic, as evidenced by swelling, headache, nausea and tiredness. This reaction is only temporary as it rarely lasts longer than two to four days after the injection. However, experiencing soreness and stiffness a couple of days afterward is normal. It is best to avoid the use of aspirin and anti-inflammatories for post-injection pain and soreness, as these medications interfere with the healing process.

How many treatments are required to receive the maximum benefit?

This is an individual matter depending on many factors.  The goal of prolotherapy is to help each patient optimize return to function through proper therapy and exercise.  The maximum benefits are achieved when full strength and endurance are reached, and posture is improved.

The degree of ligament/joint laxity and underlying arthritis will impact the number of treatments.  In general, we recommend starting with 3-5 sessions of injections performed at three-to-four-week intervals.  We then recommend waiting three months to determine if further injections are indicated.

Unlike steroid injections, the benefits of Prolotherapy evolve gradually, thus patience is encouraged with the healing process; it is beneficial to set reasonable expectations relating to the time frame for healing.  The ultimate goal of Prolotherapy is to allow each patient to be able to do more physical activity with less pain.

For additional information, please visit the following:
American Association of Orthopaedic Medicine®

Post-Regenerative Treatment Instructions

Congratulations! You have taken your first step in a process to heal your chronic condition through regenerative therapy. After your Prolotherapy Injections, there is very little downtime, as opposed to a surgical procedure, and the healing process goes on for the next 4-6months.  The first 1-2 weeks, however, are when you may feel the most discomfort. It is advisable to plan for a few days of rest post-procedure to accommodate the expected soreness.

Please follow the following guidelines to make sure your healing progresses and in order to optimize your outcome. If you have any questions or problems, please contact this office at 757-227-3820

DO's

  • DO REST. Plan to rest the treated area for the next 1-3 days.
  • DO use Tylenol to control the pain. There is now more inflammation as the healing cascade is starting and an increase in pain is expected as with any medical procedure.   A typical regimen is to take 500mg OTC Tylenol 3 x daily.
  • DO MONITOR the injection site for increasing redness or discharge. Increased  tenderness, mild swelling, and even warmth is to be expected after these treatments. However given the rather simple and more natural approach with regenerative treatments,  reactions and infection risk is rather low.
  • DO stay hydrated, well nourished, active, and get plenty of sleep. The healing is just beginning with this treatment and using the affected area with normal movements such as walking will help increase the blood flow and healing.

DON'TS

  • DON’T ICE the affected area for 72 hours; this is to allow the repair process to maximize potential.
  • DON’T take any NSAID medications, vitamins, or supplements unless approved by your clinician. This includes nutritional supplements, herbs, NSAIDs, and even marijuana and CBD for the week following your treatment.
  • DON’T apply creams, lotions, oils, or makeups to the injection sites for at least 8 hours.
  • DON’T EXERCISE or perform strenuous activity with the affected area. The procedure is trying to stimulate healing and the injured area or site needs to go through this repair process fully. You may perform ROM stretches as tolerated though.
  • DON’T SMOKE or drink Alcohol for 72 hours post injection. These items increase BAD inflammation and free radicals in our body and can delay or interfere with the healing process. Ideally minimize the use of these substances for a few weeks after your procedure or consider quitting altogether.

Frequently Asked Question About Prolotherapy Injections

Am I a candidate for Prolotherapy?

Now is the time to schedule a Prolotherapy consultation with one of our providers to find out.     

Call 757-227-3820 or visit E-mail us to schedule an appointment

Does Insurance Cover Prolotherapy Injections?

At the moment, most insurances do not cover Prolotherapy Injections or Regenerative Therapies .  We will assist you in determining if your insurance will cover the costs for these procedures.   The costs can sometimes be paid with an HSA or FSA, so you will need  to check with your Plan Administrator.

What is the cost?

At Coastal Virginia Spine and Pain Center, we believe that the cost to achieve pain relief should be affordable.   We will  make  every attempt to minimize the out of pocket cost to all of our patients.

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OUR SERVICES

INTERVENTIONAL PAIN MANAGEMENT

  • Fluoroscopically-Guided Spinal Injections
  • Musculoskeletal Ultrasound (MSKUS) Guided Joint Injections
  • Trigger Point Injections
  • Scar Tissue Injections
  • Spinal Cord Stimulator Trials

REGENERATIVE MEDICINE

  • Platelet-Rich Plasma Therapy (PRP)
  • Prolotherapy

DIAGNOSTIC STUDIES

  • Electromyography
  • Nerve Conduction Studies
  • Spinal Medial Branch Blocks

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pain-management

PHYSICAL THERAPY

  • One-On-One Care
  • Same Therapist for Each Visit
  • Individualized Care Plans
  • Spinal Stabilization and Strengthening
  • Postural Retraining
  • Restoration of Breathing Mechanics

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Medication for Management of Pain

MEDICAL WEIGHT MANAGEMENT PROGRAM

This program is for patients who....

  • Want or need to lose weight 
  • Cannot have spinal or joint surgery because of weight
  • Have been unsuccessful in weight loss or other diet programs
  • Cannot tolerate regular exercise

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Medication for Management of Pain

MEDICATION FOR MANAGEMENT OF PAIN

Coastal Virginia Spine and Pain Center use of medication for pain management places an emphasis on a multimodal approach, patient education and clinical decision making to achieve pain relief while reducing opioid-related risks.

Our priority is placed upon the identification of the source of the pain and then consider the best treatment approach for your care. We start with non-opioid medications, Physical Therapy, and potentially, interventional techniques.

When using limited opioid-based medications, in addition to the current treatment plan, strict patient compliance is necessary to reduce potential risks and maximize functional return.

Coastal Virginia Spine and Pain Center adheres to State and Federal Guidelines, as well as our Opioid Prescribing Policy related to the prescribing of controlled medications.

WORKERS COMPENSATION CASE MANAGEMENT

Coastal-virginia -spine-and-pain-center

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Location

Coastal Virginia Spine and Pain Center

Southport Center Building

4525 South Boulevard

Suite 200

Virginia Beach, Virginia  23452

VIEW MAP

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Hours

Monday-Thursday: 7:30AM - 5:00PM

Friday:  7:30AM - 4:00PM

cova-office-enter

Meet Our Providers

Dr. Robert Spear
Dr. Robert Spear
Dr. Bonnie Nock
Dr. Bonnie Nock
Abby Barney, PA-C
Abby Barney, PA-C
Claire Denny, PA-C
Claire Denny, PA-C
Kristi Nixon-Cartwright, NP-C
Kristi Nixon-Cartwright, NP-C
Kathryn Bragg, PT
Kathryn Bragg, PT
Scott Burch, PT
Scott Burch, PT
Robin Levine, PT
Robin Levine, PT

The physicians and staff at Coastal Virginia Spine and Pain Center have over 30 years of experience in Pain Management. 

We provide comprehensive treatment for spinal and musculoskeletal pain to help improve and manage acute or chronic pain.

The goal of treatment is to help our patients become empowered over their pain- to help reduce pain and increase function through intervention, therapy and education.

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Frequently Asked Questions

Schedule an Appointment

To make an appointment, you may call us at 757-227-3820 between 7:30 a.m. and 4:00 p.m. Monday – Friday, or you may stop by our office to schedule an appointment. 

You can also e-mail us, and we will reply as soon as possible.  If you wish to be called back, please include your name and preferred contact number in your e-mail. 

Patient Portal

You can access the Patient Portal after receiving a password from our office.  If you have any questions please contact us

Initial Evaluation

Patients are generally scheduled within two weeks for a new evaluation.

You will receive a welcome packet in the mail or e-mail, prior to your visit, or you can download the New Patient Packet. It is recommended that you arrive about 15 minutes prior to your initial evaluation if you have completed your paperwork, and 30 minutes before if you have not completed the paperwork.

After your initial evaluation, your provider will discuss with you the most effective treatment program and care plan for your problem.

First Appointment

To assist in making your first visit to COVA Spine and Pain Center more time efficient, please bring any relevant medical records as well as:

  • Photo ID
  • Insurance Card
  • Referrals from your Primary Care Physician
  • All completed New-Patient Paperwork
  • Co-Pay, if required

We will request any other medical records, MRI’s, CT scans, X-rays or laboratory results or MRIs be faxed to our office from your referring physician’s office. To expedite this process, you can download the Medical Records Request Form before your first visit.

Prescription Refills

You can call our office at 757-227-3820 for prescription refills, Monday through Friday between 7:30:00 a.m. and 4:00 p.m. Please allow three (3) business days to process your request.

 

If someone is picking up the prescription for you, an Authorization for Release of Prescription has to be completed in order for the prescription to be released.

prescription-refills

Pre-Authorization

You should check with your insurance to determine if a referral is necessary prior to receiving treatment.

 

If your insurance requires a pre-authorization to see a specialist, then you must get a referral from a Primary Care Physician or OB/GYN to see a pain specialist for an initial appointment.

 

After the initial consultation, our office will obtain any future authorizations, sometimes with the assistance of your referring doctor.

Medical Records Request

We will be happy to provide you with a copy of your medical records. You will need to fill out a copy of the Medical Records Release Form.

Insurance Questions

We Accept• OPTIMA - Physician Services Only, Not Physical Therapy
• Effective 3/1/2025, COVA PHYSICAL THERAPY will NO LONGER be In-Network with Anthem BC/BS.   Read more.. 
• Medicare
• Tricare
• Cigna
• Aetna
• United Healthcare
• Most Commercial Insurances
Require Referral• Tricare Prime
We DO NOT Accept
Plans which we DO NOT accept:
• HealthKeepers Plus
• Optima Family Care
• Optimum Choice
• Virginia Premier
• MAMSI
• Alliance
Worker's Comp Guidelines• Case manager or adjuster must call and schedule the first appointment
• The following information must be provided
• Date of injury
• State of injury
• Body part injured
• Case manager or adjuster’s name and number
• Insurance name, number, address and adjuster
No Health InsuranceThe costs vary depending on what type of treatment is needed. We will try to work with you to help you obtain the care you need.

Please contact our office at 757-227-3820 to see how we can hellp you.
Differnce Between a Co-Pay and Co-InsuranceA co-pay is the amount designated by your carrier that identifies a set amount for the office visit. Typically, there is one for your primary care provider and a different amount due a specialty provider.

Co-insurance is a percentage due, determined by your benefit plan and the contract with your carrier and your provider.

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