January 19, 2018

What is Cross-Linked Hyaluronic Acid * CL-HA?

• Hyaluronic acid-HA is a natural substance found in the body.

• It is used by the body to support tissues, like the skin, and in the defense against injury and disease.

• It has been cross-linked chemically in the lab to make its effects last much longer, so that the body does not break it down so quickly.

How is CL-HA used to treat pain?

• Dr. Campa discovered that it can be used to treat nerve pain by injecting very small amounts around the affected nerve.

• PATENTS GRANTED & ISSUED: He has been treating patients successfully with this substance since 2012 and was granted US patent, #9205105 B2, for the technique and use of Cross-Linked Hyaluronic Acid in the treatment of neuropathic pain in December 08, 2015. He has also been granted the Australian patent, #2014268530, for the same technique and use of Cross-linked Hyaluronic Acid in the treatment of pain on November 16, 2017 and the Canadian patent, #2,913,164, was granted on 12/11/2018, for the same technique and use of Cross-linked Hyaluronic Acid in the treatment of pain. Dr. Campa has a patent pending int the United Kingdom and the European Union.

• Cross-Linked Hyaluronic Acid for the Management of Neuropathic Pelvic Pain, Practical Pain Management, July-August, Vol. 17, Issue #5, 2018
  

• PDF download for XL-NMA treatment for Endometriosis & Pelvic Pain-Dr Campa
  

• Cross-Linked Hyaluronic Acid Injection for Neuropathic Pain, Practical Pain Management, June, Vol. 17, Issue #5, 2017

How is the injection done?

• Figure 1 below.
• First the doctor will locate and mark the most likely nerves (small 'X's in the green triangle) that are transmitting your pain. The 'T's are points where skin temperatures are checked before & after injection.Figure 1 above - Marking nerves 'X' to be treated.

• Figure 2 below.
• The skin in the small green circle is then numbed with local anesthetic.Figure 2 above - Numbing area to inject.

• Figure 3 below.
• The doctor will then slowly inject small amounts over and around the nerve through the numbed area, after moving the needle to the 'X' marks.

• Figure 3 above - Injection of CL-HA.

• Most of the time you should see improvement in your pain within 20 minutes.

• Step-by-Step Technique for Targeting Superficial Radial Nerve Pain , Practical Pain Management, June, Vol. 17, Issue #5, June 2017

• Click here for a pdf version of the article
  

 Is the injection painful?

• For most patients, there is very little or no pain felt during the injection.

Who should not receive CL-HA injections?

• Persons that are allergic to gram-positive bacteria should not receive this treatment.
• Anyone who has had a reaction to substances that contain hyaluronic acid, like some cosmetic creams and gels, should not be injected.

What are possible side-effects of the injection of CL-HA?

Though side effects are not common, these may include:

• Localized swelling, redness or itching
• Brief injection related soreness or pain
• Bruising at the injection site

 

What conditions have been treated by CL-HA?

• Diabetes neuropathy pain

• Migraine headaches

• Shingles pain

• Chemotherapy pain

• Carpal tunnel pain

• Nerve pain after surgery

• Pain & Tinnitus from Bell’s Palsy

• Tennis Elbow

• Trigeminal nerve pain

• Pelvic & Endometriosis pain

• Neuropathy Pain from Chronic Renal Failure
  

• Nerve pain of unknown cause

Is there a doctor in my area that is performing this procedure?

• Currently, Dr. Campa is the only doctor performing this injection in the US.

• There may be other doctors that we are not aware of since Dr. Campa began presenting his discovery at scientific medical meetings in the US 2015 as well as in Nice, France & Manchester, England.
• Clinician training courses are in the planning stages.

Is CL-HA FDA approved for this use?

• Its use to treat nerve pain is considered “Off-label” which means it has not yet been approved by the FDA for this use.

• It has been FDA approved since 2005 for use as a skin filler, Restylane®, and in 2006 as Juvéderm®, for improving wrinkles in the face.

• The FDA recognizes that a doctor may recommend the use an approved medication for a different use when you may have tried all FDA approved treatments without seeing any benefits.

Is the use of CL-HA to treat nerve pain covered by my insurance?

• Since it has not yet been approved by the FDA for the treatment of nerve pain, it is not covered by any commercial insurance plans.

• Some exceptions have been made by workers compensation insurance plans in New Mexico, where they have paid for an injured worker to be treated with CL-HA by Dr. Campa. Authorization must be requested ahead of time and payment must be made before treatment is begun.

• Since this is not currently covered by commercial insurance plans, all treatment costs are paid directly by the patient.

• The average cost of treatment will vary depending on the condition treated, its severity, the number of injections needed, and the current cost of the cross-linked agent used.

• Please call for current pricing: (505) 508-1543

• The injections may be needed every 2 to 4 months.

• Please note, it IS NOT reimbursable by Medicare, or any other commercial insurance plan at this time.



Patient Commentary

Endometriosis & Pelvic Pain

“I was officially diagnosed with severe endometriosis when I was 26 years old. Although, I am very certain it started years before when I was in my teens. My periods where always very heavy flow and extremely painful—painful enough that I would always need a day or two off from school or work. I started taking birth control pills when I was 18 and that seemed to suppress the progression of the disease or at least the symptoms. After I had my first child, when my cycle resumed, the pain returned. My doctor did ultrasounds, MRIs, and x-rays trying to find the cause. She decided to do an exploratory laparoscopy and that’s when they discovered I had severe endometriosis.

Over the next 15 years, I had five more abdominal surgeries. My right ovary was removed, my uterus, my appendix, along with both of my tubes and my cervix because they were covered with the disease. The endometriosis continued to spread and do damage to many nerves in my pelvic area. The nerve damage caused severe pain in my right hip, low back, and my pelvic area.

The pain gradually got worse, increasing from a few days a month to everyday. I was put on countless medications. From pain meds to hormones, birth control pills, IUD and the worst was a medication that shut down my ovaries and put me into medical menopause. I used OTC pain relievers until my stomach couldn’t handle them anymore, as well as ice, heat, and local lidocaine to no avail. Another pain management doctor gave me more medications to try as well as nerve ablation—none of which helped.

The pain was so intense that, most days, I was forced to stay home. I was unable to take care of my home or my children. I was also unable to have sex because it was too painful. When more surgery was no longer an option I began seeking someone to help me deal with the pain. At this point in my life my life quality was terrible. A friend recommended Dr. Campa [the author]. I saw him and he started a treatment plan with the injections. He gave me injections in my right hip, low back and my pelvic area.

Very early in the treatments, I began to feel improvement. The injections would bring my pain scores from a 9 or 10 down to a 2 or 3. The only drawback was that it was short relief. While they were working I was able to start participating in my family life again. I would get the injections once a week. The first three and four days were great but over the next day or two the pain would return. Although while they were working, I could be active and have intercourse that wasn’t painful. The only drawback was that the relief was so temporary.

When Dr. Campa started giving me the cross-linked injections the onset of pain relief was within 24 hours or so. The great thing about them was that they lasted for months not days! Comparing the two different injections, the cross-linked injections brought my pain scores of 9 or 10 to a 1 or 2. Only getting injections every 6 months or so compared to weekly has been so much easier and the time I saved I am able to devote to my family. The long-term pain relief has been an absolute blessing.

Before the cross-link injections, oxycodone and hydromorphone would help minimally with all the nerve pain and abdominal pain from the scar tissue and adhesions. The oral pain medication barely took the edge off of all the pain and I spent most of my time in bed or on the couch unable to move. The cross-link injections brought down my pain levels in my right hip, low back and pelvic area nerves enough that the oral pain medication made the scar tissue and adhesion pain more manageable. I continue to take oxycodone and hydromorphone to help with the severe pain that isn’t nerve related. The scar tissue and adhesion pain is a pulling pain across my whole pelvic region, but the most intense pain originates from the lower right pelvic region. This pain is controlled with opioids, which lowers the pain score from a 9 or 10/ out of 10 to about a 6 out of 10.

In the areas treated with the cross-linked injections, the pain is a least 90% better. The other areas seemed to improve some but it’s hard for me to tell if they actually improved or if they are easier to manage since the other pain is so much better.”

MG

May 2018