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Hydrodissection – Science or Science Fiction

Hydrodissection, Pudendal Neuralgia, Pelvic Pain, Levator Ani Syndrome, Pelvic Floor Dysfunction

In the last 7 years, I have witnessed an explosion of innovation in the field of pain management – treatments ranging from advanced waveforms to block pain signals in the spinal cord (i.e. BurstDR) to dorsal root ganglion stimulation, small titanium spacers to treat spinal stenosis to allogeneic grafts for reversing degenerative disc disease.  The beauty of this second renaissance in the specialty was that all of these treatments were evidence-based…they all had research and evidence to prove that they were safe and most of all that they were effective.

Unfortunately, I have also witnessed a number of imposter treatments come out over the last few years as well, all posing as cutting-edge and claiming to be “the next big thing” but in reality they are nothing but snake oil with no evidence to speak of…just good marketing.  These treatments take advantage of desperate patients in excruciating pain that will try anything just to decrease their pain enough to be able to live a normal life.  These treatments would be sitting on a shelf gathering dust, where they should be, if not for the “doctors” who choose to ignore the lack of evidence and offer these “treatments” to their patients for the promise of making a little extra money in their clinic.  It’s hard to decide whose worse: the companies who manufacture these fake treatments at the expense of desperate patients or the unethical doctors who choose to totally disregard the trust their patients have in them and peddle meritless treatments to their patients just to make more money.

Perhaps the worst of these fake treatments for pain is “hydrodissection.”  It would be one thing just to offer a treatment for pain that doesn’t actually treat pain, but it’s another thing entirely to offer it to patients with pelvic pain and making them believe that getting dozens of injections into the pelvic region will actually treat their pain.  It’s a horrible money grab that pretends to be some amazing alternative treatment that will be able to miraculously fix your pain just by injecting some fluid onto a damaged nerve.

What is “Hydrodissection?”

Hydrodissection is merely the name given to describe what one sees under ultrasound when fluid is injected into tissue.  Fluid will appear dark (hyperechoic) and appear to “dissect” apart certain layers of tissue as the fluid moves with the path of least resistance.  If fluid is injected onto a nerve or a ligament, one will see the fluid pull the tissue attached to it off and separate it from the nerve or ligament, with the dark area corresponding to the fluid sitting between them.

Sounds like a great treatment option for a pinched or compressed nerve right?.  Just inject some fluid onto a nerve to gentle remove the surrounding tissue from it and free it up so it has move room and isn’t compressed and painful anymore.  What could be better for a painful nerve that is being compressed by scar tissue or a spastic muscle?  The only problem is that the fluid only stays in the area for a few minutes before the body absorbs it up and the tissues move right back to where they were before.  Below is a before and after picture – literally just 1 hour after fluid was injected onto the median nerve in the wrist.

hydrodissection, pudendal neuralgia, pelvic pain, levator ani syndrome, pelvic floor dysfunctionAs

As anyone can see, an hour later the fluid is gone and the nerve is back to where it was before.  There is no difference.  If it was that easy to cure compressed nerves, then why isn’t that the standard of care for treating things like carpal tunnel or sciatica?  Why isn’t this treatment being offered at the top university hospitals?  The answer is simple: because it’s not an actual treatment.  In fact, there is not a single publication in existence, anywhere in the world to prove that hydrodissection is actually a real thing that can be used for compressed nerves, much less pudendal neuralgia or pelvic pain.

The worst part of hydrodissection is that this wasn’t concocted by some greedy company trying to profit off the healthcare system…but rather it was created by doctors in an attempt to scam patients.  Knowing this full well, “doctors” will offer this knowing that patients in pain are desperate and will do anything to get out of pain without having to undergo an invasive surgery that may not work, so they sell this to patients knowing that it sounds like a great idea that makes perfect sense to a person in desperation.  What they don’t tell you is that it isn’t a real treatment…just a marketing ploy.  I will say it again – THERE IS NOT A SINGLE PUBLICATION OR SHRED OF EVIDENCE SUPPORTING HYDRODISSECTION AS A REAL TREATMENT FOR PAIN.  NOT ONE.

So why would a doctor offer this when there are other treatments that are actaully effective?  Chances are the doctor doesn’t know how to do those other treatments because they aren’t trained in pain management or gynecologic surgery…but they did take a weekend course on ultrasound and every medical student knows how to give a flu shot.  So put the 2 together and you now have a pelvic pain expert that is offering the latest, “most effective treatment” and least invasive treatment for pelvic pain.

Don’t fall for it.  There’s a reason hydrodissection isn’t in any textbook, taught in any medical school, in any residency or any fellowship – because it’s not a treatment!  If your doctor offers this to you, don’t walk….run.  Offering hydrodissection for pelvic pain is just as bad as offering valium suppositories, but that is a story for another time.

Dr. Corey Hunter is a nationally recognized interventional pain physician and the founder of Ainsworth Insitute. His publications have appeared in textbooks on treating pain and he is a regular contributor in leading pain management journals.