I'm not sure how others started, but I had no luck with discussing this with referring docs. I did that partly to see if they'd send me anyone, and partly to let them know I'm gonna do it in the long run regardless. I didn't tell Ortho the trial evidence isn't great in supporting joint injections, though rt is perhaps mechanistically similar, which I did tell them. In any case, I'm now mentioning this to my patients, and honest about the controversies. My patients have said essentially, "well I have nothing to lose and lots to gain." After I do 10 patients (preferably shoulders, hips and knees, and not hands like the trial you posted), I'll reassess, and go no further if I'm not helping, placebo or not. I am quantifying things with a vas score, and more simply, an, are you happy you did it? If anything, the way I'm explaining this to them up front, gives them permission to say it did nothing. If the first ten look good, that's the data I'll take back to primary care.
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