Prolotherapy

Nonsurgical reconstructive therapy ó also referred to as “prolotherapy” or “proliferative therapy” ó evolved out of a treatment pioneered by H. I. Biegeleisen called “sclerotherapy,” which was originally (and still is) used to treat varicose veins. Prolotherapy involves the injection of an “irritant” solution into the area where ligaments are weak and/or damaged. Over the next few days, cells called “macrophages,” literally big eaters, are attracted into the area by the presence of this irritant solution. Once they arrive, these macrophages pick up the irritant solution and carry it away for disposal (they are the garbage men of the body). As the macrophages are finishing their job, the body sends in “fibroblasts,” literally connective tissue builders, to lay down fibrous tissue wherever they detect damage to connective tissue such as ligaments.

Of course, prolotherapy can be used on any weakened ligament or tendon in the body. The determining factor is the doctor’s skill in introducing the needle to exactly the right locaiton. Knees, hips, elbows, shoulders, in fact every joint in the body can develop problems which can be addressed with prolotherapy.

The doctor’s job is to introduce the irritant solution into the places where ligaments are weak or damaged. If properly placed, this causes the repair of ligaments. This new supporting structure pulls the vertebrae back into close relationship with each other correcting instability and therefore putting an end to inflammation. When inflammation disappears, so does pain! Stability is restored along with mobility.

A single treatment with prolotherapy will cost around $200. Usually not more than ten to fifteen treatments are necessary to bring a typical back pain or neck pain syndrome under control.

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The term “prolotherapy” is a derivation of “proliferative injection therapy” and is also known as sclerotherapy. The practice of prolotherapy is used by doctors of osteopathy and other physicians to treat a number of different types of chronic pain. Prolotherapy consists of a series of intraligamentous and intratendinous injections of solutions in trigger points near the pained area to induce the proliferation of new cells.

Proponents of this treatment suggest that looseness in the supporting ligaments and tendons around the joints causes the pain, inducing the muscles to contract against the ligament and irritate the nerve endings. The physicians using this treatment method for low back pain believe the ligament laxity to be concentrated in the sacroiliac joint. During a physical examination a physician will identify trigger points generally in the muscles overlying the sacroiliac joint. The physician then may inject proliferant substances into the supporting ligament and tendon tissue.

The practice of sclerotherapy or prolotherapy to produce dense fibrous tissue in an effort to strengthen the attachment of ligaments and tendons is not new. Forms of this therapy apparently date back to Hippocrates, however, prolotherapy recently found favor with osteopaths following the teachings of George Hackett, MD, who in 1939 began using a local injectable irritant to initiate the healing process. It was Dr. Hackett who coined the term “prolotherapy” because sclerotherapy implied scar formation, which, according to Dr. Hackett, did not occur with prolotherapy. Nevertheless, both processes use trigger point injections to form new cells in an effort to support weakened muscles. Although the method has been in use for some time, to date there is no strong clinical evidence to support the efficacy of the treatment.

Prolotherapy injections are intended to mimic the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue. The newly produced collagen is intended to support the injured or loosened ligaments, creating a more stable and strong muscle base, in the process, alleviating pain.

There are three classes of proliferant solutions used to initiate inflammation: chemical irritants (e.g. phenol), osmotic shock agents (e.g. hypertonic dextrose and glycerin), and chemotactic agents (e.g. morrhuate sodium, a fatty acid derivative of cod liver oil). The two studies supplied by the requestor used a dextrose-glycerine-phenol solution.

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What is known about prolotherapy outcomes for back pain?
Reported success rates range from 80%-90% when performed by a physician trained in the prolotherapy procedure. Many of these reports are based on anecdotal evidence from the physicians themselves. Studies have not yet connected positive outcomes for back pain and healing to prolotherapy.

The anecdotal reports suggest improvements such as:

* Reduction or elimination of back pain
* Increased strength of the ligament, tendon or joint capsule
* Reduced recurrence of injury to the treated site
* Improved or return to normal function

Factors that may be key for a successful outcome include:

* Proper diagnosis of the location of the sprain or strain
* Willingness of the patient to complete follow-up therapy
* Clinical skill of the physician in performing the injection

Finally, it is important to note that nobody knows exactly what happens in prolotherapy. There is no objective medical evidence, and no histology has been published as to what goes on when injection is placed into the painful soft tissues.

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