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What is Prolotherapy?
Prolotherapy is a type of therapy for musculoskeletal pain and conditions that are not effectively treated with standard therapies. Over an extended period of time, a series of injections are made at the sites of painful ligament and tendon insertions, as well as in adjacent joint space. Injections encourage the proliferation of tissue, so Prolotherapy can also be referred to as regenerative injection therapy. The specific therapy depends upon the condition, how severe the condition and pain suffered are, and the comfort and preferences of the practitioner administering therapy.
How Does Prolotheraphy Work?
Proliferative therapy, or prolotherapy, treats the body by boosting its healing process for injured joints or tissue. Physicians carry out prolotherapy by injecting a specific mixture into the body at the site of an injury to speed the healing process. Prolotherapy involves using one’s own cells from bone marrow, blood or fat and injecting them into an area of pain or injury. Several forms of prolotherapy exist and are used to repair injured tissues.
Prolotherapy takes fibroblasts, or cells used for wound healing that are found in connective tissues, and chondrocytes, or cells that exist in cartilage, and proliferates them. By using stem cells produced by the body, which are called adult or mesenchymal stem cells, the physician injects the MSCs at the area of injury and the cells repair the structure and restore the function of the injured body part, like an injured disc. Physicians take MSCs from bone marrow or fat using a local anesthetic and a needle at the hip. The physician then transfers the harvested stem cells to the site of injury by injection. The prolotherapy procedure lasts about 10 minutes and results in mild soreness. Prolotherapy treatments can be used for a number of conditions including lower back pain, joint pain, hip pain and knee pain.
The exact mechanism of action of prolotherapy is not currently known, but studies have been completed and hypotheses have been presented about how the body’s response to injections actually works.
How Long Does Prolotheraphy Last?
Generally, in prolotherapy, several injection sessions occur every two to six weeks over a course of several months. During the session, a small volume of an irritant solution is injected. The hypothesis is that these irritants cause local irritation and inflammation, and then tissue healing. Damaged ligaments and tendons become enlarged and strengthened because of the tissue-healing process. The process is thought to improve joint stability and function and decrease pain. No formal practice guidelines have been established, however.
While the mechanism of action has not been explicitly established, there are still hypotheses as to how the treatment works. Three common prolotherapy have been hypothesized to act via the following three pathways:
- Hypertonic dextrose (the injected irritant) acts by osmotic rupture of local cells
- Phenyl-glycerine-glucose (the injected irritant) acts by local cellular irritation
- Morrhuate sodium (the injected irritant) acts by the chemotactic attraction of inflammatory mediators.
Where Did Prolotheraphy Come From?
Dextrose prolotherapy was the original prolotherapy procedure and began in the early 20th century. Physicians used sugar, saltwater or other substances to inject at the site of an injury. The formula caused irritation at the spot of pain, sending growth factors racing to the site of injection to begin the healing process. Platelet-rich plasma therapy stimulates growth factors for injuries, as well.
With PRP, physicians performing the procedure draw a patient’s blood and separate the invasive surgery alternative from the rest of the blood by spinning the substance in a centrifuge. The spinning motion causes the platelets to become very concentrated and strengthen in healing power. A physician then injects the invasive surgery alternative into the patient’s body. The invasive surgery alternative contains proteins that spur healing with amplified power as opposed to the normalcy of unmodified growth factor healing.
Common Prolotherapy Ailments
In the studies that have been done of prolotherapy since its inception, the therapy has been best assessed for lower back pain, osteoarthritis and tendinopathy; each of these conditions causes significant pain, can interfere with day-to-day activities and is difficult to treat with therapies of standard care. The efficacy of prolotherapy with each of the three aforementioned conditions is discussed below.
Prolotherapy for Lower Back Pain
In studies for the evaluation of prolotherapy’s effects on musculoskeletal lower back pain, results varied. In each study, injections were made to the ligamentous insertions of the spinous processes, sacrum and ilium. Roughly 50 percent of the study’s participants reported improvement in pain and/or disability at six months.
However, the studies can be difficult to assess because experimental and control groups received different protocols for treatment. In addition, none of the trials was designed to elicit and assess a possible mechanism of action, so attributing improvement to a specific medical intervention is not possible. Overall, the positive reports of participants in the improvement of pain and disability call for more well-designed research methods.
Prolotherapy for Tendinopathies
Tendinopathies are chronic, painful overuse tendon conditions. Studies on the effects of prolotherapy on specific tendinopathies, including lateral epicondylitis (tennis elbow), Achilles tendinopathy, hip adductor tendinopathy, and plantar fasciitis have been completed.
Though all of the aforementioned tendinopathies were treated with different specific prolotherapy, all studies showed positive results in pain and disability for participants, with results that were maintained over long periods of time.
Prolotherapy for Osteoarthritis
Arthritis is a leading cause of disability in the United States, and osteoarthritis is the most common form and the most common joint disorder. Prolotherapy has been assessed as a treatment for osteoarthritis in knees and fingers and continues to be studied to treat osteoarthritis.
In the trial for the treatment of finger osteoarthritis, participants showed significant improvement in pain with movement and flexion range scores compared to those who did not have prolotherapy. In the knee trial, both groups reported improvement in a variety of areas, without significant statistical differences between each group.
In both studies, a one-year follow-up showed improved radiological features of osteoarthritis on plain x-ray. This could suggest positive disease modification properties attributed to prolotherapy.
With the negative impact on the quality of life on sufferers of lower back pain, arthritis, and other chronic pains that are refractory to standard of care practices, it is important for the medical world to keep searching for different helpful possibilities. Prolotherapy has shown positive results in many studies since its conception, but the therapy requires more study to assess its specific mechanism of action.
Prolotherapy benefits patients by increasing joint mobility, reducing pain and stimulating growth of new cells to rebuild injured joints or tissue. Prolotherapy relieves pain all over the body, including spinal pain. There are very few risks involved in prolotherapy. Prolotherapy bears a much lower risk than surgery, which involves invasion and anesthesia. Surgery can also cause additional lifelong problems. One of the most important elements of the therapy process is the physician’s experience and the quality of care. Dr. Gabriel Rodriguez and the staff at The Pain Relief Center are well trained in prolotherapy, as well as PRP, and are ready to serve the communities of Dallas, Plano, Frisco, McKinney, Allen and Carrollton.
The most critical step on the path to recovery is finding a pain management doctor who can address your pain management needs successfully. The Pain Relief Center and its five specialized institutes are dedicated to meeting any and all of a patient’s needs. Located in the Dallas-Fort Worth area, Dr. Rodriguez and his friendly staff will help you along the path to recovery.
Our new center in Dallas is part of a nationwide development by Pain Relief Centers, geared to providing individualized and comprehensive healing and pain management services with unprecedented levels of compassion, care, and comfort for each patient.