Prolotherapy
Encyclopedia
Prolotherapy is also known as "proliferation therapy" or "regenerative injection therapy."
("Proliferative Injection Therapy") involves injecting an otherwise non-pharmacological
and non-active
irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.
It is thought to do so by re-initiating the inflammatory process that deposits new additional fibers to repair a perceived injury. Once strengthened, the weak areas no longer send pain signals. Originally published in the Journal of Orthopaedic Medicine Vol 13 1991 No 3, Allen R Banks, Ph.D., has described in detail the theory behind prolotherapy in "A Rationale for Prolotherapy".
(a commonly used local anesthetic), phenol
, glycerine, or cod liver oil
extract. The injection is given into joints or tendons where they connect to bone. The Injected solution causes the body to heal itself through the process of inflammation
and repair. The process may result in as much as 30-40% strengthening of the connective tissue. Although well designed traditional placebo controlled scientific studies are still few, increasing numbers of good studies have been seen lately. There are now medical textbooks available to teach principles and practice of prolotherapy such as that by Dr's Ravin, Cantieri and Pasquarello.
Prolotherapy treatment sessions are generally given every three to six weeks. Many patients receive treatment at less and less frequent intervals until treatments are rarely required, if at all.
Prolotherapy is sometimes used as an alternative to arthroscopic surgery.
of the medical literature as of January 2004 on the efficacy of prolotherapy injections in adults with chronic low-back pain found four controlled trials, all measuring pain and disability levels at six months. The review concluded:
The review also noted: "[m]inor side effects from the treatment, such as increased back pain and stiffness, were common but short-lived." ("Stiffness" is an expected short-lived side effect, as the goal is to cause irritation and the corresponding body reaction of temporary inflammation and repair.)
Currently, a few medical insurance companies have started to cover prolotherapy.
In addition, there is a lack of solid evidence that prolotherapy is effective. Recent Cochrane reviews and controlled studies of the treatment did not find any proof prolotherapy was any more effective than other fringe treatments.
, placebo
control study is currently recruiting patients to determine whether prolotherapy can decrease pain and disability from knee osteoarthritis
. This study is sponsored by the National Center for Complementary and Alternative Medicine (NCCAM).
A double blind pilot study found strong evidence that prolotherapy can be an effective treatment for epicondylosis.
("Proliferative Injection Therapy") involves injecting an otherwise non-pharmacological
Pharmacology
Pharmacology is the branch of medicine and biology concerned with the study of drug action. More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function...
and non-active
Biological activity
In pharmacology, biological activity or pharmacological activity describes the beneficial or adverse effects of a drug on living matter. When a drug is a complex chemical mixture, this activity is exerted by the substance's active ingredient or pharmacophore but can be modified by the other...
irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.
It is thought to do so by re-initiating the inflammatory process that deposits new additional fibers to repair a perceived injury. Once strengthened, the weak areas no longer send pain signals. Originally published in the Journal of Orthopaedic Medicine Vol 13 1991 No 3, Allen R Banks, Ph.D., has described in detail the theory behind prolotherapy in "A Rationale for Prolotherapy".
History
The concept of creating irritation or injury to stimulate healing has been recorded as early as Roman times where hot needles were poked into the shoulders of injured gladiators. This practice continues with little change in present vetrinary medicine - more frequently for horses where it is presently called "needling." In the 1940s George S. Hacket started performing injections of irritant solutions in an effort to repair joints and hernias. This practice is what would eventually evolve into modern day prolotherapy. He was joined in this practice by Gustav Anders Hemwall in the 1950s. In 1955, a Dr. Hemwall became acquainted with George Hacket at an American Medical Association and started practicing prolotherapy. Today, Dr. Hemwall is regarded as an expert in prolotherapy. He has treated and collected data on more than 8,000 paitents so far.Prolotherapy in clinical practice
Prolotherapy (PROLiferation therapy) involves the injection of an irritant solution into an area where connective tissue has been weakened or damaged through injury or strain. Many solutions are used, including dextrose (a sugar), lidocaineLidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
(a commonly used local anesthetic), phenol
Phenol
Phenol, also known as carbolic acid, phenic acid, is an organic compound with the chemical formula C6H5OH. It is a white crystalline solid. The molecule consists of a phenyl , bonded to a hydroxyl group. It is produced on a large scale as a precursor to many materials and useful compounds...
, glycerine, or cod liver oil
Cod liver oil
Cod liver oil is a nutritional supplement derived from liver of cod fish. It has high levels of the omega-3 fatty acids, EPA and DHA, and very high levels of vitamin A and vitamin D. It is widely taken to ease the symptoms of arthritis and for other health benefits...
extract. The injection is given into joints or tendons where they connect to bone. The Injected solution causes the body to heal itself through the process of inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
and repair. The process may result in as much as 30-40% strengthening of the connective tissue. Although well designed traditional placebo controlled scientific studies are still few, increasing numbers of good studies have been seen lately. There are now medical textbooks available to teach principles and practice of prolotherapy such as that by Dr's Ravin, Cantieri and Pasquarello.
Prolotherapy treatment sessions are generally given every three to six weeks. Many patients receive treatment at less and less frequent intervals until treatments are rarely required, if at all.
Prolotherapy is sometimes used as an alternative to arthroscopic surgery.
Signs used by practitioners as possible indicatons for prolotherapy
- Laxity of a tested joint that fails self resolution
- Distinct tender points at tendons or ligaments as they attach to the bones
- Recurrent swelling or fullness involving a joint or muscular region
- Popping, clicking, grinding, or catching sensations in joints
- Temporary benefit from chiropractic manipulation or manual mobilization that fails to persistently resolve
- Aching or burning pain that is referred into an upper or lower extremity
- Recurrent headache, face pain, jaw pain, ear pain
- Chest wall pain with tenderness along the rib attachments on the spine or along the sternum
- Spine pain that does not respond to surgery, or whose origin is not identified by extensive studies
Evidence based medicine
A Cochrane reviewCochrane Collaboration
The Cochrane Collaboration is a group of over 28,000 volunteers in more than 100 countries who review the effects of health care interventions tested in biomedical randomized controlled trials. A few more recent reviews have also studied the results of non-randomized, observational studies...
of the medical literature as of January 2004 on the efficacy of prolotherapy injections in adults with chronic low-back pain found four controlled trials, all measuring pain and disability levels at six months. The review concluded:
- "There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low-back pain. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injections alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently."
The review also noted: "[m]inor side effects from the treatment, such as increased back pain and stiffness, were common but short-lived." ("Stiffness" is an expected short-lived side effect, as the goal is to cause irritation and the corresponding body reaction of temporary inflammation and repair.)
Criticism
Most major medical insurance policies do not cover the treatment. After a 1999 review of the medical evidence, Medicare declined to cover prolotherapy for chronic low back pain citing that prolotherapy "was last examined for coverage by the Health Care Financing Administration (HCFA) in September 1992".Currently, a few medical insurance companies have started to cover prolotherapy.
In addition, there is a lack of solid evidence that prolotherapy is effective. Recent Cochrane reviews and controlled studies of the treatment did not find any proof prolotherapy was any more effective than other fringe treatments.
Knee injuries
A randomized, double-blindDouble-blind
A blind or blinded experiment is a scientific experiment where some of the people involved are prevented from knowing certain information that might lead to conscious or subconscious bias on their part, invalidating the results....
, placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...
control study is currently recruiting patients to determine whether prolotherapy can decrease pain and disability from knee osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
. This study is sponsored by the National Center for Complementary and Alternative Medicine (NCCAM).
Tennis elbow
A randomized, double-blind, placebo control study is currently recruiting patients to determine whether prolotherapy can be an effective treatment for lateral epicondylitis (tennis elbow).Thumb Joint Arthritis
A randomized, double-blind, placebo control study is currently recruiting patients to compare prolotherapy to injection of corticosteroids in treating carpo-metacarpal joint arthritis of the thumb.Plantar Fasciitis
Sonographically guided dextrose injections showed a good clinical response in patients with chronic plantar fasciitis insofar as reducing pain during rest and activity. Further studies including a control group are needed to validate these outcomes.A double blind pilot study found strong evidence that prolotherapy can be an effective treatment for epicondylosis.
Temporomandibular Joint Hyper mobility
This study concludes"Prolotherapy with 10% dextrose appears promising for the treatment of symptomatic TMJ hypermobility, as evidenced by the therapeutic benefits, simplicity, safety, patients' acceptance of the injection technique, and lack of significant side effects. However, continued research into prolotherapy's effectiveness in patient populations with large sample sizes and long-term follow-up is needed."Knee disorders
This study demonstrated functional improvement and radiological improvement after prolotherapyExternal links
- www.indianprolotherapy.org
- www.ACOPMS.com - The American Osteopathic Association of Prolotherapy Integrative Pain Management, affiliated with the American Osteopathic Association, is an association of licensed practitioners dedicated toward improving the practice of, and disseminating knowledge about Prolotherapy.
- Prolotherapy.org is a source for extensive articles, diagrams and other resources related to prolotherapy.
- American Association of Orthopaedic Medicine is a non-profit organization that promotes prolotherapy.
- http://www.NewEnglandProlotherapy.com is a source of a dozen videos about prolotherapy for athletes and a wide variety of injuries. Dr. Albert Franche produced the videos for his patients.