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TWENTY COMMON QUESTIONS ABOUT PROLOTHERAPY
DAVID
HARRIS, M.D.
1) Is Prolotherapy
painful?
The injection is
considered mild to moderately painful, and there is typically a
"flare" of soreness for 3-7 days afterwards. A mild pain medication,
such as Ultram or Tylenol, is usually sufficient to control the discomfort.
The doctor can prescribe stronger medication if needed.
2) Are there any
medication interactions?
Because the effect of
Prolotherapy is to initiate a "healing cascade" which requires
inflammation, the patient is advised to avoid anti-inflammatory
medications, both over-the-counter and prescription. Aspirin may also
interfere with the process to some degree, but if an individual is taking
Aspirin to reduce risk of stroke or heart attack, a small amount of Aspirin,
such as a "Baby Aspirin" (80 mg) is acceptable. The results of
Prolotherapy while taking these medications may be slower and less consistent
than if the patient avoids these medications.
3) Is Prolotherapy
safe?
Using the current
solutions and techniques, there have been no reported significant side
effects of this treatment in over 35 years. There is occasionally some
bruising, and very rarely, a nerve may be injured, usually transiently. The
procedure has been used for over 60 years. In the late 1950's, some solutions
were used which were much more potent and placed inappropriately into the
spine region, and this led to nerve injury and even a lethal reaction. Those
who currently practice Prolotherapy strive to keep the technique safe by
providing educational seminars emphasizing correct technique and solutions.
4) How does
"sugar water" have a chance of solving the painful condition?
The Dextrose is
actually quite irritating in the standard 50% concentration. This is then
diluted with water, anesthetic such as Lidocaine, or Sarapin, a water-based
herbal extract of the Pitcher Plant, to a concentration of 12-15%. This is
thought to "dehydrate" the injected tissues, causing an injury
signal for the body, and initiating the healing process. Dextrose has
been shown to be a growth stimulant on it's own as well.
5) What tissues of
the body are treated by Prolotherapy?
The ligaments, which
connect bones together, may be stretched and torn. Tendons attach muscles to
bone and may also be torn. The capsule surrounding joints may become lax
(loose) and also contribute to pain. All of these may be strengthened and
"tightened" with Prolotherapy, reducing the "play" in
the joints, reducing arthritis, and bonding the clicking or popping
structures in a way that is much more functional and normal. Cartilage
has been shown to be repaired and thickened after a series of Prolotherapy
injections.
6) Are back and neck
pain always resolved with Prolotherapy?
No. Prolotherapy is
an excellent treatment for many spine disorders, and can reduce pain and
improve function in a great many cases which conventional physicians might
consider "psychological", or at least not evident on imaging tests
such as MRI or CT scans. The general public often expects these tests to be
infallible, but the truth is that these tests often miss the true source of
pain in the spine and pelvis. The structures which Prolotherapy treats
almost never are visualized on such types of testing, unfortunately, and this
is confusing for the patient as well as the physician who doesn't understand
ligamentous pain. Pain from ligaments frequently is "referred", that
is, travels down the arm, buttock, or leg, much in the same way that pain can
refer from a "nerve pinch." If one is unaware of these patterns, it
is not surprising that the true cause of the pain remains an enigma. Some
conditions are better treated with epidural steroid injections, physical
therapy, chiropractic, or surgery. However, it is clear that prolonged
treatment with any of the above, if not resulting in clear progress, may be
futile and that an alternative should be sought. If you are told that the
"pain is in your head", and you can put your finger on it, you
should see a Prolotherapy specialist.
7) Do you treat
muscle pain with Prolotherapy?
It is not appropriate
with Prolotherapy to inject the muscle bellies themselves, as one might have
experienced with "trigger point" injections. However, used to
strengthen the attachments of these same muscles where their tendons connect
to the bones, this type of pain is very treatable with much more permanent
results. Myofascial pain is frequently cured with this approach, unlike
the traditional and well-known practice of massage, trigger point injection,
spray and stretch, and similar techniques. When these techniques do not
provide resolution of pain within 3-4 months, the patient should strongly
consider the more permanent and cost-effective technique of Prolotherapy.
8) Does Prolotherapy
involve steroid injections?
Not usually.
Occasionally, the physician may try a steroid injection first, as this is a
mainstream, accepted approach for these types of injuries. If this is not
curative with 1-2 efforts, then repeat steroid injections are unlikely to
resolve the problem and Prolotherapy is a safer, more permanent solution.
Steroid injections are well known to have complications, usually mild but
occasionally significant, and repeating them unnecessarily increases the risk.
Each steroid injection weakens the underlying connective tissue, and
may result in a need for additional Prolotherapy injections to regain any lost
ground from steroid injections. Even if a steroid injection provides temporary
benefit, which is usual for 3 days to 2-3 weeks, the typical recurrence of
pain when the steroid "wears off" often occurs.
9) Are headaches
treatable with Prolotherapy?
Definitely, with a
typical 80% or better success rate. The muscular attachments of the neck
muscles on the base of the skull frequently become torn from injury, and can
lead to dizziness, nausea, headaches, eye and ear pain, TMJ pain, and facial
pain. These attachments are strengthened with Prolotherapy, and the pain and
symptoms resolve accordingly. If you experience frequent headaches, even if
you are told you have "migraine" headaches, or "post-concussive
headache" from head injury, you should consider seeing a specialist
in Prolotherapy.
10) How does
Prolotherapy treat TMJ and other joint problems?
It is interesting to
note that Prolotherapy (then called Sclerosing Therapy) was the treatment of
choice for TMJ dysfunction 60-80 years ago. It was actually fairly successful
and still is. With the advent of surgical approaches, many of which have been
discontinued because of poor outcome, many oral surgeons are no longer
educated in the technique. Prolotherapy is a safe, conservative, and
cost-effective TMJ treatment, resulting in reduced joint popping and clicking,
improved gliding, and improved opening of the jaw, because of the greater
stability and reduced "play" in the joint. It works similarly on
many other joints of the body, including knees, hips, and hand and wrist
joints.
11) Does Prolotherapy
treat foot and ankle pain?
Many foot and ankle
problems are treated and resolved with Prolotherapy. The most common and
notable are Plantar Fasciitis, Morton's Neuroma, bunions, and chronic ankle
sprains. Each of these involves stretching of ligaments and joint capsules,
which respond quite well to Prolotherapy. If steroid injections do not provide
long-term relief for these, you should strongly consider Prolotherapy. You
certainly can bypass steroid injections and surgery; treatment with
Prolotherapy can and usually does achieve a great deal of success.
12) How can I test
myself to see if Prolotherapy could help me?
The signature finding
is pain that you can put a finger on. This may be at the top of the
neck or base of the skull for headache pain, the top of the shoulder, the
inner or outer elbow, the sides of the knee, or the groove between the inner
edge of your hip bone and your tailbone (the Sacroiliac joint), or a number of
other common places where these tissue injuries occur. If you can precisely
point to your source of pain, there is an excellent chance that Prolotherapy
will resolve or at least greatly improve it.
13) Shouldn't I be
skeptical of such a weird idea that few doctors know about?
Of course, I
certainly was! I knew about this technique for over 8 years, read about it
carefully for 4 years, learned how to perform it, and still didn't use it
except on my worst patients who had tried all options for their pain. I
certainly didn't tell my referring doctors at first that I was using
Prolotherapy, for fear that I would be "too alternative." I remained
skeptical for the first 6 months of using this technique, until my patients'
success became difficult to ignore. I now use Prolotherapy as one of my many
tools that I have available to treat my patients, and over time it has become
one of my primary tools because of the vast array of problems solvable with
this technique. Be skeptical, but be open-minded; you have almost nothing
to lose and a great deal to gain.
14) So Prolotherapy
is a cure for everything?
Of course not. Many
diseases and illnesses are not resolvable with Prolotherapy. Pain can
originate in many tissues, and a complete, thorough examination is absolutely
essential. The physician who practices Prolotherapy is usually one who has a
great deal of experience with the treatment of musculoskeletal disorders, and
should also examine and test the patient for other causes of pain using
appropriate studies, lab tests and other manner of testing to ensure that your
condition is correctly managed. At times, consultation with a surgical
specialist, a gynecology specialist, a gastrointestinal specialist, etc. may
be necessary to ensure that your evaluation is complete.
15) Will Prolotherapy
improve my loose joints?
Prolotherapy has been
shown to increase the ligaments around joints by approximately 30-40% in
strength and mass. This can remarkably improve torn ankle, knee, and other
ligaments. Even if there is minimal pain with some of these injuries, the
weakness can ultimately tear further and create greater dysfunction. Many
athletes utilize Prolotherapy to strengthen their weak ligamentous tissues to
reduce future risk of tears and injury. Prolotherapy is the only clinically
proven method of regenerating and repairing torn cartilage inside joints.
16) Does Prolotherapy
treat Fibromyalgia?
A well-done study
in the literature showed that approximately two-thirds of Fibromyalgia
patients treated with Prolotherapy 1 year later stated that it was the best
treatment that they had ever received for their pain. Fibromyalgia is a
complex, painful syndrome that is poorly understood. Patients usually note
sleep deficit, fatigue, depression, anxiety, bowel problems, and diffuse pain,
along with other concerns. The cause is not yet known, and it is likely that
there are a number of different causes that produce a patient with the
symptoms and signs of Fibromyalgia. There is evidence suggesting poor healing,
and one theory is that small "micro-injuries" of the fibrous tissues
simply never heal satisfactorily, possibly because of an as yet undiagnosed
hormonal deficit, such as Growth Hormone, Testosterone, Estrogen,
Progesterone, Thyroid, or adrenal gland. Although Prolotherapy may not treat
the underlying cause of Fibromyalgia, the tender points of this syndrome are
frequently improved.
17) How many visits
are necessary, and how frequent are they scheduled?
Most conditions are
treated with 4-8 visits, but may take more. The timing of visits varies from
weekly to every 4-6 weeks or more. Rarely, 10-15 visits may be required as
long as progress is being made.
18) How long does it
take to know if I will be improved or cured with Prolotherapy?
Patients occasionally
experience a great deal of relief after their first injection; most, however,
note improvement after 3-4 injections, with the duration of treatment then
determined by the rate of progress. Studies suggest a success rate
("greater than 50% improvement in pain level") of 80-90%.
19) Is Prolotherapy
expensive?
Compared to many
treatments that are much less permanent and carry greater risk, it is very
cost-effective. A typical treatment costs $125-500, depending on the
number of body regions and time involved. The total cost of a course of
treatment may easily be less than the cost of an MRI scan and a series of
X-Rays. Insurance companies, in general, including Medicare, are slow to
realize the tremendous gain in cost-effectiveness that Prolotherapy offers
them. Many practitioners of Prolotherapy thus must charge their patients on a
cash / fee-for-service basis, until the insurers understand the obvious
benefits and cover the treatment in time.
20) Are there any
activity restrictions following the injection?
Most practitioners
recommend careful resumption of activity as tolerated. This can include normal
exercise routines, walking, sports, and other activities. Physical therapy,
massage, chiropractic and other treatment does not usually need to be stopped
and may in fact assist with the overall process.
(c) David
Harris, M.D.
The opinions expressed
here does not necessarily reflect the views of the other member physicians of
getprolo.com.
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Orthopedic Medicine: A
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