PROLOTHERAPY

NUTS AND BOLTS

Prolotherapy is a natural and nonsurgical way to treat chronic pain. Prolotherapy (short for proliferative therapy) stimulates the body to repair the painful area when the natural healing process needs a jump start.

Chronic pain from sprains and strains can be devastating for those who suffer from them. This pain is often caused by weakened connective tissue, especially where tendons or ligaments connect with bones and hese sorts of injuries tend to heal poorly as blood supply is limited in these tissues. When these structures are injured, they tend to heal at about 15% per week for the first 6 weeks or so, with the remaining 10-15% happening over the ensuing 2 years. If you’ve had pain for longer than than 6 weeks, the body has done almost all the healing it’s going to do for that injury. The resulting stretch in a ligament compromises joint stability and as the joint becomes unstable, excessive wear and tear occurs in the joints – pushing the area to be more susceptible to arthritis, bone spurs, muscle spasm and pain.

CANDIDATES

You may consider prolotherapy if you are suffering from long term chronic pain, arthritis, and/or have developed a recent injury to a ligament or tendon. Prolotherapy has been successful in eliminating chronic muscle spasm due to ligament instability, and can help reduce arthritis pain.

Factors that can interfere with results from prolotherapy include hormonal and nutritional deficiencies. One of the things that sets us apart as a pain clinic is we look at pain from an holistic approach and addresses these deficiencies along with the prolotherapy injections.

WHEN WILL MY PAIN GO AWAY

Procaine or Lidocaine, local anesthetics, are part of the prolotherapy solution. Patients experience immediate relief of their pain after a prolotherapy session, yet as the anesthetic wears off, it’s expected and normal to have more pain, swelling and tenderness over the area injected for up to 72 hours as the body brings inflammatory cells into the site. NSAIDS and ice are to be avoided here, or the healing process may be thwarted. As this initial process settles down, pain may return, yet usually to a lesser degree than at onset. Follow up exam and/or treatments are indicated to further push this process and bring complete resolution of pain along with full healing of the ligaments and tendons.

HOW MANY TREATMENTS

Treatments are traditionally given 2 to 4 weeks apart. The number of treatments varies based on the degree of injury and how chronic the injury is. Most patients receive between 4 and 6 treatments. You should expect to see improvement in your pain by the second or third treatment.

WHAT DOES IT COST

Injection visits vary from $190-350 depending on the size and complexity of the treatment area, number of problem areas, the different types of treatments that may be needed (see also Perineural therapy), and whether ultrasound is used. An estimate will be given at the time of the initial assessment so you know up front what to expect. Our clinic can in most cases direct bill extended health providers (like Blue Cross, Great West Life, Greenshield, etc) for services under Naturopathic benefits. On average EHP’s pay about 80% of the cost of the treatments up to $600 per year, though every plan is different.

SOME EVIDENCE FOR PROLOTHERAPY

For Knees:

Efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline for knee osteoarthritis: a protocol for a triple-blinded randomized controlled trial

Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes

Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis

For Shoulders:

Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions

Comparative Effectiveness of Ultrasound-Guided Intratendinous Prolotherapy Injection with Conventional Treatment to Treat Focal Supraspinatus Tendinosis

Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy

For TMJ Pain:

Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover

PLATELET RICH PLASMA

Platelet Rich Plasma (PRP) has been used for decades in surgical settings – from bone grafting in dentistry to hastening healing times and reducing infection rates in cosmetic surgery. It is only in recent years that this application has come into the chronic pain arena. PRP is being used to treat knee meniscal tears, rotator cuff tears, osteoarthritis, hip joint degeneration, back pain, tendonosis, to name a few.

The story here belongs to platelets. The heroes in the platelets are cytokines. The cytokines release growth factors and stimulate genetic activation directly at the site of injury. Among these growth factors are bone growth factors, cartilage growth factors, ligament growth factors, circulation growth factors and cellular adhesion molecules. Laying these growth factors in the heat of the damaged tissue helps to regenerate degenerated connective tissue.

PROCEDURE

Your blood is drawn and spun down into layers by a centrifuge. The platelet poor plasma is drawn off. What is left is the platelet rich portion. This concentrate is 3-5x higher in platelets than in normal blood. This small concentrate is then injected into the injured area.

The injection technique is the same as in prolotherapy. Just different ingredients. PRP is essentially a ramped up version of prolotherapy. PRP can be initiated within weeks of an acute injury and is administered every 4 weeks. Typically two to three treatments are required.