Some reporting has occurred to counter this recent disinformation, including reporting aiming to correct the record about autism, Tylenol, leucovorin, and childhood vaccines in general. Other reporting has focused on providing accurate information about the MMR vaccine in particular, while still other reporting has aimed to set the record straight about the Hepatitis B vaccine. Only time will tell whether these attempts at sharing accurate medical information will outweigh people’s belief in the disinformation.
My own medical writing, like the reporting aiming to counter medical disinformation, aims to present understandable, factual information about conditions and treatments. In the past, I’ve provided information about thoracic outlet syndrome, quadrilateral space syndrome, and hydrodissection. In this post, I’ll present information about a treatment called prolotherapy, a type of injection known to help with pain relief.
What is Prolotherapy?
As reported by Healthline, “prolotherapy involves injecting a dextrose [sugar] or saline [salt] solution into an injury site to promote a healing response.” This article explained that “these injections aim to trigger the body’s inflammatory healing process in the area.” The article noted that “in theory, the solution acts as an irritant, which may stimulate the growth of new tissues.”
As described by an article published by the American Society of Regional Anesthesia and Pain Medicine, “most [prolotherapy] injections are done in an office setting, and patients may receive topical local anesthetic solutions or subcutaneous lidocaine [delivered under the skin by needle] at the site of injection. Using ultrasound as a guide, articular spaces [joints] or tendons and ligaments are identified and the proliferant [a substance causing rapid growth of cells] is injected.” This article also explained “it is important that patients who are going to receive prolotherapy do not take anti-inflammatory medications, because they would prevent the inflammation that is required for cell regeneration.”
It should be noted that a doctor I spoke to in doing research for this blog post explained that receiving prolotherapy and avoiding anti-inflammatory medications afterword can be quite painful. However, the period of intense pain caused by the prolotherapy treatment should be relatively brief, lasting about a week to ten days, after which pain relief should occur. Those considering this treatment option should be aware of the pain the treatment causes before embarking on it.
Unlike surgical treatments, which remove or replace injured body parts such as joints, disks, or tendons, prolotherapy aims to treat body parts in place. And, whereas other treatments such as steroid injections, topical ointments, or pain-relieving tablets, that treat body parts without removing them have the aim of reducing inflammation, prolotherapy aims to cause inflammation. This is because inflammation is the means through which the body heals itself.
An article published in the journal Anesthesia and Pain Medicine explained the process of healing triggered by prolotherapy in this way: “The injected proliferant causes a healing process that is similar to the body’s natural healing process….” In this healing process, “…a local inflammatory cascade is initiated, which triggers the release of growth factors and collagen….”
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The biology of prolotherapy. (Chronic Neck Pain: Making the Connection Between Capsular Ligament Laxity and Cervical Instability/Danielle Steilen et al.) |
What is the History of Prolotherapy?
Prolotherapy has been around for a long time. As explained by an article in Clinical Medicine Insights: Arthritis and Muskuloskeletal Disorders, “prolotherapy has been used in clinical practice for more than 80 years to treat various chronic musculoskeletal conditions.” The article noted that the treatment was “formalized by Dr. George Hackett in the 1950s.” Some researchers, such as the authors of the article provided by the American Society of Regional Anesthesia and Pain Medicine, date Hackett’s work to 1937. Whichever date is correct, the treatment is not new.
Over the past few decades, as noted by the Clinical Medicine Insights article, interest in prolotherapy has grown. This is because scientific research into its use and effects has blossomed. It’s also because this research has shown both the usefulness of the treatment and a lack of serious negative side effects accompanying the treatment.
Who Can Benefit From Prolotherapy?
In speaking with a doctor about prolotherapy, I learned that the area making up the quadrilateral space in the back of the shoulder can be treated with prolotherapy. Other body parts that can benefit from prolotherapy as noted by the Healthline article include tendons, muscles, or ligaments that have been strained or sprained; joints such as knees, hips, or fingers affected by arthritis; or spinal discs that are degenerating. Seemingly a wide range of body parts can be treated with prolotherapy.
Research studies back up these generalized assertions about where prolotherapy can be effective. For example, the article in Anesthesia and Pain Medicine reviewed “10 studies involving 750 participants” that participated in “randomized controlled trials which compared the effect of…prolotherapy with that of other therapies….” The conditions the patients in those studies were treated for included knee osteoarthritis, rotator cuff tendinopathy, chronic plantar fasciitis, chronic low back pain, osteoarthritis in the thumb and finger, and osteoarthritis in the first carpometacarpal [the joint at the base of the thumb].
The article in Clinical Medicine Insights reviewed 33 studies examining the use of prolotherapy. In addition to some of the conditions listed in the article in Anesthesia and Pain Medicine, this article listed a few others that can benefit from prolotherapy. They included Osgood-Schattler disease (a disease of the patellar tendon at the base of the knee), patellar tendinopathy, temporomandibular joint (TMJ) syndrome (a condition affecting the jaw joint), Achilles tendinopathy, lateral epicondylitis of the elbow (also known as tennis elbow), groin pain, discogenic leg pain (leg pain originating from a spinal disk in the low back), spine pain (in the neck, torso, or low back), and pain in the pelvic, coccyx (tailbone), or sacroiliac region.
Still another article, this one in the Journal of Rehabilitative Medicine, focused on osteoarthritis. It listed, in addition to the studies about knee and hand osteoarthritis I’ve already mentioned, a study focused on hip osteoarthritis involving 23 participants where prolotherapy had good results. Overall, the sampling provided by these articles offers a glimpse into the wide range of body parts that can be treated with prolotherapy.
How Many Prolotherapy Treatments are Required?
As noted by the article provided by the American Society of Regional Anesthesia and Pain Medicine, treatments generally follow “a protocol of solution injection in 2-to-8-week intervals over the course of several months.” The doctor I spoke to who uses prolotherapy as a treatment in his practice indicated that most studies indicate a total of six or seven treatments can be used, after which a long pause of six to twelve months should be allowed before more prolotherapy is administered. A review of the research studies I looked at confirms this.
For example, the article in the journal Anesthesia and Pain Medicine reviewed 10 articles that used an “injection interval [that] ranged from weeks to months.” Specifically, the studies reviewed in this article reported using a low of two injections to a high of six and spacing of the injections ranging from a low of one week apart to a high of two months apart. The same range in the number and spacing of injections was reported by the article in Clinical Medicine Insights, which reviewed 33 studies. The article in the Journal of Rehabilitative Medicine reviewed 14 studies with a low of one injection to a high of six and a low of spacing the injections one week apart to high of two months apart.
As for having more injections if full pain relief isn’t achieved by the initial protocol, two of the articles I reviewed mentioned this possibility, with the article in the journal Anesthesia and Pain Medicine noting a low of a three month wait time for additional treatments to a high of a six month wait time. Of the studies reviewed by the article in Clinical Medicine Insights, those that mentioned additional injections after the initial protocol indicated a low of a one month wait time to a high of a six month wait time. One study reviewed in this article provided additional treatments with no wait time. This seems to be an outlier.
Overall, it seems there is variability in treatment plans. Each provider likely considers each case and determines which protocol to follow and whether to allow additional treatments after the initial protocol is completed. If you are considering this treatment for pain, you will need to consult with your provider to find out what to expect about number and spacing of injections.
Who Provides Prolotherapy?
A range of providers can administer prolotherapy. As noted by the article published by the American Society of Regional Anesthesia and Pain Medicine, prolotherapy is often offered by doctors practicing at pain clinics. Authors of the other articles I’ve drawn on in writing this post were doctors working in physical medicine and rehabilitation, cerebellum medicine, regenerative medicine, and anesthesiology. The doctor I spoke to in preparing this post was a doctor of sports medicine.
This range in types of providers can be both helpful and confusing at the same time. On the helpful side, patients seeking prolotherapy as a treatment might find several specialists providing the treatment in several different specialty clinics. However, on the confusing side, patients might need to try reaching out to several doctors in different specialties to find someone local who provides the treatment.
What Makes Prolotherapy an Alternative Treatment?
It should be noted that prolotherapy is considered an alternative treatment option. This is because “this therapy is not approved for use by the Federal Drug Administration (FDA),” as explained by the article provided by the American Society of Regional Anesthesia and Pain Medicine. To be more specific, “Dextrose proliferant has been approved for injection by United States Food and Drug Administration but not for prolotherapy; thus, it is currently used in prolotherapy as an off-label substance,” as elucidated by the article in Clinical Medicine Insights.
Despite the alarming feeling patients may experience when told a treatment they are considering for pain relief is not approved by the FDA, this state of affairs does not mean such a treatment is not safe. None of the 57 studies I read about in the articles I looked at in writing this post reported any injuries caused by prolotherapy treatment. At worst, some patients did not achieve full pain relief.
For this and other reasons, many medical providers and institutions are moving away from the label “alternative” for non-FDA approved treatments. As the Cleveland Clinic put it, the term “alternative” is “becoming outdated as providers turn to an ‘integrative’ approach instead.” This type of approach incorporates “different types of evidence-based therapies to care for all of you.” Such an approach “can be especially helpful if you have a long-term (chronic) or complex condition.”
Disclaimer
As with my other pieces of medical writing, I offer this one as informational only. Before undertaking any medical treatment, you should check with a doctor or other licensed medical professional.