Arthritis, pain and joint problems are some of the most common presentations to doctors’ offices. For many years, techniques and medications have been developed to try to change pain and dysfunction. Most of these, however, fall short of any real result because they are primarily focused on treating the symptom. After a while, the medication doesn't work any longer, and another or more is needed. In many cases, people feel better with a medication and tend to go back to their activities and damage the tissue further because they don't feel the pain warning signs. With the typical symptom treatment approach, the body never gets stronger. There is an excellent technique that began back in the early 1900's that addresses the cause of dysfunction. This has been called "Prolotherapy", "Reconstructive Therapy" and "Sclerotherapy".
All of these terms describe a technique that involves stimulating tissues to heal with injections of various solutions. Dr.'s Gedney, Schuman and Hackett have been credited as the first to use these injections to treat back and joint pain. Their work in the 1920's, and that of their students or proteges has allowed hundreds of thousands of people to benefit over all of these years and allover the country.
The idea is simple. Certain substances, when injected into ligaments and tendons, create a mild irritation or inflammation. This process, in a beneficial way, stimulates the body to respond to the area. Without causing pain, but alleviating pain, the solution helps to focus healing at the site. New blood vessels can come to the area and bring the healing effects of oxygen, hormones, and growth factors. Various studies have shown that ligaments and tendons become thicker, stronger and have better attachment to the bone. Other studies describe significant improvement in pain and mobility after even 5 to 6 treatments.
The articles attached are a sample of some of the literature. Please see the "Article" section of my website for more Prolotherapy research.
I have treated thousands of patients with Prolotherapy over the years, and have added my own philosophy to the existing knowledge. I also try to maximize nutritional and hormonal state in patients receiving the treatment so as to further enhance the healing capabilities.With vitamin, mineral or hormone deficiency, healing is negatively affected.
The injections are done with a very small gauge needle,( 25 G) and take seconds to perform.
The solution can vary depending upon the amount of damage and area in question, but I like to use the mildest formula first, then if needed add a little of a stronger dose. I like to inject once a week to stimulate a faster healing response. Some doctors, however use stronger more irritating solutions and inject every 2 to 3 weeks. This may cause unnecessary discomfort.
As healing and results occur, then I recommend the addition of physical therapy.This is usually done after prolo begins, because so many people complain of pain with physical therapy initially.
The technique can be done on any ligaments, tendons or joints of the body.
Please call the office for further info or help regarding your medical concerns.
Thanks,
Dr. Calapai
Journal of Alternative and Complementary Medicine
Objectives: To determine the clinical benefit of dextrose prolotherapy (injection of growth factors or growth factor stimulators) in osteoarthritic finger joints.
Design: Prospective randomized double-blind placebo-controlled trial.
Settings/Location: Outpatient physical medicine clinic.
Subjects: Six months of pain history was required in each joint studied as well as one of the following: grade 2 or 3 osteophyte, grade 2 or 3 joint narrowing, or grade 1 osteophyte plus grade 1 joint narrowing. Distal interphalangeal (DIP), proximal interphalangeal (PIP), and trapeziometacarpal (thumb CMC) joints were eligible. Thirteen patients (with seventy-four symptomatic osteoarthitic joints) received active treatment, and fourteen patients (with seventy-six symptomatic osteoarthritic joints) served as controls.
Intervention: One half milliliter (0.5 mL) of either 10% dextrose and 0.075% xylocaine in bacteriostatic water (active solution) or 0.075% xylocaine in bacteriostatic water (control solution) was injected on medial and lateral aspects of each affected joint. This was done at 0, 2, and 4 months with assessment at 6 months after first injection.
Outcome Measures: One-hundred millimeter (100 mm) Visual Analogue Scale (VAS) for pain at rest, pain with joint movement and pain with grip, and goniometrically-measured joint flexion.
Results: Pain at rest and with grip improved more in the dextrose group but not significantly. Improvement in pain with movement of fingers improved significantly more in the dextrose group (42% versus 15% with a p value of .027). Flexion range of motion improved more in the dextrose group (p = .003). Side effects were minimal.
Conclusion: Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints.
http://www.liebertonline.com/doi/abs/10.1089/10755530050120673?journalCode=acm
A rationale for prolotherapy.
Prolotherapy, the technology for strengthening lax ligaments, has found increased acceptance in recent years. However, despite its greater use, the mechanism of action of prolotherapy is not well understood.
In the past few years a number of advances have been made in the understanding of wound repair. This author believes the increased knowledge which has been made available in the field of wound healing has application to a more complete understanding of prolotherapy. There follows a general discussion of wound healing and a hypothesis which provides a basis for understanding prolotherapy.
During prolotherapy, proliferating agents are injected directly into stretched or torn ligaments, resulting over a few weeks' time in the loss of pain in the affected area and return to normal function of the associated painful skeletal articulation. Following injection of the proliferant, the clinician observes an immediate localized inflammation which diminishes gradually over several days. Patients are cautioned against taking aspirin or other anti-inflammatory agents to relieve the discomfort. Over a period of several weeks or months, the pain with which the patient presented recedes and the treating physician observes a hypertrophied ligament with improved function of the articulation. (There issome debate concerning the relationship between mechanical dysfunction and the associated pain of ligaments involved. It is not the purpose of this discussion to venture beyond the biochemical mechanism of prolotherapy).
How does prolotherapy occur and what is the underlying bio-chemical mechanism? Why is an injured ligament painful if injected with proliferant but an uninjured ligament remains relatively pain-free when injected? Why do non-steroidal anti-inflammatory agents (NSAI), relieve the discomfort so rapidly? Is itreasonable that NSAI should diminish the therapeutic result? What is the purpose of the various mixtures that are used in treatment? How do they achieve their results? In order to answer some of these questions one must first understand, in a general way, how the healing process occurs. (For a more comprehensive description of the inflammatory process and its relationship to wound healing, the reader may consult some references listed at the end of this article).
Please, click on the link below to read the whole article
http://www.kalindra.com/prolo_banks.pdf
Retrospective Case Series on Patients with Chronic Spinal Pain Treated with Dextrose Prolotherapy.
Objectives: To determine the clinical benefits of dextrose prolotherapy in patients with chronic spinal pain.
Design: Retrospective case series.Setting/location: During the first 2 years at an outpatient prolotherapy clinic.
Subjects: One hundred and seventy-seven (177) consecutive patients with a history of chronic spinal pain completed prolotherapy treatment and were followed for a period ranging from 2 months to 2.5 years.
Interventions: Patients were treated with a proliferant solution containing 20% dextrose and 0.75% xylocaine. One half milliliter (0.5 mL) of proliferant was injected into the facet capsules of the cervical, thoracic, and lumbar spine, or combinations of the three areas. The iliolumbar and dorsal sacroiliac ligaments were also injected in patient with low back pain. Injections were typically done on a weekly basis for up to 3 weeks. A set of three injections was repeated in 1 month's time if needed.
Outcome measures: Level of pain, and improvement in activities of daily living were measured on a fivepoint scale. Improvement in ability to work was also assessed.
Results: Ninety-one percent (91.0%) of patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work. Women required on average, three more injections than men. Cervical spine response rates were lower than thoracic or lumbar spine. No complications from treatment were noted.
Conclusions: Dextrose prolotherapy appears to be a safe and effective method for treating chronic spinal pain that merits further investigation. Future studies need to consider differences in gender response rates.
http://www.liebertonline.com/doi/abs/10.1089/acm.2004.10.670
Efficacy of Dextrose Prolotherapy in Elite Male Kicking-Sport Athletes With Chronic Groin Pain.
Objective: To determine the efficacy of simple dextrose prolotherapy in elite kicking-sport athletes with chronic groin pain from osteitis pubis and/or adductor tendinopathy.
Design: Consecutive case series.
Setting: Orthopedic and trauma institute in Argentina.
Participants: Twenty-two rugby and 2 soccer players with chronic groin pain that prevented full sports participation and who were nonresponsive both to therapy and to a graded reintroduction into sports activity.
Intervention: Monthly injection of 12.5% dextrose and 0.5% lidocaine into the thigh adductor origins, suprapubic abdominal insertions, and symphysis pubis, depending on palpation tenderness.Injections were given until complete resolution of pain or lack of improvement for 2 consecutive treatments.
Main Outcome Measures: Visual analog scale (VAS) for pain with sports and the Nirschl Pain Phase Scale (NPPS), a measure of functional impairment from pain.
Results: The final data collection point was 6 to 32 months after treatment (mean, 17mo). A mean of 2.8 treatments were given. The mean reduction in pain during sports, as measured by the VAS, improved from 6.3± 1.4 to I.0±2.4 (P<.001), and the mean reduction in NPPS score improved from 5.3±0.7 to 0 .8t 1.9 (P<_001).Twenty of 24 patients had no pain and 22 of 24 were unrestricted with sports at final data collection.
Conclusions: Dextrose prolotherapy showed marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes.
http://www.treatingpain.com/efficacy_dextrose_prolotherap.pdf