Prolotherapy

Prolotherapy
Intervention
Gustav Hemwall circa 1990-1995
HCPCS-L2	M0076

Prolotherapy is also known as "proliferation therapy," "regenerative injection therapy," or "proliferative injection therapy". It 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.^[1]

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".^[2]

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 veterinary 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 patients 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), lidocaine (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.

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.^[2]

Signs used by practitioners as possible indications for prolotherapy

^{[citation needed]}

• 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 review of the medical literature as of October 2006 on the efficacy of prolotherapy injections in adults with chronic low-back pain^[3] concluded:

Of the five studies we reviewed, three found that prolotherapy injections alone were not an effective treatment for chronic low-back pain and two found that a combination of prolotherapy injections, spinal manipulation, exercises, and other treatments can help chronic low-back pain and disability. Minor side effects such as increased back pain and stiffness were common but short-lived. Based on these five studies, the role of prolotherapy injections for chronic low-back pain is still not clear.

Criticism

Most major medical insurance policies do not cover the treatment. After a 1999 review of the medical evidence, US 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".^[4]

Although more research is needed, studies have shown that prolotherapy seems to be more effective when done in a combination with other treatments, such as exercise and adjustments. In these studies, individuals who used prolotherapy recovered better and had less pain than individuals who did not. "Although absolute efficacy for the above mentioned conditions remains elusive, it should be pointed out that facet joint injection, intradiscal steroid injection and epidural steroid injection for low back pain may have even less evidence yet these procedures are considered mainstream treatments. Mooney in his editorial in The Spine Journal states “this fringe treatment is no longer at the periphery and seems to be at the frontier of a justifiable, rational treatment with significant potential to avoid destructive procedures”.15

The economic and quality of life burden that chronic musculoskeletal pain places upon many people in our society is immense. In the best interest of our patients, it may be time to consider co-management of non-responsive patients with a physician practicing prolotherapy." ^[5]

See also

• Pin firing
• Gustav Hemwall
• Sclerotherapy

References

External links

• 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.
• [2] 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.