Prolotherapy is the treatment of soft-tissue damage through the use of injections. The injections lead to inflammation in the area, and the body reacts by increasing the blood supply and sending more nutrients to the area, resulting in tissue repair. The term prolotherapy is derived from the word prolo, short for proliferation, as the therapy is intended to proliferate tissue growth in the damaged area.
The idea behind this therapy dates back more than 2000 years to Hippocrates, who used it to treat soldiers with injured shoulders. Instead of injections Hippocrates used a hot poker, which he speared into the shoulder joint, causing inflammation and stimulating the body to repair itself. Prolotherapy using injections was derived from a treatment developed by H.I. Biegeleisen called sclerotherapy, used to treat varicose veins. In the 1950s, George Hackett, often called a pioneer of prolotherapy, was experimenting with and touting the benefits of the procedure.
Prolotherapy has been used to treat chronic neck and back pain, joint pain from arthritis, headaches, fibromyalgia, sports injuries, carpal tunnel syndrome, and partially torn tendons, ligaments, and cartilage.
The benefit of prolotherapy is that it is a non-surgical procedure that can be administered in a clinic, saving patients from undergoing anesthesia and surgery followed by a long recovery period. It's also cheaper than surgery. The average back or neck surgery costs about $40,000, while a single prolotherapy treatment runs anywhere from $90–$200, though patients may need several treatments. Furthermore, with prolotherapy there is no loss of mobility as there is with back surgery, when doctors fuse together the vertebrae in an effort to create stability in the spine.
Another benefit is that prolotherapy takes patients off drugs. Patients escape the cost of pain killers and their side effects.
In prolotherapy, a doctor injects a sugar water or salt water-based solution into the damaged ligament or tendon at the point where it attaches to the bone. The injection produces an inflammation, which increases blood flow, swelling, and pain. The body then launches a course of repair and healing. The inflammation tricks the body into thinking another injury has occurred, so it sends in macrophages, which are cells that ingest and destroy the irritant solution. These cells clean up the area. The body then sends in fibroblasts, which are cells that help build fibrous tissue. The fibroblasts excrete collagen, a protein that makes the ligaments denser and stronger. The stronger ligaments provide more support for the joints, often alleviating the pain.
The length of treatment sessions varies and depends on the area being treated. For example, treatment of an injured elbow involves injections only in one site, whereas treatment of larger areas, like the neck and back, involves more injections. Treating an elbow may take only a few injections, whereas the back may involve up to 50 injections for one treatment. The more injections, the longer the treatment.
The treatment generally involves several sessions, usually three to six, which are separated by two or three-week intervals. Some practitioners space treatments four or six weeks apart.
Though doctors have practiced prolotherapy for more than a half-century, it is still considered an alternative treatment; therefore most insurance policies don't cover it.
Analgesics and sedatives may be given before treatment to reduce discomfort. Many patients, however, forgo sedation because they cannot drive home afterward. Many doctors use topical freeze sprays, ice packs, or anaesthetic cream to reduce skin sensation.
As with all procedures, there are risks. Patients are asked to sign a consent and waiver. Since the treatment involves inserting a needle into the body, there is a chance of puncture to arteries, nerves, or even lung tissue, depending on the area to be treated. Some patients may have allergic reactions to the substance injected.
The most common side effects include pain during the injections and soreness and stiffness afterward. Patients are reminded not to take any anti-inflammatory drugs, such as ibuprofen, because these will impede the healing process prolotherapy aims to set in place.
Research & general acceptance
According to the Alternative Medicine Network, studies show prolotherapy relieves 92% of those treated; however, the therapy is relatively untested.
Opponents wonder how prolotherapists decide where to make their injections since areas of ligament weakening won't show up on an x ray. Others fear nervous system damage should the substance be injected too close to the nerves. Prolotherapy received a bad name in the 1950s when the Lancet reported three cases of paralysis and two deaths after treatment. It did not resurface for a number of years. As of 2000, there were only 400–500 U.S. doctors administering the treatment.
In the April 1997 issue of Headache, Dr. Irwin Abraham of Rochester, New York, reported preliminary findings of a study on prolotherapy to cure chronic headaches with neck pain. Of 17 patients, 11 said their symptoms were improved or relieved after treatment. At a two-year follow-up, nine reported complete relief, one had partial relief, and one's symptoms had relapsed.
Training & certification
Abraham stated in Headache that prolotherapy is a "safe, simple, and long-lasting treatment that any primary care physician can perform in the office setting." Doctors can learn prolotherapy through observation and instruction by a skilled prolotherapist.
The American Association of Orthopedic Medicine offers courses and workshops to train physicians and works to increase the number of physicians using the therapy.
Abraham, Irwin. "Prolotherapy for Chronic Headache." Headache (April 1997): 256.
Jennings, Suzanne. "The Prolotherapy Option." Forbes 152, no. 13 (December 1993): 248.
American Association of Orthopedic Medicine. (800) 992-2062. http://www.aaomed.org.
"Prolotherapy: The Natural Solution for Pain." Mark T. Wheaton's Orthopedic Practice Page. http://www.wheatons.com/Prolotherapy_CommonQuestions.htm. (June 2000).
"Prolotherapy defined." Prolotherapy.com http://www.prolotherapy.com/prolodefine.htm. (June 2000)
"The Thinking Person's Guide to Perfect Health: Sclerotherapy (Prololotherapy)." The Alternative Medicine Network. http://www.sonic.net/-nexus/sclero.html. (June 2000).