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Prolotherapy for Joint Pain Relief
LIGAMENTOUS RECONSTRUCTION BY INJECTION
Information for patients
One cause of chronic pain which is often neglected is laxity of the ligament fibers which stabilize joints. A technique called Prolotherapy utilizes injection of a stimulant solution into the attachments of these ligaments, to promote proliferation and toughening of the fibers, reducing the abnormal laxity of the joints and producing remarkable and long-lasting reduction in chronic pain. This technique can help correct many common problems, including NECK AND BACK PAIN, TMJ SYNDROME, SHOULDER MOTION PAIN, TENNIS ELBOW, CARPAL TUNNEL SYNDROME, SORE WRISTS, KNEES AND HIPS, ANKLE LAXITY and PLANTAR FASCIITIS (HEEL SPURS). Prolotherapy has proven to be especially helpful for LOW BACK PAIN. Prolotherapy treatments are now available at MINOR PROCEDURES.
Background
Prolotherapy (prolo = proliferation) involves the injection of irritants into ligamentous structures in the neck, back or extremities. Ligaments are strong, flexible connective tissues (like ropes or guy wires) which support the joints and bind our bones together. These injections cause those structures to be strengthened, thus improving support and relieving pain. The procedure originated in the late 1940's and has been refined since.
Prolotherapy involves carefully placed injections of a mixture of lidocaine (which temporarily numbs the tissues to relieve pain) and dextrose (sugar water) in a strength sufficient to irritate the tissue and cause repair by the body’s own healing mechanisms. Additional medications may be added to increase the body’s response if needed.
It is thought that laxity of the connective tissues and failure to maintain the original tissue support allows joints and movements to become mechanically unstable, and that loose, floppy joint support is a major cause of chronic pain. This looseness is a result of previous injury, or often accompanies simple ageing. In addition, it appears that prolotherapy also acts to reset pain nerves that have become abnormally overactive.
Experiments in animals and humans have shown that ligaments and tendons are strengthened and thickened by prolotherapy. Studies have shown this to be an effective therapy in relieving chronic pain.
The injections are placed in painful ligaments or tendon attachments to stimulate the body to heal itself. The injection of the irritant solution activates a mild inflammatory response very locally. Weaknesses and faulty structural elements are thus detected and repaired, and the resulting improvement in function and relief of pain are very often dramatic. Many patients who have previously undergone multiple other forms of treatment without pain relief, including physical therapy, chiropractic adjustments, and even surgery, receive lasting pain relief after prolotherapy is performed.
Procedure
Prolotherapy involves injecting small amounts of solution into ligamentous structures that are painful and/or weak. Depending upon the site and size of area involved, this may necessitate many injections during one office visit. These injections may be uncomfortable because they require multiple needle sticks. Tiny injections of numbing medicine are usually given first, so there is much less pain as the treatment itself is performed.
Most patients tolerate this well but some patients, prior to the procedure, may require some medication for pain control. Please discuss premedication with the doctor if you feel you have unusually strong reactions to discomforts that are part of minor procedures (such as a dental repair in your past.) Apprehension (fear of needles) can also be eased with premedication if needed, and if another driver is available to transport you.
After the injection procedure, most patients feel fullness and numbness in the areas injected. Most post-prolotherapy patients fall into one of the following three groups:
• In the first, the pain is immediately relieved due to the injection of the numbing medicine into the area of pain. Then, during the next 24 to 48 hours, their pain may return and may be, initially, more severe. The pain will gradually decrease in intensity as healing and strengthening occur.
• The second group of patients have little or no pain post injection and the pain stays relieved permanently.
• Another group of patients finds that their pain is relieved initially but returns after 2 - 3 weeks, necessitating further injections. Of course, there are some patients who do not benefit from these injections.
The number of injections to obtain relief varies considerably from patient to patient and injury to injury. Some people are relieved totally with one injection whereas others required a series of injections which may total 15 - 20 or more sessions. Generally, several injection sessions are done with most patients. If, after 3 or 4 sessions there has been an adequate inflammatory response but no improvement in pain, prolotherapy will usually not be continued.
If progress is being made with prolotherapy injections, the usual time between subsequent injections is 4 to 6 weeks. Occasionally, injections will be recommended at closer intervals.
After prolotherapy, patients are encouraged to do regular stretching exercises but not to over stress the areas that have been treated - to allow for proper healing and strengthening. It is important to remember that even if your pain is relieved and structures strengthened, it is possible to re-injure yourself at some time in the future, so it is important to take good care of the previously injured ligaments so as to minimize the risk of re-injury.
There is no known contraindication to doing prolotherapy on diabetics. The small amount of dextrose does not affect a diabetic’s blood glucose levels.
Risks and Complications
There are potential risks and complications with Prolotherapy. Injections are carefully placed, which minimizes potential damage to both nerves and blood vessels, but damage can occur. As with all medical procedures, side effects must be discussed with all patients considering a procedure.
Any medical procedure carries potential risks and complications. After prolotherapy, these could include increased pain, numbness (very rarely even permanent numbness), infection, abscess, allergic reaction to medications injected, weakness, temporary or even permanent paralysis, headache, pneumothorax (collapse of the lung), dizziness, nausea and even death.
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