Prolotherapy

Prolotherapy is not a rare treatment for back pain, but it is less likely to be used early in a patient's treatment. Typically, this type of treatment protocol is more likely to be used when conservative treatments (i.e. icing, NSAIDs, physical therapy) have not produced desired benefits. Other names for this type of therapy include "regenerative injection therapy", "proliferation therapy", "nonsurgical ligament reconstruction", "regenerative injection therapy", and "sclerotherapy". Though this procedure, like the sacroiliac joint block and facet neurotomy, involves the injection of chemicals into the soft tissues of the back, it actually involves the stimulation of an inflammatory response, rather than the inhibition of one. This procedure involves the injection of an irritant, via needle, into the injured soft tissues of the back. The concept of this procedure is that the inflammatory response to the chemical irritants will increase blood flow to the area, supplying the soft tissues of the back with oxygen nutrients necessary to stimulate healing. If successful, the results of this procedure will include an accelerated healing of the small tears in the discs, tendons, and joints of the back to produce a lasting healing of the tissues involved.

Research results are mixed for this procedure. Some studies support the benefits of this therapy, while others report insignificant results compared to placebo. The doctors who regularly use this type of therapy in their practice swear by it, though others do not consider it a viable therapy for back pain. This treatment is not widely practiced in the US. This type of therapy is less likely to be taught or practiced by western M.D. doctors. This treatment is not typically part of the traditional medical school curriculum.



When this therapy is used, it is applied by neurosurgeons, physiatrists, orthopedic surgeons, and anesthesiologists who have been trained to perform this treatment. To become an expert and qualified to perform this procedure, doctors may take training courses at professional medical organizations such as the American Association of Orthopedic Medicine, and the American Academy of Musculo-Skeletal Medicine.

Why it's done: Prolotherapy is most commonly used to treat back pain conditions such as sciatica, degenerative disc disease, and whiplash. Whiplash is an injury that can affect several types of soft tissues of the neck and back simultaneously due to an accident that suddenly whips the body in on direction, followed by another violent movement in another direction. Car accidents and sports injuries are two of the most common causes of whiplash injuries. Whiplash can cause damage to the spinal cord, vertebrae, ligaments, tendons, and nerve roots in and around the spine, particularly in the cervical (neck) region.

How it's Done: Though this procedure must be performed by skilled doctors, it may be conducted in clinics outside of hospitals, in outpatient clinics. The doctor will first identify the section of the spine where the damage has occurred, and then inject the irritant (a dextrose, or sugar, solution) into the affected tissues. The number of rounds of treatment required for a successful outcome vary from patient to patient. Some patients may experience significant back pain or neck pain relief from a few treatments, while others may require as many as ten.

Prognosis: There are few large patient population studies that report clear benefits from this type of procedure. Most of the positive findings in the literature and medical community come from individual doctor and patient testimonials. Thus, most of the positive findings in the medical and scientific community come from anecdotal evidence.