Prolotherapy does it work?

[rustybedspring]

Hi, I was here before. I have Foraminal stenosis and degenerative changes to L5/SI. Anyways I got sent to see a doctor about injections. He thinks prolotherapy will work for me. Anybody had it? Does it do anything? I have been having chronic back and leg pain for year and a half now and nothing has worked.

I also had a question about headaches being caused by neck problems. I went to a chiropractor months ago and when he showed me an x-ray of my neck I have no curve in my neck at all. Anyways I have been getting bouts where I have these horrendous headaches that are localized in the back of my head. That get worse when I move or lye down. I sure as heck can't walk. I get headaches that last for months. I went through a four month stretch last year. Now I have had daily headaches for the past two and a half months. Can anybody with similar experiences tell me what to do.

Thanks,
Rick

[Jolene]

Mail Kathi49 in case she doesn't see your post. I think she can help answer your headache quest. Slipinslide also.

[Tbackpain1]

This is one of those times where I wish I had access to the archives lost with the crash. Hopefully the information will be restored.

The general consensus of the research folks on the forums was that prolotherapy is not a good option. From what I remember, there is no objective medical evidence, and no histology has been published as to what goes on when injection is placed into the painful soft tissues. And one comment I particularly remember was that in prolotherapy, they can inject anything from normal saline or dextrose solutions, or something as whacked out as ground up pumice (rock) in a solution :eek:

I will see if I can find some of the old info. that was cached, but I don't know how successful it will be.

If you've really got your heart set on the procedure, I would research it out fully...find out ALL of the details from the doc who's doing the procedure, make sure all of his/her credentials are in order (AAOM, ISIS, etc.) and then make an informed decision from there. Its too easy for us as spineys in pain to hope for the miracle cure, only to have the wool pulled over our eyes because we'll jump at any chance to relieve the pain.

Theresa

[Kathi49]

Hi Rick,

I noticed Jolene threw my name out there LOL! I can't address prolotherapy as I know nothing about it. But the headaches are another matter. I had them too, EVERY DAY for 3 years! First of all, DO NOT let a chiropractor do any spinal manipulations of your neck. Secondly, you can google on occipital neuralgia and/or cervicogenic headache with variant migraine. That is what I had and due to, basically, arthritic changes at the C3/C4. A fusion took care of the headaches. But prior to that I took every med known to man, had facet injections and trigger point injections and selective nerve root injections. All of which helped a little. Finally, my PM did an injection at the C3/C4 and it gave me about 3 months of relief. You could try Neurontin, Lyrica or Depakote but I will warn you now that they do cause dizziness and in my case, made me worse with even more dizziness and nausea. I know what you mean by not being able to walk and those types of headaches are not the normal ones by any means...the pain is severe! Until you can find out what is causing it I would suggest trying Biofreeze to get SOME relief and apply it to the base of your skull. Maybe buy a cervical pillow and/or use heat or ice alternately. I wouldn't suggest massage therapy at this point until you find out EXACTLY what is going. And I say that because I did the massage therapy at first and when they did the occipital region, it really triggered an attack. PT didn't work for me either and made me hurt even worse. Don't take too many narcotics if you have them, it can cause rebound headaches. I learned that one the hard way too. Standing in a hot shower and letting it just pour on your head while stretching a little may help. But I think if you read up on what I said above, you will get an idea if this is what you have or not. And, last but not least, maybe Slipnslide will come along and give her input. I wish you luck! :)

[nopain]

Prolotherapy can and does work for some people. Like everything else it really depends on an accurate diagnosis. If in fact tightening your ligaments will stabalize your spine then you are probably a good candidate.

The problem with Prolotherapy is it isn't taught in the majority of Medical Schools.

You can read this:

http://www.prolonews.com/ross_hauser.htm

He loves to do it, write about it, and promote it.

As far as the Headaches go your neck certainly could be the cause, but headaches are tough to figure out. And straightened curve in the neck will take a long time to fix. You'll need to work with therapists - massage, pt, or the right chiro (Chiros scare me... too few good ones). I'd opt for a massage therapist that works with structural integration/deep tissue/myfascial release.

These problems are the result of incorrect postural habits. These need to be corrected, then you need to make yourself aware of them.

It's tough because so much of what we do from working on the computer, cooking, bathroom tasks - brushing the teeth, etc. All have our bodies in positions that are not good for our spine. Then we go to jobs that have us sitting all the time, or working in postions that are bad.

It's a wonder more people don't suffer.

[ChiroGeek]

With regard to chronic low back pain, it's a split decision: 2 randomized controlled trials support prolotherapy's efficacy and 2 don't .

Personally, I can't how see such a treatment would ever work for chronic discogenic pain (other than a placebo effect) and can't/don't recommend it.

Clin J Sport Med. 2005 Sep;15(5):376-80.

A systematic review of prolotherapy for chronic musculoskeletal pain.

Rabago D, Best TM, Beamsley M, Patterson J.

University of Wisconsin-Madison, Madison, WI 53715, USA.
David.Rabago@fammed.wisc.edu

OBJECTIVE: Prolotherapy, an injection-based treatment of chronic musculoskeletal
pain, has grown in popularity and has received significant recent attention. The
objective of this review is to determine the effectiveness of prolotherapy for
treatment of chronic musculoskeletal pain. DATA SOURCES: We searched Medline,
PreMedline, Embase, CINAHL, and Allied and Complementary Medicine with search
strategies using all current and historical names for prolotherapy and
injectants. Reference sections of included articles were scanned, and content
area specialists were consulted. STUDY SELECTION: All published studies
involving human subjects and assessing prolotherapy were included. MAIN RESULTS:
Data from 34 case reports and case series and 2 nonrandomized controlled trials
suggest prolotherapy is efficacious for many musculoskeletal conditions.
However, results from 6 randomized controlled trials (RCTs) are conflicting. Two
RCTs on osteoarthritis reported decreased pain, increased range of motion, and
increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low
back pain reported significant improvements in pain and disability compared with
control subjects, whereas 2 did not. All studies had significant methodological
limitations. CONCLUSIONS: There are limited high-quality data supporting the use
of prolotherapy in the treatment of musculoskeletal pain or sport-related soft
tissue injuries. Positive results compared with controls have been reported in
nonrandomized and randomized controlled trials. Further investigation with
high-quality randomized controlled trials with noninjection control arms in
studies specific to sport-related and musculoskeletal conditions is necessary to
determine the efficacy of prolotherapy.

[carbolic]

Personally, I can't how see such a treatment would ever work for chronic discogenic pain (other than a placebo effect) and can't/don't recommend it.

Based upon Bart Koes 1996 meta-analysis of research regarding the efficacy of manipulative therapy, most would not endorse manipulative therapy on that basis- Nonetheless, manipulative therapy absolutely does have a place in the arsenal of medical treatment of a variety of pain conditions. I know that you, in particular, like to review what is happening in the realm of pain treatment and I think you do a pretty good job of explaining things on your site- However, there is much to learn from the physical performance of such treatments, ie, you yourself know what manipulation has been able to do in your hands, despite what research may or may not say to the contrary-

Consider these studies:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed

http://www.painphysicianjournal.com/2006/april/2006;9;115-121.pdf

I am not a Chiropractor- I am a pain interventionalist and I have a number of learned Chiropractic colleagues.

[brians2000]

http://www.wehelpwhathurts.homestead.com/prolotherapy.html


I have done prolotherapy with this guy above. It seemed to work for awhile but it is very expensive and if you dont like getting shots in my back then dont have it. The doctor said my legiments were weak and prescribed prolotherapy. I guess it tightened my ligements because I had a reduction in pain while going thru threatments. The therapy never ends because the ligiments get weak again so the shots are ongoing. I posted a reply earlier and I dont think it went thru but I provided a link above. Brian

[nopain]

Just a couple more reference for you to consider.

http://www.jointrehab.com/
http://www.prolotherapysandiego.com/
http://www.drmagaziner.com/koop.htm - everybody likes to talk about Dr. Koop

Everyones healing potential is different. Again if you are a candidate and tightening your ligaments addresses your specific issues then it may be worth a try. There is no one cure for everyone.

I haven't really read of a downside other than the needeling is not the most pleasant thing. I've done accupuncture and facet blocks and a bloodpatch. And at this point if needeling solved my problems I'd say "start poking".

If it doesn't work for you and it is not a financial burden on you, then at least you tried. Sounds like a crazy philosphy but its not. When you take pain meds you are just trying something. The Doc's adjust meds and dosage to find something that works then hopefully manage the side effect profile. Surgery is just trying to find a solution. Pretty much everything is trying and many things do work. If only we had a machine that could scan us and tell the Docs what is the EXACT cause of our pain.

If Prolotherapy had a zero % success rate it would probably not be endorsed by any MD's. So the real question you have to decide is just like any other proceedure. What are the risks what are the costs and am I willing to try.

Keep in mind there are different solutions used as well. I think this is a lot less invasive than back surgery and the side effects are primarily localized pain during the prodceedure.

[carbolic]

If all you have is a hammer, then everything looks like a nail- Prolotherapy is a tool, not a panacea. I have been able to successfullt bill for prolo injections for years without difficulty- Here is the dilemma in the industry:

-Most prolo injectionists just do prolo- They do strictly cash because they do not perform other types of injections- They do not want to deal with third party payors- "Prolo" is not a covered service according to a review by the CMS

-While the theories behind growth factor elaboration is interesting and with clear merit, there has historically been 1 flaw in the prolo studies- No pre and post histology- In other words, they didn't take a tissue sample, show that it was physically deranged, do the injections and then demonstrate tissue reorganization in a subsequent tissue sample. Therefore they can't prove that they grew anything. What they can prove is that Mr. Smiths pain was a 10 before and now it is a 3 or 4- That is a nerve block by definition- Since the industry is set up to recognize the benefis of neural blockaid, they have appropriate codes that can be successfully billed- Hypertonic Dextrose IS a neurolytic above 12%- I use 15-18%-

More when I have time...

[carbolic]

Despite many studies performed on Epidural steroids, there is still nothing conclusive and reproducible that shows that they work (some show they do and others not)- Nonetheless, they represent the most commonly performed pain procedure in the world- As an aside, they can be miraculous in terms of their benefit or worthless, depending upon the true source of the pain-

All pain treatment represent tools- Problem is, pain is an invisible entity and thus, the source of it can be challenging to find- There has never been a proven relationship between visible pathology in the spine as it relates to a bonafide source of a given patient's pain- We used to think that the most common cause of pain was one of physical (mechanical) pressure of one structure upon another. A number of studies have identified varied spinal pathologic changes evident on x-ray, CT, MRI, etc, in patients without any history of pain complaints- Even more frustrating are those individuals in significant pain, yet without demonstrable pathology in these same tests-

As a result, the thought processes surrounding the treatment of pain are much like detective work. One must determine the potential sources of one's pain based upon the patients areas of indicated pain then correlated with physical exam- The result is a list of possibilities- The provider must create a hierarchy so as to prioritize from "most likely" to "least likely"- Then, we get to work- When one considers the variety of treatment options and the fact that "everything helps someone but nothing helps everyone", well it can become quite complicated to know, at the outset, what the magic ticket will be.

There are two basic reasons that a treatment will fail to work:

-it is rendered properly but to the incorrect location (not the source of the pain)

-it is rendered to the proper location yet it is insufficient in terms of actual clinical benefit (the "problem" is bigger than the "fix")

When rendering treatment we want to obtain both diagnostic AND therapeutic information:

For instance, when performing a targeted epidural injection (patient has lateral leg pain and thus we target L5) we want to actually make slight contact with the nerve during the procedure so as to actually reproduce what we hope will be the patient's usual pain distribution- The patient will actually be able to tell (the pain reproduced is not severe; rather it is just enough to tell)- Following this, a small amount of anesthetic and steroids are injected directly upon the nerve- Pain relief (or substantially so) should follow for about 1-3 hours- That will constitute the diagnostic part-

If the patient goes on to experience substantial pain relief over the next several days then inflammation may be presumed to represent a percentage part of the patients pain (more diagnostic information!) A second and possible third injection will follow so as to maximize the benefit-

However, if the patient has relief with the anesthetic and then experiences a full return of pain, the procedure can be repeated but likely, there is not an inflammatory component- Hopefully, you can see the differences here-

IMHO, all pain begins as a mechanical problem (traumatic or mileage related) that goes undiagnosed- The most common is the garden variety age related wear and tear- Eventually the worn parts experience progressive dysfunction, overgrowth (thickening) leading to further mechanical compromise and eventually, the possibility of narrowing, pressure and inflammation- So where is the pain coming from in these patients? Well, that's the reason for all of these threads, isn't it?

[rustybedspring]

I'm actually rethinking the Prolotherapy. Due to the fact that I have been getting lots of pain between my shoulders that feels like someone jabbing me with the edge of a hockey stick. I haven't been sleeping well at all because of it. And I also have been having trouble with my back between my shoulders up to the back of my head. That whole area goes real stiff just looking straight forward. So I'm going to a doctor tomorow to see if something can be done.

So unless I can get those problems fixed. I'm not going to bother with the injections for my lower back because I wouldn't be resolving everything.

Thanks again!

Later
Rick

[carbolic]

I'm not going to bother with the injections for my lower back because I wouldn't be resolving everything.



Be aware that a number of pain conditions have no "fix"- In that way, it is not unlike Diabetes, hypertension or asthma, etc- These are conditions that have no "fix"- The key then is quality of life- If any treatment, injections included, were to provide you with a reduction in pain, even if only for a few months at a time, then they should be considered- The least invasive treatment (most conservative) that provides that relief should be utilized. Some people need chronic pain meds; others do well with a single epidural steroid injection every three months, year round- For others manipulative therapy once every week or two does the trick- It is all about finding the thing that gives you the best control, for the longest period of time.

[Maggie]

I have written this 3 times and when I would hit the backspace button, it disappeared. I hope it isn't my new laptop.

My H/A's were worse than any migraine I ever had. My plan was comprehensive, which all of them probably should be. First, I had trigger point injections into the muscles (knots deep in the muscle and the size of grapes) . (My husband now does the thumb massage on them before they get too bad and that works just as well.) Next, my PT, who has continued training in spine problems, saw me three times a week and did manual massage, along with ultrasound ionipheresis (sp?). I can't take muscle relaxers but they could help.

After 3 months of this my headaches got better, my arms quit being numb, and legs felt stronger. This has been two years and I am still maintaining a somewhat comfortable level with meds. I too thought I could "fix" one end before working on the other but that didn't happen. I had three lumbar surgeries but still have to take pain medications for that.

[dekram1]

Hi:
Has anyone had success in Prolothearpy? I have a torn Rotator Cuff and had surgery on one shoulder but I still have the pain. I also have a torn Rotator Cuff on my left shoulder all due to working out with weights.

I now had my first set of shots in my left shoulder and going again tomorrow for my second set of shots. The first set did nothing and I want to see if the second set will take away the pain. I will keep everyone informed about it.

When I first saw the Doctor, he said I was a good canadate for the procedure. He took no x-rays so I am telling myself, "How does he know". I don't know if this is all BS but I am willing to give him another shot at it.

Thanks for listening.
Bob