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An Effective Treatment for Chronic
Pain
Prolotherapy is an injection technique designed to stimulate
healing of chronic ligament and tendon weakness. Chronic weakness or "laxity" of
ligaments and tendons is a rather common problem that is frequently undiagnosed
and a significant source of chronic pain. Pain can occur at the actual site of
the injury/weakness, or due to reflex muscular spasm and changes in the muscles
associated with that ligament or tendon. Many people with chronic pain find
temporary relief using modalities such as physical therapy, manipulation,
medications, etc. only to find that the pain continues to recur. This is
commonly and frequently due to ligament or tendon injury that has failed to
heal.
The only non-surgical treatment available for treatment of
ligament and tendon injuries and/or weakness is
Prolotherapy. It is an
extremely safe effective procedure that has performed successfully on thousands
of patients for the treatment of chronic pain.
Prolotherapy is the injection of a "proliferant" solution into
the areas where ligaments and tendons attach to the bones. This solution is
usually a naturally occurring substance(s) such as sugar water or cod liver oil,
that stimulates the body's own healing mechanisms in the area treated. These
injections should only be performed by a physician who has specific training in
Prolotherapy.
Chronic pain in the neck, back, shoulders, hips, knees, etc.,
can frequently be relieved by Prolotherapy. Headaches, TMJ Syndrome and many
other chronic pain processes will respond to this treatment.
If you suffer from Chronic pain that has a refractory to other
treatment modalities you may be a candidate for Prolotherapy. To find out more
about Prolotherapy or to determine if you are a candidate,
request a consultation
with Dr. Matez. Dr.
Matez is a board certified surgeon now specializing in non-surgical therapies
such as Prolotherapy. Dr. Matez has trained extensively in Prolotherapy with
some of the country's leading experts in the field.
Is Prolotherapy Painful?
The injection is considered mild to moderately painful, and there
is typically a "flare" of soreness for 3-7 days afterwards. A mild
pain medication, such as Ultram or Tylenol, is usually
sufficient to control discomfort. The doctor can prescribe stronger
medication if needed.
Are there any medication interactions?
Because the effect of Prolotherapy is to initiate a "healing
cascade" which requires inflammation, the patient is advised to
avoid ant-inflammatory medications, both over-the-counter and
prescription. Aspirin may also interfere with the process to some
degree, but if a person is taking Aspirin to reduce the risk of
stroke or heart attack, a small amount of Aspirin, such as "baby
Aspirin" (80 mg) is acceptable. The results of Prolotherapy while
taking these medications may be slower and less consistent than if
the patient avoids these medications.
Is Prolotherapy safe?
Using the current solutions and techniques, there have been
no
reported significant side effects of this treatment in over 35
years. There is occasionally some bruising, and very rarely, a
nerve may be injured, usually transiently. The procedure has been
used for over 60 years. In the late 1950's some solutions were used
which were more potent and placed inappropriately into the spine
region, and this led to nerve injury and even lethal reaction. Those
who currently practice Prolotherapy strive to keep the technique
safe by providing educational seminars emphasizing correct technique
and solutions.
How does "sugar water" have a chance of solving the
painful condition?
The Dextrose is actually quite irritating in the standard 50%
concentration. Thus, it is diluted with water, anesthetic such as
lidocaine, or Sarapin, a water-based herbal extract of the Pitcher
Plant, to a concentration of 12-15%. This is thought to "dehydrate"
the injected tissues, causing an injury signal for the body, and
initiating the healing process. Dextrose has been shown to be a
growth stimulant on it's own as well.
What tissues of the body are treated by Prolotherapy?
The ligaments, which connect bones together, may be stretched and
torn. Tendons attach muscles to bone and may also be torn. The
capsules surrounding joints may become lax (loose) and also
contribute to pain. All of these may be strengthened and
"tightened" with Prolotherapy, reducing the "play" in the
joints, reducing arthritis, and bonding the clicking or
popping structures in a way that is much more functional and
normal. Cartilage has been shown to be repaired and thickened
after a series of Prolotherapy injections.
Are back and neck pain always resolved with
Prolotherapy?
No. Prolotherapy is an excellent treatment for many spine
disorders, and can reduce pain and improve function in a great many
cases which conventional physicians might consider "psychological",
or at least not evident on imaging tests such as MRI or CT scans.
The general public often expects these tests to be infallible but
the truth is that these tests often miss the true source of the
pain in the spine and pelvis. The structures which Prolotherapy
treats almost never are visualized on such types of testing,
unfortunately, and this is confusing for the patient as well as the
physician who doesn't understand ligamentous pain. Pain from
ligaments frequently is "referred", that is, travels down the arm,
buttock, or leg, much in the same way pain can refer from a "nerve
pinch". If one is unaware of these patterns, it is not surprising
that the true source of the pain remains an enigma. Some conditions
are better treated with epidural steroid injections, physical
therapy, chiropractic, or surgery. However it is clear that
prolonged treatment with any of the above, if not resulting in clear
progress, may be futile and an alternative should be sought.
If
you are told the "pain is in your head", and you can put a finger on
it, you should see a Prolotherapy specialist.
Do you treat muscle pain with Prolotherapy?
It is not appropriate with Prolotherapy to inject the muscle
bellies themselves, as one might have experienced with "trigger
point" injections. However, used to strengthen the attachments of
these same muscles where the tendons connect to the bones, this type
of pain is very treatable with much more permanent results.
Myofascial pain is frequently cured with this approach, unlike the
traditional and well-known practice of massage, trigger point
injection, spray and stretch, and similiar techniques. When these
techniques do not provide resolution of pain within 3-4 months, the
patient should strongly consider the more permanent and
cost-effective technique of Prolotherapy.
Does Prolotherapy involve steroid injections?
Not usually. Occasionally, the physician may try a steroid
injection first, as this is a mainstream, accepted approach for
these types of injuries. If this is not curative with 1-2 efforts,
then repeat steroid injections are unlikely to resolve the problem
and Prolotherapy is a safer, more permanent solution. Steroid
injections are well known to have complications, usually mild but
occasionally significant, and repeating them unnecessarily increases
the risk. Each steroid injection weakens the underlying connective
tissue, and may result in a need for additional Prolotherapy
injections to regain any lost ground from steroid injections. Even
if a steroid injection provides temporary benefit, which is usual
for 3 days to 2-3 weeks, the typical recurrence of pain when the
steroid "wears off" often occurs.
Are headaches treatable with Prolotherapy?
Definitely, with a typical 80% or better success rate. The
muscular attachments of the neck muscles on the base of the skull
frequently become torn from injury, and can lead to dizziness,
nausea, headaches, eye and ear pain, TMJ pain and facial pain. These
attachments are strengthened with Prolotherapy, and the pain and
symptoms resolve accordingly. If you experience frequent headaches,
even if you are told you have "migraine" headaches, or
"post-concussive headache" from head injury, you should consider
seeing a specialist in Prolotherapy.
How does Prolotherapy Treat TMJ and other joint
problems?
It is interesting to note that Prolotherapy (then called
Sclerosing Therapy) was the treatment of choice for TMJ dysfunction
60-80 years ago. It was actually fairly successful and still is.
With the advent of surgical approaches, many of which have been
discontinued because of poor outcome, many oral surgeons are no
longer educated in the technique. Prolotherapy is a safe,
conservative, and cost-effective TMJ treatment, resulting in reduced
joint popping and clicking, improved gliding, and improved opening
of the jaw, because of the greater stability and reduced "play" in
the joint. It works similarly on many other joints of the body,
including knees, hips, and hand and wrist joints.
Does Prolotherapy treat foot and ankle pain?
Many foot and ankle problems are treated and resolved with
Prolotherapy. The most common and notable are Plantar Fasciitis,
Morton's Neuroma, bunions, and chronic ankle sprains. Each of these
involves stretching of ligaments and joint capsules, which respond
quite well to Prolotherapy. If steroid injections do not provide
long-term relief for these, you should consider Prolotherapy. You
certainly can bypass steroid injections and surgery; treatment with
Prolotherapy can and usually does achieve a great deal of success.
How can I test myself to see if Prolotherapy could
help me?
The signature finding is pain you can put a finger on.
This may be at the top of the neck or the base of the skull for
headache pain, the top of the shoulder, the inner and outer elbow,
the sides of the knee, or the groove between the inner edge of your
hip bone and your tailbone (the Sacroiliac joint), or a number of
common places where these tissue injuries occur. If you can
precisely point to your source of pain, there is an excellent chance
that Prolotherapy will resolve or at least greatly improve it.
So Prolotherapy is a cure for everything?
Of course not. Many diseases and illnesses are not resolvable
with Prolotherapy. Pain can originate in many tissues, and a
complete, thorough examination is absolutely essential. The
physician who practices Prolotherapy is usually one who has a great
deal of experience with the treatment of musculoskeletal disorders,
and should also examine and test the patient for other causes of
pain using appropriate studies, lab tests and other manner of
testing to ensure your condition is correctly managed. At times,
consultation with a surgical specialist, a gynecology specialist, a
gastrointestinal specialist, etc. may be necessary to ensure that
your evaluation is complete.
Will Prolotherapy improve my loose joints?
Prolotherapy has been shown to increase the ligaments around
joints by approximately 30-40% in strength and mass. This can
remarkably improve torn ankle, knee and other ligaments. Even if
there is minimal pain with some of these injuries, the weakness can
ultimately tear further and create greater dysfunction. Many
athletes utilize Prolotherapy to strengthen their weak ligamentous
tissue to reduce the risk of tears and injury. Prolotherapy is
the only clinically proven method of regenerating and repairing torn
cartilage inside joints.
Does Prolotherapy treat Fibromyalgia?
A well done study in the literature showed that approximately
two-thirds of Fibromyalgia patients treated with Prolotherapy 1 year
later stated that it was the best treatment they had ever received
for their pain. Fibromyalgia is a complex, painful syndrome that
is poorly understood. Patients usually note sleep deficit, fatigue,
depression, anxiety, bowel problems, and diffuse pain, along with
other concerns. The cause is not yet known, and it is likely that
there are a number of different causes that produce a patient with
the symptoms and signs of Fibromyalgia. There is evidence suggesting
poor healing, and one theory is that small "micro-injuries" of the
fibrous tissues simply never heal satisfactorily, possibly because
of an as yet undiagnosed hormonal deficit, such as Growth Hormone,
Testosterone, Estrogen, Progesterone, Thyroid, or adrenal gland.
Although Prolotherapy may not treat the underlying cause of
Fibromyalgia, the tender points of this syndrome are frequently
improved.
How many visits are necessary, and how frequent are
they scheduled?
Most conditions are treated with 4-8 visits, but may take more.
The timing of the visits varies from weekly to every 4-6 weeks or
more. Rarely, 10-15 visits may be required as long as progress is
being made.
How long does it take to know if I will be improved or
cured with Prolotherapy?
Patients occasionally experience a great deal of relief after
their first injection; most, however, note improvement after 3-4
injections, with the duration of treatment then determined by the
rate of progress. Studies suggest a success rate ("greater than 50%
improvement in pain level") of 80-90%.
Is Prolotherapy expensive?
Compared to many treatments that are much less permanent and
carry greater risk, it is very cost-effective. A typical
treatment costs $125-500, depending on the number of body regions
and time involved. The total cast of a course of treatment may
easily be less than the cost of a MRI scan and a series of X-rays.
Insurance companies, in general, including Medicare, are slow to
realize the tremendous gain in cost-effectiveness that Prolotherapy
offers them. Many practitioners of Prolotherapy thus must charge
their patients on a cash / fee-for-service basis, until the insurers
understand the obvious benefits and cover the treatment in time.
Are there any restrictions following injection?
Most practitioners recommend careful resumption of activity as
tolerated. This can include normal exercise routines, walking,
sports, and other activities. Physical therapy, massage,
chiropractic and other treatment does not usually need to be stopped
and may in fact assist with the overall process.
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