Prolotherapy and chronic back pain
Prolotherapy introduction
Prolotherapy is a
non-surgical injection procedure used to treat connective
tissue injuries of the musculoskeletal system that
have not healed by either rest or conservative therapy
in order to relieve back pain.
The injections promote a healing response in small
tears and weakened tissue, with the goal of alleviating
back pain and improving function. Prolotherapy is
also referred to as sclerosant therapy, sclerotherapy,
regenerative injection therapy, “proliferative” injection
therapy and nonsurgical ligament reconstruction.
Prolotherapy has been used in pain management and treatment
of numerous conditions, including back pain and neck
pain due to spine related conditions such as:
A theory behind prolotherapy is that back pain is
related to activation of pain receptors in tendon or
ligament tissues, which are sensitive to stretching,
pressure, etc. It is thought that the cause of back
pain is from ligamentous laxity.
With the prolotherapy procedure, the substance injected
into the soft tissue causes an inflammatory response
at the site, which in turn causes natural healing
to take place (formation or “proliferation” of
new blood vessels), with the goal of strengthening
the torn or injured soft tissue and reducing the back
pain.
While a history of the prolotherapy treatment approach
has been traced back to ancient times, it is not yet
widely practiced in the United States and many practitioners
consider it an alternative therapy.
Prolotherapy as a means of pain management
is not taught
in medical school or residency training programs.
There currently are few studies that show the effectiveness
of the prolotherapy procedure for allieviating back
pain. Patients considering prolotherapy for back pain
should ask their physician if he or she is trained
and experienced in the procedure.
Who does prolotherapy for back pain?
A physician who has specific training in prolotherapy
should perform the prolotherapy injection procedure.
Physicians (either M.D.s or D.O.s) who typically perform
prolotherapy for spine conditions include physiatrists,
anesthesiologists, orthopedic surgeons and neurosurgeons.
A number of organizations provide educational programs
and training on prolotherapy for doctors, including:
- American Association of Orthopaedic Medicine
- American Academy of Sclerotherapy
Other organizations that may be contacted about the
procedure and doctors who perform
prolotherapy for back pain
include:
- International Spinal Injection Society
- American Academy of Physical Medicine and Rehabilitation
What is known about prolotherapy outcomes for back
pain?
Reported success rates range from 80%-90% when
performed by a physician trained in the prolotherapy
procedure. Many of these reports are based on anecdotal
evidence from the physicians themselves. Studies have
not yet connected positive outcomes for back pain
and healing to prolotherapy.
The anecdotal reports suggest improvements such as:
- Reduction or elimination of back pain
- Increased strength of the ligament, tendon or joint
capsule
- Reduced recurrence of injury to the treated site
- Improved or return to normal function
Factors that may be key for a successful outcome include:
- Proper diagnosis of the location of the sprain or
strain
- Willingness of the patient to complete follow-up
therapy
- Clinical skill of the physician in performing the
injection
Finally, it is important to note that nobody knows
exactly what happens in prolotherapy. 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.
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