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It is not a secret that chronic musculoskeletal pain is the number one cause of chronic disability in North America. Nor is it a secret that chronic back pain is the leading cause of disability in Americans under the age of 45. What is a secret is that this rampaging epidemic of pain can conceivably be eliminated in 80-90% of sufferers. Prolotherapy, a treatment that relies on the body's own healing process to eliminate pain, is not among the traditionally accepted modes of pain therapy. The conventional and prevailing model of pain management relies on anti-inflammatory drugs cortisone injections, a course of therapies that has provided little in the way of comfort for chronic pain sufferers and whose long term use has been warned against by many medical organizations. In fact, many traditional pain specialists are discouraging the chronic use of drugs, as they may be detrimental to the patient by adding to depression, increasing pain, and producing other side effects such as gastrointestinal bleeding and ulcers. Surgery is often recommended when drugs and injections of cortisone or steroids fail.

What is Prolotherapy?
Prolotherapy is a regenerative injection therapy that treats the cause of the pain - not just the symptom.  Contrary to popular belief, damaged muscles are usually not the cause of joint pain.  Muscles simply move joints, whereas ligaments and tendons serve to stabilize the joints.  When these stabilizers are damaged, they can become loose and weak, causing muscle spasms, tightness, popping, clicking, soreness and general pain. Prolotherapy strengthens and tightens weak ligaments or tendons, thereby treating the CAUSE of the pain. No surgery, treatment or medicine can do what prolotherapy does.

Why Does Prolotherapy Work?

Developed in the 1940's by Dr. George Hackett, Prolotherapy stimulates the body to repair painful areas. Its effectiveness is wide-ranging and includes pain associated with: the back, the neck, all joints throughout the body, arthritis, migraines fibromyalgia, sciatica, herniated discs, and TMJ. Most neck, back and other musculoskeletal pain is due to weakness of ligaments and tendons. Since ligaments and tendons are the connective tissues that hold our muscles to bone, and bone to bone, both must be taut and strong. Prolotherapy involves the injection of an "irritant" solution into the area where the ligaments have either been weakened or damaged through injury. The injection is given at the point where the ligament connects to the bone. This causes the body to heal itself through the process of inflammation. When an irritant is introduced at the site of injury, the immune system is summoned to the area. The body begins a healing process exactly where the pain is located. New fibrous tissue is laid, repairing and strengthening the ligaments so that they can pull the vertebrae back where they belong and alleviate pain.

Prolotherapy treatment sessions are generally given every four to six weeks to allow time for the growth of the new connective tissue. Patients usually require four to six treatment sessions for complete recovery, some experience more immediate results.

Harold Wilkinson, M.D. professor and former chairman of the Division of Neurosurgery at the University of Massachusetts Medical Center, performed a 16-year Prolotherapy study culminating in 1995. In his report, Dr. Wilkinson claims it was noteworthy that "a sizeable portion of people with unresolved chronic pain had more than a years pain relief with only one Prolotherapy injection." While these results were obtained with a single injection, most Prolotherapy sessions involve multiple injections given in each session.

Standard medical and surgical procedures cannot match Prolotherapy’s 80-90% effectiveness in eliminating chronic pain, nor can standard medicine match the relative low cost of treatment. Prolotherapy treatments can range from $100-750, where a typical surgical procedure may cost up to ten times that amount!

Why is Prolotherapy Unknown?
The position taken by the American Association of Orthopaedic Medicine (AAOM), says that the teaching of Prolotherapy is suppressed in medical schools and residency training programs because there are organizations that have a vested interest in continuing traditional treatment methods (surgery and drug therapies). Prolotherapy has been shown to be equally effective at eliminating the pain of such conditions as arthritis, migraines, tension headaches, sports injuries, fibromyalgia, loose joints, TMJ Syndrome, tendinitis, sciatica, herniated discs and degenerated joints. More information written by Ross Hauser, M.D. can be obtained at www.caringmedical.com 

                                       
 
Another Prolotherapy Endorsement:
"Ten years ago I was skeptical regarding Prolotherapy...I had heard the testimonials and I had spoken to senior physicians. I thought it was professional mass confusion until I developed my own experience. I was surprised about positive and lasting results on selected patients. In my practice today, I routinely utilize Prolotherapy for management of mechanical lower back pain discomfort and various sports-related injuries. Prolotherapy is the only methodology I have ever utilized with limited risk yet potential for significant benefit.  Prolotherapy is a secret that needs to be discovered." Lloyd R. Saberski, M.D. Former Medical Director, Yale University School of Medicine, Center for Pain Management
 

The first year of medical school requires students to read a book titled Pathologic Basis of Disease, a section of chapter 3 is summarized for you below.  This is probably the most important day for medical school students, especially if they end up specializing in musculoskeletal medicine.

"The inflammatory response is closely intertwined with the process of repair.  Inflammation serves to destroy, dilute, or wall off the injurious agent, but in turn, sets into motion a series of events that, as far as possible, heal, and reconstitute the damaged tissue."
Robbins, Pathologic Basis Of Disease, 5th Edition.

Chapter 3, Inflammation and Repair

History of Prolotherapy:
Prolotherapy has undergone many changes over the centuries. Hippocrates, the father of modern medicine, used this technique in 500 BC to treat shoulder dislocations of Olympic javelin throwers and patients who had back pain. Prolotherapy made its return in 1937 with a paper written by Dr. Louis Schultz, who was both a dentist and a medical doctor. In his publication, Schultz researched temporomandibular joint (TMJ) syndrome and concluded that traditional treatments of rest, splints, physical therapy and surgery had only limited success. He pioneered the first modern day prolotherapy treatment.

In the 1940s, Dr. George Hackett conducted multiple studies and became a leading proponent for prolotherapy. Many of his studies were published in prestigious medical journals, bringing the benefits of prolotherapy into the mainstream. In a meeting of the American Medical Association in 1955, Dr. Hackett met the man who would become his apprentice and the leading practitioner of modern-day prolotherapy. This man, Dr. Gustav Hemwall, treated more than 10,000 patients worldwide. Through his years of research, Dr. Hemwall would refine the technique of prolotherapy with amazing results.  "More than 99% of his patients who completed treatment found long-term relief of their chronic pain."

Professionals in the medical field, despite the numerous studies available, have scrutinized this technique demonstrating its restorative powers. Former Surgeon General, C. Everett Koop, has been an advocate of prolotherapy since successfully undergoing treatment for his back and leg pain. Click Here to read former Surgeon General, C. Everett Koop's story!

The Mayo clinic has also begun to utilize regenerative injection therapy. The Mayo clinic wrote an article in the clinic's April 2005 Newsletter that recognized prolotherapy as a technique for chronic pain.  Below is a letter that Dr. Ross Hauser received from the medical editor of the Mayo Clinic Health Letter.
 
June 6, 2005

Ross Hauser, MD

Dear Dr Hauser:

Thank you kindly for your letter regarding our article on prolotherapy. As medical editor of the Mayo Clinic Health Letter I seek the input of our board and suggestions to provide a broad perspective on availability of therapies that may be of benefit to our patient population.

There are individuals at Mayo Clinic that do Prolotherapy both in our health system at Mayo Rochester and Mayo Jacksonville. I first learned of Prolotherapy through C. Everett Koop’s interest in the technique. This led me to further study to understand its potential value in treating patients with specific types of problems. Since chronic pain is such a substantial burden to our population I wanted to provide information on additional treatments that are gaining in prevalence and may be available to help them with these chronic conditions. That in a nutshell is the evolution of our article containing information on Prolotherapy. 

With respect,
Robert D. Sheeler, MD
Medical Editor
Mayo Clinic Health Letter

Prolotherapy is not yet recognized as a standard of care treatment by most insurance companies. Prolotherapy is not covered by any health insurance company but is covered by auto insurance and workmans' compensation. Currently, the "standard of care" for musculoskeletal injuries is anti-inflammatory medication, physical therapy,  cortisone or steroid injections and surgery. 

Who can benefit from Prolotherapy?

If you have back, neck or knee pain; osteoarthritis; degenerative disc disease; tendonitis; ligament tears; or want to avoid total joint replacement, prolotherapy can help.  Most chronic pain can be tracked back to ligament laxity in the body and only a well-trained physician using his/her hands during an physical exam can diagnose ligament laxity and the CAUSE of the pain.   If you currently suffer from chronic inflammation, prolotherapy can rid you of pain by healing the damaged area.  Chronic inflammation is harmful and is different than acute inflammation.  We use the regenerative effects of acute inflammation to heal your chronic pain. 

Images from Caring Medical in Chicago, IL

Images from Caring Medical in Chicago, IL