Prolotherapy 3

State of the Art Prolotherapy Theatre

Prolotherapy 1

Sclerosant Injections to Ligaments

Prolotherapy 2

Reduces the Risk of Recurring Back Pain

Prolotherapy 4

Neural Prolotherapy

Prolotherapy Research

Authors
Dr Simon Petrides MB BS DM-SMed DO Dip Sports Med FFSEM (UK & I)
Dr John Tanner BSc MB BS FFSEM D M-S M DSMSA
Dr. Keith Bush MB BS MD (Lond) FFSEM(UK)

Introduction to Prolotherapy


Prolotherapy
has become an accepted intervention for a variety of musculoskeletal complaints, including back pain despite its controversial 60 year history and failure so far to enter mainstream practice. This is not because of the lack of research or reasonable proof of its safety and efficacy but more likely due to its development outside the NHS since the profession of Musculoskeletal Medicine is not widespread as a career pathway within the current NHS system.

Prolotherapy for back or neck pain consists of a series of injections of an irritant, usually a dextrose based compound, into the supporting intervertebral ligaments. The injection has an osmotic and chemical irritant effect and has been shown to stimulate a controlled inflammatory response. This in turn causes a release of growth factors, which stimulate a fibroblastic response resulting in thickening and augmentation of connective tissue and collagen fibres. The proven increase in tensile strength gives rise to a more stable and therefore less painful intervertebral segment, or joint.

The indication for spinal prolotherapy is for subacute/chronic/recurrent spinal/pelvic axial or referred pain. Clinical (not just radiological) instability can respond well to prolotherapy. The relevant diagnoses are numerous and diverse but centre on cases where the natural healing or spinal support mechanisms are inadequate. However it may help prevent progress to more chronic problems and may also help avoid progress to fusion surgery.

Research shows that best results for back pain are when the course of injections is accompanied by active rehabilitation and advice on self management. In those patients for whom the technique is successful, there is usually a period of greatly reduced pain and infrequent or rare attacks of back pain for several years. Pain relief should be accompanied by steadily increasing levels of activities. Some patients, especially those with back pain, may require a further course if there is a prolonged relapse. Most practitioners would agree that pain relief can last for at least 5 years.