Prolotherapy: A Controversial Remedy for Muscle and Ligament Pain

Prolotherapy, short for proliferation therapy is a controversial technique that involves a series of injections of an inactive irritant substance into a painful joint, or area where ligaments or tendons insert into bone.  The injected substance can be dextrose, phenol, saline solution, glycerol, lidocaine, or even cod liver oil extract.  Prolotherapy injections are intended to artificially initiate the natural healing process by causing an influx of fibroblasts that synthesize collagen at the injection site, leading to the formation of new ligament and tendon tissue.

Some of the signs that might benefit from prolotherapy include:

  • Joint laxity, such as in the shoulder, that does not resolve with standard treatment
  • Distinct tender points at tendons or ligaments as they attach to the bones
  • Unresolved, intermittent swelling or fullness involving a joint or muscle
  • Popping, clicking, grinding, or catching sensations in joints
  • Temporary benefit from chiropractic manipulation or manual mobilization
  • Aching or burning pain that is referred into an upper or lower extremity
  • Recurrent headache, face pain, jaw pain, ear pain
  • Chest wall pain with tenderness along the rib attachments on the spine or along the sternum
  • Spine pain that does not respond to surgery, or where there is no definitive diagnosis despite X-rays, MRIs and other tests.

So why is prolotherapy considered “controversial?”  Because, according to the federal government (Health Care Financing Administration) there is currently no strong, compelling study that proves prolotherapy can cure cases of soft tissue pain.  A “strong” study is one that has at least several hundred test subjects; has a control group (who get a placebo, or fake treatment) and is done in a “double-blind” methodology where the test subject and the administering doctor do not know if the injection is a prolotherapy agent (only a third member of the research study knows).  However, there are numerous studies in the literature using smaller test populations (less than a hundred) that support prolotherapy as an effective treatment for pain.

A 2005 study entitled A systematic review of prolotherapy for chronic musculoskeletal pain (Clin J Sport Med. 2005 Sep;15(5):376-80) analyzed major studies on prolotherapy and reached the following conclusion:

  • Two RCTs (randomized controlled trials) 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.

There is a research project at the University of Wisconsin involving prolotherapy to treat knee osteoarthritis that is due to publish its results soon.

So, if you have chronic musculoskeletal / joint pain, especially related to trauma, that has not resolved with cortisone injections, chiropractic, physical therapy, personal training, surgery, and time, prolotherapy may be worth investigating.  The good thing about it is that it is generally safe.

Depression Can Make Knee Pain Worse – Study

A recent study in The Journal of Bone and Joint Surgery showed that people who had mild to moderate knee osteoarthritis and were depressed rated their pain as severe, the level which others in the study who had x-ray documented advanced osteoarthritis reported.

I’ve always believed that there is a “mind-body” connection, and this is yet another study that supports this.  The thoughts that you allow to enter your mind can have a definite effect on your physiology, whether it be blood pressure, heart rate, respiration rate, digestion, strength, immune response, or pain.   Check out this cancer treatment center’s use of visual and music therapy to help with treatment.

Jon T. Giles, MD, an assistant professor of medicine at Columbia University and rheumatologist at New York Presbyterian Hospital in New York City, says this study adds further weight to the existing medical literature highlighting the effect of psychosocial issues on pain responses.

“Painful sensations are relayed through the brain in a very complex way, and can be modulated up or down,” he says. With stress, poor sleep, anxiety and depression, which are known to influence pain levels, “stimuli feel more painful than they would in someone without the adverse psychosocial factors. This probably explains in part why the largest effect of depression in the study was seen in those without much OA to see on X-rays.”

The study recommends that patients fitting this profile get psychiatric evaluation and treatment, including anti-depressant drugs, in order to help alleviate their pain.

The study does not outright say that only “clinical” depression can make pain worse.   If you have pain, persistent negative thoughts are more likely to make it appear worse than it actually is.  Remember, the perception of pain is a complex neurological pathway that is not entirely understood.

I can sympathize with those experiencing chronic pain– it can be a terrible cycle, where the pain itself can push the patient to negative thoughts and depression, embedding it further and further into the body’s central nervous system.  Speaking as a human being, and not just a health care provider, I can offer the following suggestions to break the cycle.  And I’m sure it’s not all new, but worth repeating here:

1.  Don’t hang around negative people.  Their negative energy will bring you down.  Instead, hang around those with “positive buoyancy,” the ones who can lift you up emotionally.  Most small children fit in this group.

2.  Similar to #1, avoid negative stimuli in your environment– crime shows, news, reality TV, newspaper headliners, internet news, etc.

3.  Find something to keep your mind occupied; something that requires active brain usage (not passive, like watching TV).   Social activities that involve interacting and working with other people is a good choice; especially if it is for a good cause.  Arts and crafts is another good choice.

4.  Get a pet.  There’s nothing like a dog who exhibits unconditional, total loyalty to you.

5.  Eat only those foods that nourish the body.  The nutrient dense foods that occur naturally; i.e. plants and animals are the best for a body experiencing pain:  fruits, green leaf plants, sardines, lean meat, nuts.  Definitely avoid cigarette smoke, alcohol, corn syrup, sugar, and food preservatives.

6.  Get out in the sun.  Take of your shirt, expose your trunk to the sun several times throughout the day.

7.  Stay active, as much as your pain will allow.  Tai chi and yoga are good if your body can’t handle the forces of running , jumping, and lifting weights.  Walking briskly is good, too.

8.  Get fresh air.  Drive to your nearest nature preserve, far enough away from the city and suburbs and get some negative ions (the only good, negative thing if you’re in pain!) and clean oxygen in your lungs.

 

Knee Pain, Roosters and Osteoarthritis?

Knee Pain, Roosters and Osteoarthritis?

Osteoarthritis occurs when the cartilage lining the articulating (contacting) surfaces of a joint gets damaged or wears out, exposing nerve endings inside and leading to inflammation.  Since a joint is a precision, biological mechanism the slightest change in any of its components will eventually lead to breakdown, much like car engine.

As the cartilage thins, bone on bone contact occurs.   Since bone is living tissue, it will respond to this irritation by forming osteophytes, better known as bone spurs.  The osteophytes compound the problem by disrupting proper joint movement and irritating surrounding ligaments.  And to make matters worse, the joint fluid, called synovial fluid gradually loses its ability to cushion the joint.  Synovial fluid to a joint is like motor oil to a car engine’s cylinder:  it enables “near frictionless” movement.   It forms a thin, lubricating buffer between the ends of the two bones that make up a joint; for example in the knee, the tibia (lower leg) and femur (upper leg).

The knee is perhaps the most common joint to experience osteoarthritis.  It is a large, primary weight bearing joint that takes a lot of punishment in the course of a day.  Basic activities like walking, running, going up stairs, stepping down from a curb, exercising, and sports really put the knees to task.  Those who have advanced osteoarthritis in the knees realize how important they are to a normal life.

I ran across this treatment for knee osteoarthritis that involves a single injection that can last for six months.  It is called Synvisc-One, and it’s made from the combs of roosters.  Apparently, the substance found in rooster combs is similar in biochemical make up to that of synovial fluid.   If you’ve ever pressed or bent a rooster’s comb, you can see why– it is soft, cushiony, and rebounds quickly to its original shape.

synvisc injection into the knee joint

The procedure is a relatively quick outpatient procedure.  After filling out the necessary forms to ensure you have no contraindications, especially any known allergies to birds, the doctor injects the Synvisc into your knee joint using a large caliber needle.  There, it occupies the capsular space just like motor oil occupies a car engine’s cylinder.  The substance cushions the knee joint surfaces (distal femur-proximal tibia articulation) and lubricates the space to minimize abrasion of these surfaces.

Synvisc is indicated for the treatment of pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen.  It can be an option for total knee replacement for some people.

The drawback is that you have to keep getting them.  But for those who have severe osteoarthritis in both knees and can’t afford or do not desire knee replacement surgery, six months of less pain is a pretty big deal.  As with all forms of treatment options, a lot of it is personal choice.  Not everyone’s situation is the same.

Check out our Self Treatment for Knee Pain video for non-drug, non-surgical therapies to manage osteoarthritis of the knee.

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