Prolotherapy

THE HEALING POWERS OF PROLOTHERAPY

By Vladimir Djuric, M.D.

My rather shocking introduction to prolotherapy was during a fellowship in New Orleans in 1994. Dr. Doyle was a septuagenarian solo practitioner with flair. If her high-pitched voice, Irish accent and up-tempo pace were not enough to get your attention, her style of medicine certainly would. She was the person to see for a variety of chronic painful conditions and prolotherapy was her secret weapon. Although she had mentioned the term on several occasions, the reality of it failed to register until I actually observed the procedure myself. The patient on the other side of the needle was both eager and apprehensive. I soon discovered why. Prolotherapy is not for the faint-hearted.

The term "prolotherapy" was coined by George S. Hackett, an industrial surgeon practicing in Canton, Ohio in the 40’s, 50’s and 60’s. Prolo is short for proliferate; ergo: proliferant therapy or prolotherapy. The treatment involves injection of a pro-inflammatory solution into damaged ligaments and tendons; the connective tissue usually injured during trauma or repetitive motion. This induced inflammation stimulates fibroblast proliferation and collagen synthesis. Collagen, being the chief building block of connective tissue, is necessary for any tissue repair to occur. The goal of the treatment is to stimulate the body to repair itself. Since inflammation is the first step in the healing cascade, injection of an irritant solution gets the process started. An injury-repair sequence is triggered in which the end product is stronger ligaments and tendons and tighter joints.

Various forms of this treatment have been in existence for centuries. Stronger "sclerosing" solutions have been used to treat everything from hernias to varicose veins. What distinguishes prolotherapy are it’s relatively mild sclerosing properties and its multitude of applications. It is an effective treatment for everything from tension headaches and TMJ syndrome to ankle sprains and heel spurs. The most popular solution currently in use is dextrose (sugar water) mixed with local anesthetic. The injections are usually performed at 2-6 weeks intervals with the idea that a cumulative effect will ultimately be achieved. Each simulated "injury" will lead to additional collagen synthesis, thus stronger, tougher ligaments and tendons. Typically 4-6 such treatments are necessary. Both human and animal studies have confirmed that up to a 40% increase in tissue size and strength can be achieved with the injections. Stronger ligaments and tendons lead to less joint irritation and hence less pain. Good clinical research in the form of double-blind clinical trials (neither the patient nor physician administering the treatment knows what is being injected) further supports this as a viable treatment for chronic back pain.

Dr. Doyle’s patients came from throughout the Golf Coast seeking the healing powers of prolotherapy. They were eager to find "the cure"; a solution to their many problems. My initial apprehension and doubt soon turned into curiosity and wonder. To my amazement even some of the patients who I would have considered hopeless cases actually benefited, at least to some extent, from the treatment.

I was eager to find out more. After attending a meeting of the American Association of Orthopedic Medicine, a medical society which promotes prolotherapy, I was hooked. At the completion of my training, I was hired by Dr. Doyle as her associate; a sort of protégé. Soon, I was practicing prolotherapy myself. My desire to be closer to family and friends prompted me to move back to Northeastern Ohio, the birthplace of prolotherapy. To my surprise, very few people here had even heard of the term. Alas, the circle had been completed. Prolotherapy was back where it had started.

My experience with prolotherapy has been everything from miraculous to disappointing. After five years and many hundreds of patients, I have learned to temper my enthusiasm. I have found it to be a very valuable tool when used in the appropriate circumstances. An ongoing clinical trial currently underway will be a more objective measure of my personal success rate with this unique treatment for pain. For the many patients whose lives have been improved by prolotherapy, this will be irrelevant. They are living proof of its amazing healing properties.