What is Prolotherapy?
Prolotherapy or Regenerative Injection Therapy, as it is also known, is a method of treating soft tissue injuries (tendons and ligaments).
How is Prolotherapy performed?
Prolotherapy involves injecting the painful and damaged area of soft tissue with a proliferant (“irritant”) solution. The theory behind this is that it initially causes an inflammatory type reaction to stimulate the body’s own immune system. Reparative cells are sent to heal the area by producing new collagen. This is believed to strengthen the area and also likely will lessen or eliminate pain.
Is this the same as a cortisone injection?
No. Cortisone injections are a synthetic corticosteroid that are injected in the joints or areas of soft tissue to reduce pain and inflammation. While cortisone injections in limited amounts can be helpful, they do not alter the underlying cause (disease process) and therefore often have to be repeated. There are many documented risks of having “too much cortisone” and suppression of the immune system.
Prolotherapy on the other hand is used to treat the disease process utilizing the body’s own natural growth factors and inflammatory modulators. It is an alternative to cortisone injections. With Prolotherapy, the overall risks are much less.
What musculoskeletal conditions can be treated with Prolotherapy?
Neck and back pain, trigger points, whip-lash injuries, sacroiliac pain, shoulder pain, rotator cuff injuries, knee pain, tennis elbow, golfers elbow, chronic ankle pain, Achilles tendonitis, carpal tunnel syndrome, hip bursitis.
How do I know if I am a candidate for Prolotherapy?
A consultation is required before any treatment may take place. The consultation includes a comprehensive review of your complaints, medical history and a thorough examination will be conducted.
Diagnostic studies will be reviewed and/or ordered at the time of the consultation to determine the cause of your complaint(s). Once a diagnosis is established, Dr. Shim will discuss treatment options with you including if you are a candidate for Prolotherapy. Prolotherapy is often just one element of a comprehensive treatment program.
Is Prolotherapy painful?
While everyone’s pain tolerances vary, patient’s report a range of discomfort from mild to moderate with Prolotherapy injections. Small needles are used and in some cases a skin refrigerant may be used to “numb” the skin.
How many injections will I need?
This is no universal answer to this question. Much of this depends on the chronicity and location of your problem. Some patients can successfully be treated with one injection while others require multiple injections over a time period to eliminate or reduce pain to an acceptable level.
How long does Prolotherapy take to perform?
Depending on the number of areas being treated, most procedures will be completed in 15 to 30 minutes.
How do I know if Prolotherapy has helped me?
The answer to this is simple. Prolotherapy does not “mask” your pain and other symptoms like pain medication. If Prolotherapy has helped you, you will notice a difference in your overall pain level and function. Many patients will see an increase in overall pain levels initially, but as the healing process occurs, symptoms are expected to resolve gradually over the course of 4 to 6 weeks on average. For some patients, repeat treatments may be needed.
How long does the effect from Prolotherapy last?
This is different for everyone. Much depends on the underlying disease process and whether there have been a recurrent injury to the affected area. It is impossible to predict if and when further treatments will be needed for a specific condition. In some cases, patients do come back months or years later for repeat Prolotherapy injections.
Is Prolotherapy experimental?
Some insurance carriers deem Prolotherapy as investigational as there has not been enough large studies of Prolotherapy conducted. Again, Prolotherapy has been around for over 60 years and many have been safely and successfully treated with this procedure.
Several large national medical organizations including the American Osteopathic Association do not consider Prolotherapy as experimental as it is a recognized specialty and is taught at post graduate programs for the healing arts. Furthermore, there are numerous Level I and II studies attesting to the safety and efficacy of use.
Why is Prolotherapy not covered by my health insurance plan?
As above, most insurance carriers deem Prolotherapy as investigational since there is not a significant amount of large, well-controlled published studies in the medical literature. Many patients find the out of pocket cost well worth the investment in trying to reduce pain and disability.
What are the possible side effects?
As with any type of injection, there is a small risk of infection, injury to blood vessels and risk of bleeding. While not truly considered a side effect, many patients will experience increased pain or discomfort for a temporary period following the treatment. If you have been ill or running fever, it is advisable to discuss this with the physician before considering this type of treatment.
Can I be allergic to the solutions injected?
Dextrose is a naturally occurring sugar found in plants and animals. Although extremely unlikely, it is possible that your immune system might not recognize dextrose and create antibodies to fight it as a foreign invader. This can cause a reaction.
What is the success rate of Prolotherapy?
Taken directly from the published literature on Prolotherapy including randomized controlled trials and case series that included over 2440 patients, better than 80% of patients appropriately treated with Prolotherapy reported greater than a 50% reduction in pain level. No one can guarantee 100% success.
What are the costs of Prolotherapy?
An initial consultation is required to determine if you are a candidate for Prolotherapy. Within our practice, we offer patients several options:
- Consultation with John Shim, M.D, Orthopaedic Spine Surgeon
- Please call the office to inquire about consultation and injection charges.
I have already had treatment for my condition but want to consider Prolotherapy. How do I obtain more information and schedule an appointment?
Please call our Westchase Office at (813) 814-9251 to schedule. We also encourage you to thoroughly review this website as the information contained within will answer most questions. We can offer you a timely and convenient appointment for your consultation. Based on prior treatment and work-ups you have had done already, in many cases, we can offer the Prolotherapy procedure the same day.
If Prolotherapy is so great then why have I not heard about it before?
As previously mentioned, the techniques behind Prolotherapy have been around since the 1950’s. Prolotherapy is not something that is commonly taught as a part of a standard medical school curriculum. As the treatment for many diseases and disorders continues to evolve, we continue to expand on traditional treatments in search of ones that are more efficacious and safe. Most people are looking for the newest and high-end technology to treat their problem. However, relatively simple treatments are often discounted or overlooked. Prolotherapy relies on a simple solution of dextrose (sugar water) mixed with a local anesthetic and the body’s own healing mechanisms to treat disease.
What can I do after having Prolotherapy? Activity levels?
It is recommended that you drink plenty of fluids following your treatment. Your physician will advise you to limit strenuous activity such as working-out for a certain period. You should also avoid the use of anti-inflammatory medications (Ex: Advil, Motrin, Aleve, etc.) for the prescribed period of time. These medications inhibit the body’s ability to heal. It is important that you also complete follow-up visits so that the physician can evaluate your progress. Skipping appointments and waiting too long may compromise the effect of future treatments. Specific instructions will be provided at the time of your treatment. A structured rehabilitation program will often be included with Prolotherapy injections.
I keep hearing about 'stem cells'. What is the difference between Prolotherapy and Stem Cells?
The other treatment available is Platelet Rich Plasma (PRP) or stem cells as many refer to it as. This involves drawing blood from the patient’s arm, spinning it in a centrifuge and re-injecting it into the affected area. The concentrated platelets are full of growth factors that can enhance recovery.
Both treatments fall under the category of Regenerative Medicine. Both treatments have been shown to be safe and efficacious in the medical literature. Both Prolotherapy and PRP studies lack large well controlled studies to define how much a patient needs, concentrations, and duration of treatment. Many treatment protocols have been developed based on experience of the physician who performs the procedure. Lastly, neither Prolotherapy or PRP injections are covered by most major insurers. PRP is significantly more costly to the patient due to the supplies needed.