Prolotherapy and chronic back pain

Prolotherapy introduction

Prolotherapy is a non-surgical injection procedure used to treat connective tissue injuries of the musculoskeletal system that have not healed by either rest or conservative therapy in order to relieve back pain. The injections promote a healing response in small tears and weakened tissue, with the goal of alleviating back pain and improving function. Prolotherapy is also referred to as sclerosant therapy, sclerotherapy, regenerative injection therapy, “proliferative” injection therapy and nonsurgical ligament reconstruction.

Prolotherapy has been used in pain management and treatment of numerous conditions, including back pain and neck pain due to spine related conditions such as:

• Degenerative disc disease

• Sacroiliac problems

• Sciatica

• Whiplash

A theory behind prolotherapy is that back pain is related to activation of pain receptors in tendon or ligament tissues, which are sensitive to stretching, pressure, etc. It is thought that the cause of back pain is from ligamentous laxity.

With the prolotherapy procedure, the substance injected into the soft tissue causes an inflammatory response at the site, which in turn causes natural healing to take place (formation or “proliferation” of new blood vessels), with the goal of strengthening the torn or injured soft tissue and reducing the back pain.

While a history of the prolotherapy treatment approach has been traced back to ancient times, it is not yet widely practiced in the United States and many practitioners consider it an alternative therapy. Prolotherapy as a means of pain management is not taught in medical school or residency training programs.

There currently are few studies that show the effectiveness of the prolotherapy procedure for allieviating back pain. Patients considering prolotherapy for back pain should ask their physician if he or she is trained and experienced in the procedure.

Who does prolotherapy for back pain?

A physician who has specific training in prolotherapy should perform the prolotherapy injection procedure. Physicians (either M.D.s or D.O.s) who typically perform prolotherapy for spine conditions include physiatrists, anesthesiologists, orthopedic surgeons and neurosurgeons.

A number of organizations provide educational programs and training on prolotherapy for doctors, including:

• American Association of Orthopaedic Medicine

• American Academy of Sclerotherapy

Other organizations that may be contacted about the procedure and doctors who perform prolotherapy for back pain include:

• International Spinal Injection Society

• American Academy of Physical Medicine and Rehabilitation
  

What is known about prolotherapy outcomes for back pain?

Reported success rates range from 80%-90% when performed by a physician trained in the prolotherapy procedure. Many of these reports are based on anecdotal evidence from the physicians themselves. Studies have not yet connected positive outcomes for back pain and healing to prolotherapy.

The anecdotal reports suggest improvements such as:

• Reduction or elimination of back pain

• Increased strength of the ligament, tendon or joint capsule

• Reduced recurrence of injury to the treated site

• Improved or return to normal function

Factors that may be key for a successful outcome include:

• Proper diagnosis of the location of the sprain or strain

• Willingness of the patient to complete follow-up therapy

• Clinical skill of the physician in performing the injection

Finally, it is important to note that nobody knows exactly what happens in prolotherapy. There is no objective medical evidence, and no histology has been published as to what goes on when injection is placed into the painful soft tissues.

By: Vert Mooney, MD and Bjorn Eek, MD
January 25, 2000