Prolotherapy for low back pain

Prolotherapy: an alternative low back pain treatment

Recent surveys have concluded that over half the adults with low back pain or neck pain in the U.S. use complementary or alternative medicine (CAM) to treat their pain. These treatments include massage therapy, chiropractic, herbs, nutritional supplements, acupuncture and prolotherapy.¹ The latter, prolotherapy, (also known as proliferative therapy, regenerative injection therapy, or ligament sclerosant therapy) is practiced by hundreds of physicians in the U.S. as a treatment for low back pain.

Although it has been used to treat spinal conditions for over 60 years, there are still doubts about the efficacy of prolotherapy and people are still debating whether it actually helps low back pain. As with many other treatments commonly used for low back pain, including epidural steroid injections and trigger point injections, researchers cannot offer a clear answer about prolotherapy and its use remains somewhat controversial. This article summarizes previous research studies that have been published about prolotherapy so that patients can compare it to other treatments they may be considering for their low back pain.

Prolotherapy is used to treat a range of conditions under varied protocols

At its most basic, prolotherapy involves injecting a solution in or around a painful joint to provoke a biological response that results in the proliferation of new cells. The type of response that prolotherapy tries to provoke is a controlled, local inflammatory reaction. The theory behind prolotherapy is that the new cells will strengthen weakened ligaments, tendons, or other connectives tissues, and that this repair process will eventually lead to a stronger joint and less pain. Ingredients in the solution injected may also give short or long-term pain relief by affecting nerve fibers near the injection.

Prolotherapy has been used to treat all areas of the spine that are prone to ligament damage, including the following conditions:

• Low back pain

• Neck pain (including whiplash)

• Thoracic/upper back pain

The specific clinical diagnoses treated with prolotherapy include low back pain due to ligament laxity, degenerative disc disease, sacroiliac joint disorder, sciatica, and non-specific low back pain.

The practice of prolotherapy is not standardized and there are several important differences in how it is practiced by different physicians. Among the differences reported in various research studies are:

• Type of sclerosing solutions injected. Over 20 types of solutions are used in prolotherapy. The most frequent injection is called P2G, and is composed of dextrose, glycerin and phenol, usually administered with a local anesthetic such as lidocaine.²

• Quantity/Number of injections. The number of injections given for low back pain can vary from one to ten, with six being about average. The quantity of the solution injected during each treatment also varies greatly from one mL to 30 mL.

• Location of injections. Some studies reported that practitioners make dozens of injections throughout the low back area, while others attempt to reach all of the affected areas from only two injection sites.

• Treatment intervals. Injections are usually given weekly, but at times the interval can lengthen to bi-weekly or even monthly.

• Adjunct therapies undertaken. Practitioners often prescribe stretching exercises after prolotherapy to help new tissues grow correctly, spinal manipulation to help mobility near the injection site, or physical therapy to strengthen the muscles. Nutritional supplements and pain relievers are also used with prolotherapy.

Because of these different techniques and the lack of standardized protocols, a comprehensive, objective evaluation of the effects of prolotherapy on low back pain is somewhat difficult. However, research in this area is growing and the results of previous studies on prolotherapy for low back pain can now be summarized, allowing patients to have an informed discussion with their physician if they are contemplating prolotherapy

References:

1. Wolsko, PM, et al. Patterns and perceptions of care for treatments of back and neck pain: results of a national survey. Spine. 2003; 28:292-8.

2. The author notes that the only sclerosing agent currently approved by the FDA is Sotradecol (sodium tetradecyl sulfate) for use in treating varicose veins.

By: Simon Dagenais, DC, PhD
January 30, 2007