Prolotherapy (Regenerative Injection Therapy) in Chronic Pain – A review of the Literature and Clinical Experience Robert Banner MD, CCFP, FRCP, Beverley Padfield PT, FCAMT, Cathy Rohfritsch RN Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada Background The use of prolotherapy or regenerative injection therapy to treat chronic musculoskeletal pain related to connective tissue pathology is largely unknown in conventional medicine but is used by a small group of allopathic and osteopathic physicians. It is important for those who look to treat pain to be aware of alternative or complementary therapies. Such treatments require scrutiny and scientific evaluation before being accepted and or recommended for patients with chronic musculoskeletal pain References: 1. Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to treatment of chronic low back pain. Lancet 1987;18: Reeves Kd. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Ther health Med 200;6(2):68-74, Dechow E, Davies RK, Carr AJ, et al. A randomized, double-blind, placebo controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology 1999:38: Klein RG, Dorman TA, Johnson CE. Proliferant injection for low back pain: histologic changes of injected ligaments and objective measurements of lumbar spine mobility before and after treatment. J Neurol Orthop Med Surg 1989;10: Klein RG, Eck BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 1993;6: Hackett GS, Hemwall GA, Montgomery GA. Ligament and tendon relaxation treated by Prolotherapy. Oak Park, Illinois. Modern prolotherapy evolved from an injection technique called sclerotherapy, first used in the 1920’s to treat hernias and hemorrhoids. In the 1940’s Earl Gedney, a well-known osteopath at the Philadelphia College of Osteopathic Medicine began to use sclerotherapy for back-related ailments. It was George Hackett a physician from Canton, Ohio who first coined the term “prolotherapy” in the 1950’s. His book “Ligament and Tendon Relaxation Treated by Prolotherapy” continues to be used as a training reference. A new textbook will soon be published by Tom Ravin MD, Mark Cantieri DO and George Pasquarello DO. Proponents of regenerative injection therapy propose that when ligaments and tendons are stretched, torn or fragmented, joints become painful. Prolotherapy has the ability to address the cause of instability and repair the weakened sites, resulting in permanent stabilization of the joint. When precisely injected into the site of pain or injury, prolotherapy creates a controlled inflammation that stimulates the body to lay down new tendon or ligament fibers resulting in a strengthening of the weakened structure. When the joint becomes stronger, nerves are no longer “stretched” and pain may be relieved. Prolotherapy has been observed to increase the size of tendons and ligaments by up to 40% and increase their tensile strength by 200%. The tissue formed is healthy, strong flexible ligament or tendon. For the past 18 months, prolotherapy has been offered in the outpatient clinic setting of the multidisciplinary pain clinic of the University of Western Ontario, London, Ontario, Canada. History and clinical assessment by the first two authors determine the appropriateness of RIT. Of the patients seen to date, approximately 50% have been discharged from the clinic with improved function and less pain. Therapy consists of prolotherapy injections with appropriate manual orthopedic physical therapy and medications when necessary. History of Prolotherapy A complementary therapy such as prolotherapy or regenerative injection therapy may be useful for some chronic pain patients. Future research should consider collection of outcomes after standardized treatment to develop criteria for who would be appropriate for this therapy. Such exploratory cohort studies would then require further testing to determine the validity of these findings. What factors indicate a high chance of success with prolotherapy and the most appropriate treatment approach could be answered with a mixed model design. Future Conclusions Clinical Experience