Prolotherapy (Regenerative Medicine) and
Real Hope for Pain Sufferers
Real Hope for Pain Sufferers
K. Dean Reeves, M.D., F.A.A.P.M.&.R
Introductory information
Here you will find specific answers about how physicians use Prolotherapy to help pain sufferers feel better. The "Patients" and "Hope" tabs above provide summary explanations and the research that backs up our claims. There you will also find information primarily on prolotherapy with dextrose, and injection of PRP. In addition to dextrose and PRP injection, ozone injection is likely helpful, but ozone use has minimal research evidence thus far, and will not be emphasized. Stem cell use is likely the most powerful approach for benefit, but its cost effectiveness is uncertain at this point and for that reason its use will not be emphasized on this website. It is Dr. Reeves experience that full diagnosis and full treatment with a combination of dextrose and PRP injection about ligaments, tendons and injections (prolotherapy) and about nerves (perineural injection therapy and hydrodissection) offers the most effective, and cost-effective approach to the most difficult pain conditions.
Medical professionals interested in training opportunities may use the "Training" tab above under "More" for more direction
Medical professionals interested in training opportunities may use the "Training" tab above under "More" for more direction
What Can Prolotherapy Do For You?
For those who have suffered chronic pain and found only temporary benefit from other treatments, prolotherapy (injection to repair or regenerate ligament, tendon or cartilage) and Perineural Injection treatment (PIT) (injection to restore normal function in nerves which cause pain and degeneration) are options to directly treat common underlying causes of chronic pain.
Evidence for benefit from therapeutic injection of dextrose is considerable and increasing. This statement is based on the presence of level B or higher evidence of efficacy in multiple treatment areas. The research sections on this site review that.
For those who have suffered chronic pain and found only temporary benefit from other treatments, prolotherapy (injection to repair or regenerate ligament, tendon or cartilage) and Perineural Injection treatment (PIT) (injection to restore normal function in nerves which cause pain and degeneration) are options to directly treat common underlying causes of chronic pain.
Evidence for benefit from therapeutic injection of dextrose is considerable and increasing. This statement is based on the presence of level B or higher evidence of efficacy in multiple treatment areas. The research sections on this site review that.
Below is a video of a talk that summarizes Prolo and PIT and compares them for those who prefer audio. It is presented differently, so may be helpful in addition to the written summaries above.
Dextrose is the human form of glucose, is the only sugar that our brains can function on, and is the primary energy source for ATP which we learned about in our schooling. This short video explains visually what dextrose is.
A common question we hear is "dextrose is a simple sugar; how can it be helpful."Here are a set of short videos that explain the many things that injection of dextrose can do.
During injury, the ligaments that hold bones together and the tendons that hold muscles onto bone are weakened and repair incompletely (about 80% or so). Repeat injuries cause weakness increase to the point of starting pain. Unlike in diabetes where glucose is high in the circulation but not outside of ligament and tendon cells, in prolotherapy blood sugar is not affected but dextrose is elevated about the ligament and tendon cells. An important effect of dextrose injection is to cause new growth of ligament and tendon tissue. Dextrose cannot be brought into the cell without automatically turning on repair signals by the ligament or tendon cells (called fibroblasts). Providing dextrose in high concentration is similar to supplying fuel to a factory to allow it to begin production.
Note in these slides (A) means the primary information is from animal study, and (H) means the primary information is from human study.
Note in these slides (A) means the primary information is from animal study, and (H) means the primary information is from human study.
Patients often are told not to take arthritis (anti-inflammatory) medications when receiving prolotherapy, due to concern that it will prevent prolotherapy from working. That does not appear to correct. If you need to take them, we consider that ok, but the goal of course is to treat and resolve the original pain source, so as not to need them.
We often see patients that have sprains (ligaments) or strains (tendons) that have not completely healed and do not support or protect properly, and sometimes we see patients with inability to properly heal their ligaments and tendons. Looseness is problem in several ways. One is that nerves may be put under tension and cause pain through being stretched in weakened tendons. Another is that tissues that hold bones together, such as ligaments in the spine, support the spine and affect disc movement. If there is lack of support for bones, they respond by trying to self-stabilize by growing spurs (arthritis), or they move too much causing wear and tear such as with discs in the back (degenerative disc disease), or lose cartilage due to abnormal stresses on joints (arthritis). It is useful to note that the body appears to know the level of tension that is best, as it has not been reported that "over-tightening" occurs.
When a sprain or strain occurs, the tissue is both stretched and thinned. The goal of restoration is to both tighten and thicken the tissue. This describes how thickening was shown.
In the process of thickening and tightening tissue the result is to strengthen tissue back to a normal level. Here is an example of how that was shown.
Tissue that appears thicker than normal on ultrasound may not be stronger. Instead it may appear thicker due to an abnormal accumulatio of fluid (edema) without the structure. This is classically what one sees with plantar fascia problems in the feet. This video describes how that was use in a clinical study.
Immediately after injection, such as in the Achilles tendon, one might be concerned that there would be a weakening of the tendon that would predispose to rupture. An animal study has shown that is not likely. It is still wise to ease back into activity and to limit activity according to symptoms, but this study was reassuring that rupture of a weakened structure is not more likely soon after treatment.
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