Thoughts on Prolotherapy?

[bluedawg12]

A little carbolic acid injected in the tissues makes the pain go away?

http://www.prolotherapy.org/

Prolotherapy

Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance.

That's all the body needs, the rest it can take care of on it's own.

A substance is injected into the affected ligaments or tendons, which leads to local inflammation. The shrinking collagen tightens the ligament that was injected and makes it stronger.

Prolotherapy has the potential of being 100 percent effective at eliminating and chronic pain due to ligament and tendon weakness, but depends upon the technique of the individual Prolotherapist.

The most important aspect is injecting enough of the solution into the injured and weakened area. If this is done, the likelihood of success is excellent.

The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue, up to 40% stronger in some cases!

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http://en.wikipedia.org/wiki/Prolotherapy

Prolotherapy involves the injection of an irritant solution into the area where connective tissue has been weakened or damaged through injury or strain. Many solutions are used, including Dextrose, Lidocaine, Phenol**, Glycerine, or Cod Liver Oil extract. The injection is given into joint capsules or where tendon connects to bones.

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http://www.mayoclinic.com/health/prolotherapy/AN01330
A review of five well-designed studies involving 366 participants concluded that prolotherapy alone was ineffective in treating chronic low back pain. However, when combined with other treatments — such as spinal manipulation and exercise — prolotherapy may improve chronic low back pain.

A typical course of prolotherapy treatment is six to 10 sessions, sometimes with multiple injections at each session.

More research is needed to clarify what role, if any, prolotherapy plays in the treatment of chronic low back pain.

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Wiki mis-statements:

“As of April 2005, doctors at the Mayo Clinic began supporting prolotherapy. Robert D. Sheeler, MD (Medical Editor, Mayo Clinic Health letter) first learned of prolotherapy through C. Everett Koop’s interest in the treatment. Mayo Clinic doctors list the areas that are most likely to benefit from prolotherapy treatment: ankles, knees, elbows, and sacroiliac joint in the low back. They report that "unlike corticosteroid injections — which may provide temporary relief — prolotherapy involves improving the injected tissue by stimulating tissue growth."

See what a Mayo physician says in the above section. More research is needed.

“Prolotherapy is often used as an alternative to invasive arthroscopic surgery. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in July 2002 and concluded that the group that received actual arthroscopic surgery did not report better function or pain than the placebo group.<2> Arthroscopic surgery of the knee is performed for the indication of osteoarthritis, but rather for mechanical tears or disruptions of cartilaginous tissue. Doctors and surgeons have given anecdotal accounts of successful prolotherapy treatment for knee injuries, shoulder separation, and typical injuries to golfers.”

Often used as an alternative for arthroscopic surgery by prolotherapi$t$ !!!

Here is a clever bit of misdirection. In the summer of 2002 a NEJM article showed that arthroscopy for osteoarthritis of the knee provides only short term relief, not worth the risk and cost. Cool! Standard of Care (SOC).

Now watch them prolo piggyback onto the ascope NEJM story creating a little misdirection if one does not read carefully.

Prolotherapy is often used as an alternative to invasive arthroscopic surgery. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in July 2002 and concluded that the group that received actual arthroscopic surgery did not report better function or pain than the placebo group.

Exactly, we have known this for seven years, we have stopped scoping people for DJD alone, and the NEJM article had nothing to do with prolo!

Plantar Fasciitis
Sonographically guided dextrose injections showed a good clinical response in patients with chronic plantar fasciitis insofar as reducing pain during rest and activity. Further studies including a control group are needed to validate these outcomes.

Horse and pony show, if you need to use a sonogram to find the fracking plantar fascia please inject phenol into self!

Doctors and surgeons have given anecdotal accounts of successful prolotherapy treatment for knee injuries, shoulder separation, and typical injuries to golfers.”

Anecdotals aren’t worth the toilet paper they are published on.


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Of course the idiot media has weighed in with a breathless title like:
"Injections to Kick-Start Tissue Repair". New York Times. 2007-08-07. http://www.nytimes.com/2007/08/07/health/07brod.html. Retrieved on 2008-07-24.

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What about this claim in wikipedia prolotherapy section:

More recently, Rabago et al. noted: "Two on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy."

Increased joint cartilage thickness?! Wow. That’s awesome. Yippee!

Clin J Sport Med. 2005 Sep;15(5):376-80.
A systematic review of prolotherapy for chronic musculoskeletal pain.Rabago D, Best TM, Beamsley M, Patterson J.
University of Wisconsin-Madison, Madison, WI 53715, USA.

OBJECTIVE: Prolotherapy, an injection-based treatment of chronic musculoskeletal pain, has grown in popularity and has received significant recent attention. The objective of this review is to determine the effectiveness of prolotherapy for treatment of chronic musculoskeletal pain. DATA SOURCES: We searched Medline, PreMedline, Embase, CINAHL, and Allied and Complementary Medicine with search strategies using all current and historical names for prolotherapy and injectants. Reference sections of included articles were scanned, and content area specialists were consulted. STUDY SELECTION: All published studies involving human subjects and assessing prolotherapy were included. MAIN RESULTS: Data from 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations. CONCLUSIONS: There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandomized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with noninjection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy.

Boo-hiss!

“However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations. ”

** Phenol: Phenol, also known as carbolic acid, is a toxic, white crystalline solid with a sweet tarry odor, commonly referred to as a "hospital smell" -wiki

[bluedawg12]

1. "...to carry out this type of research. "

what research? testimonials?

http://www.camresearch.com/

How about this research?

Prolotherapy injections for chronic low-back pain.Dagenais S, Yelland MJ, Del Mar C, Schoene ML.
CHEO Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada, K1H 8L1.

BACKGROUND: Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness. OBJECTIVES: To determine the efficacy of prolotherapy in adults with chronic low-back pain. SEARCH STRATEGY: We searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. SELECTION CRITERIA: We included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible. MAIN RESULTS: We identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores.Three randomized controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50% improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity.Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50% reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling. AUTHORS' CONCLUSIONS: There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

"Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions."

[TZ]

2. ummm you irritate the joints to heal them? WTF?

Can anyone say possible route of infection? Holy shit. And fucking Phenol? Hello isn't that a suspect carcinogen?
I'm sorry but injecting a foreign substance into tissues does NOT sound like a good idea to me.

[bluedawg12]

4. Especially joints.

It's crazy enouogh injecting phenol a toxic substance as you noted or cod liver oil, but joints are delicate and one ought to be pretty careful about injecting chemicals that might damage the articular surface.

Maybe they reserve hypertonic dextrose for the lucky knees. :eyes:

I need to see if there are any studies about the actual increase in strength they claim, by irritating connective tissue. Not buying it just yet. :(

I give it four quacks.

[Warpy]

3. quack quack quack quack....

They've injected steroids into tendons and muscle spasms for a long time on the theory that reducing the inflammation was beneficial. A double blind study some 10 or so years ago demonstrated that dry needling was just as effective.

Injecting irritants into already inflamed tissues looks like a sure loser to me. It would be far better to get some acupuncture and not do more damage to already damaged tissue.

[bluedawg12]

5. Duck!

No I mean really, duck! This is some odd stuff isn't it?

I wouldn't even advise steroid injections into tendons directly, as that weakens a tendon.

Of course the whole premise is suspect that claims: weakened tendons, ligaments, muscles, joint capsule and articular cartilage can ALL be strengthened by this Rx.

The words "weak" and "strong" are weasel words too. Just what do they mean by that and how are those "weaknesses" shown to be the pain generator? In fact how are they diagnosed?

Take the none sense about knee instability. Let's assume it's the ACL and it has been injured. Rarely, is there a case of isolated ACL injury. Usually the ACL, MCL and joint capsule are involved.

Now, here is the corker. The assumption is that surgeons, who reconstruct complex rotatory instabilities around the knee know this Rx and avoid it so they can do their $$$$ surgery. Really? It's the other way around, if this stuff worked to restore a knee during functional activities and to withstand the forces of pivoting and sheer forces, this wold be a mainstay in orthopedic surgery and they would then focus on other surgeries. Heck, there is no shortage of people in need of hip replacement or discectomies. There is never "a treatment that is so great that the medical profession doesn't want you to know about it." It would be the opposite. Everyone would be doing this to make a nice income, if it were proven. There is always something else that needs surgery.

It is all too neat a package starting with the first assumption: "weak."

But ya' know, people actually line up for this costly, invasive Rx, even though the data is not there at this time, most insurers do not cover it and Medicare has reviewed the science behind it and rejected it for coverage. Now, there is a motivator to keep costs down. Medicare costs. If this were proven Medicare would demand a course of prolo before any knee replacement I should think.:eyes:

Four quacks and a tsk tsk! LOL. :rofl:

[Silent3]

6. I certainly trust it more than amateur lotherapy.

Always look for a fully-qualified, board-certified professional lotherapist.

[bluedawg12]

7. I am not familiar with lotherapy.

What is that?

[TZ]

8. It's amatuer PRO-lotherapy

Someone is being to literal;)

[Silent3]

9. So many therapies, so little time.

Lotherapy treats your base chakra, hitherapy treats your crown chakra, and then there's midtherapy for all of the other chakras in between.

This makes lotherapy into a kind of spiritual proctology. Or at least prolotherapy would be spiritual proctology. Plain old lotherapy might only be spiritual ctology.

[bluedawg12]

10. I get it now.

Prolotherapy would be spiritual proctology, and low-therapy might be like a high colonic with a slurry of coffee grounds and pond water (without frogs)? :P