Prolotherapy and PRP for Mechanical Neck and Back pain
|Today’s traditional and well accepted treatment for physical therapy resistant spine pain is cortisone injections or pain killers. If these do not provide enough relief, surgery is often recommended. After failing conservative and interventional treatments, patients are forced to turn to more radical options. They are having to choose between minimally invasive surgical procedures, disc replacement surgery, laminectomy, and even fusion with hardware placement. Other patients are not offered surgery and therefore rely on a slew of different pain medicines that may have undesirable side affects or just not be “strong enough”.
What is Prolotherapy?
Prolotherapy has been around for decades and the American Society of Orthopaedics is dedicated to this form of treatment, also known as Regenerative Injection Therapy (RIT). Another common and accurate description is Ligamentous Sclerosing Therapy, as it actually does shorten elongated weak ligaments and makes them stronger and more functional. Prolotherapy of the spine is a series of injections directed to an area of the neck, mid-back including ribs and sternum, or low back and sacral regions where it is weak and painful.
How does Prolotherapy Work?
RIT induces natural healing by stimulating the body’s innate response mechanism to a stimulus, such as the prolotherapy injected agent (also known as proliferant). This treatment skillfully uses the body’s ability to create an inflammatory environment in specific spine regions, which segues into a full-blown healing cascade ultimately leading to a stronger and more resilient spine. The proliferant is commonly made up of a dextrose solution consisting of saline, dextrose, and Lidocaine plus trace amounts of other components such as Vitamin B12, Sarapin, Sodium Morrhuate, or Phenol.
How is Prolotherapy Administered?
Typically, spine Prolotherapy is performed by injecting various soft tissue structures including ligaments and ligamentous joint capsules throughout the vertebral body junctions along spiny segments. Traditionally, prolotherapy is to be injected into structures based on gross anatomic landmarks (also known as “blind injections” meaning without any image guidance). However, with the exploding field of Musculoskeletal Ultrasound (MSKUS) for guided injections particularly in the field of Physical Medicine and Rehabilitation, more prolotherapy is being performed under MSKUS although it is still not a common practice. Prolotherapy and all other procedures performed at the Orthohealing Center have always been performed under image guidance.
What is expected during Prolotherapy Treatments?
The strength and intensity of the proliferant can be tailored to the patient according to how they tolerate the soreness that is expected after each treatment. Patients should be experiencing some degree of tightness and discomfort after each treatment. A minimum of 4-8 treatments are typically required for spine prolotherapy. Frequency of prolotherapy sessions is typically every 2-4 weeks. Expected time frame for improvement to be noticed usually occurs after the 3rd or 4th treatment. Healing can continue to occur up to 3-6 months after the last treatment. Anti-inflammatories are restricted during Prolotherapy and ice should be used minimally.
What are the long term affects of Prolotherapy?
Prolotherapy is not a bandaide or a “quick fix” but rather a long lasting and potentially permanent reparative process if the area is not overused or re-injured after the treatment series and especially if the patient commits to even a minimal home exercise program with emphasis on core strengthening. The soft tissue cables that connect the bones of the spine together are regenerated in a way, since they have reverted back to a functional healthy length and width that allows them maximum strength balanced with ideal range of motion. The healing process is gradual and progressive, initially subtle during the early phases but usually significant and dramatic by the completion of treatment. More endurance, less pain, and better function will continue to be noticed over time.
Evolution of Prolotherapy to Platelet Rich Plasma Therapy…
The premise behind prolotherapy for the spine is injecting an acidic irritant to reproduce an injury and subsequently stimulate healing & restore ligament structure. However new technology has emerged that allows us to inject a patient’s own biologic healing properties. Growth factors are small proteins that are released from platelets to coordinate repair and regeneration. We are able to re-inject a patient’s own growth factors over 1000% baseline. We find that PRP injections are associated with less discomfort and require less frequent treatments vs. the standard prolotherapy.
What is the role of Platelet Rich Plasma (PRP) Therapy in the spine?
PRP is considered experimental at this time for all conditions. To date there are no controlled human studies involving PRP in the spine. All of the studies available related to Regenerative Injection Therapy (RIT) of the spine are based on Prolotherapy data. However, based on the theory of similar healing mechanisms of prolotherapy, PRP clinically is proving more powerful & effective.
Orthohealing is a fantastic place. Great care, great people, cutting edge treatment. I cannot say enough good things about them. I started there in October/2013 as a difficult case from 3 neck surgeries to fuse my neck and 1 lower back surgery with an artificial disc. I’ve done a lot of damage to my body over the years playing Football and heavy weight lifting. They threw the kitchen sink at me so to speak until we found bone marrow cell injections (BMC) with PRP for my neck to be the right prescription. I am 4 weeks out from my last procedure and am 100 percent pain-free. I know I’m still early in the process and still have work ahead of me, but achieving this base-line of success is making all the difference for me returning to exercise and strengthening my body to become permanently well. The biggest thing for me is having a place to go that I have confidence in when I find myself needing a boost to my health.
To Dr. Aufiero, I must say you are truly one of a kind. You are the sweetest, most caring, compassionate and intelligent Dr. I’ve come across in my travails with my Spine. Shelley, the best practice administrator out there – thanks for your due diligence in scheduling me as often as you did. I’ve enjoyed our conversations and your can-do spirit. To the techs, Michelle, Melissa and Isabelle who laugh at my jokes (which I still think are courtesy laughs – because I’m not that funny) while I’m on the table getting the shots, thank you too. Forever indebted.
The PRP treatments I received at the Orthohealing Center under the of Dr. Aufiero is one of the best and most beneficial medical experiences I have ever had.
It has been approximately one month since I completed a series of three PRP treatments for chronic lower back pain due to degenerative disks and associated joint and nerve problems. The results have far exceeded my expectations.
Over the years I have tried numerous methods and procedures in an attempt to find relief from the chronic and increasing debilitation of my lower back pain. Most provided no relief while others were mildly effective although temporary. The constant search for relief ultimately led me to the Orthohealing Cneter.
The entire experience was a pleasure starting with the courteous, professional, and caring staff followed by very clear concise consultations by Dr. Aufiero to detail my condition, the treatment process and the expected results, which have been very realistic as proven over time. I believe I achieved a 70% reduction in all the symptoms associated with my lower back and honestly feel like I have control over my daily life again and literally have not felt this good in many years.
I would like to express my sincere thanks to Dr. Aufiero and the entire staff at Orthohealing for their care, skill, competence, and most of all for rejuvenating my daily life.