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.
I have had chronic back pain for 15 years. I have had a microdiscectomy at L5-S1 and I have recently been advised to have a fusion or disc replacement surgery at L5-S1. A diagnostic exam with Dr. Charchian indicated that my pain may be caused by my facet joints as opposed to my herniated disc. We decided to treat my facet joints with PRP therapy. After one round of injections my symptoms and pain level have decreased dramatically. I missed no time from work and I only took three days off from exercising. I have been able to swim, surf, hike, and exercise with much less pain since receiving PRP. I am highly encouraged by my results from the PRP therapy. I have already recommended Dr. Charchian and PRP to a few friends and associates. I am actually looking forward to my 2nd and 3rd rounds of treatment. I am extremely happy with the care that I have received from Dr. Charchian and with results from the PRP therapy. Very exciting and progressive treatment!