The Use of Prolotherapy in Pain Management
Dr. Tim Schwaiger
“The mind is seldom quickened to very vigorous operations but by pain, or the dread of pain. We do not disturb ourselves with the detection of fallacies which do us no harm.” - Samuel Johnson
Every person experiences some level of physical pain during his or her life. Pain not only has various causes, each person�s response to pain is fairly unique.
During the initial consultation, it is important to establish the type of pain, degree of severity and complexity, and the underlying physiological cause. At times it is necessary to obtain x-rays or other types of imaging of the affected area(s) prior to establishing the best type of treatment. In addition to finding the “cause” it is important to address lifestyle and exercise, psychological and emotional influences and realistic goals of pain relief. Treatment always includes helping the individual achieve maximum pain relief. This may include methods of relaxation, exercise or referral to other clinicians for physical therapy, biofeedback or counseling.
What is Prolotherapy?
Prolotherapy is the treatment of soft-tissue damage using injections. The injections lead to inflammation in the area, and the body reacts by increasing the blood supply and releasing growth factors to the area, resulting in tissue repair. The term prolotherapy is derived from the word prolo, short for proliferation. The therapy is intended to proliferate tissue growth in the damaged area. This therapy fits well with one of the basic principles of naturopathic medicine: “the healing power of nature”.
The healing power of nature is based on the principle that the body has the inherent ability to establish, maintain, and restore health. The healing process is ordered and intelligent; nature heals through the response of the life force. The physician's role is to facilitate and augment this process, to act to identify and remove obstacles to health and recovery, and to support the creation of a healthy internal and external environment.
What are the Benefits of prolotherapy?
Prolotherapy is very helpful in chronic pain, especially when tendons and ligaments are involved. Many patients come for treatment when they have exhausted all options and are considering surgery. Adult patients of all ages may benefit. In addition, individuals on drugs can often go without these medications following a series of prolotherapy.
Some pain is caused by the overuse of muscles and tendons. A good example of this is something called tennis elbow. A game such as tennis requires repetitive motions of the arm and wrist. Over a period of time some individuals develop elbow pain. Usually one to two sessions of prolotherapy can resolve the problem.
Other sports can cause similar discomfort to other areas of the body. Shoulders and knees are some of the more common areas. High impact sports such as running or basketball can weaken knee ligaments. Weight lifters can experience problems related to the shoulders or upper back.
I have experienced a great deal of benefit for low back pain regardless of the cause. There has been numerous patients� suffering from disc herniations that have been helped with prolotherapy.
What Does Prolotherapy involve?
Prolotherapy involves injection of a solution of dextrose (type of sugar) and Lidocaine or Procaine (anesthetic) directly into damaged ligaments or tendons. These ligaments and/or tendons attach to important bones or muscles. These areas are often weakened or stretched due to overuse or injury. This injection causes a temporary inflammation, which the body tries to heal. In this healing process, the body sends cells called fibroblasts that produce collagen. Collagen makes the ligaments and tendons stronger. This additional strength can often alleviate pain and increase strength to the area.
How Many Treatments Do I Need?
The number of injections depends on the area treated and each person�s response. Areas that are more complicated in structure usually require more injections. The back is more complex and usually involves several treatments. On the other hand, the elbow may require less.
I may order diagnostic tests such as x-rays or an MRI if the injury appears complex or if patient does not respond to treatment as expected.
Return visits usually are from three to six weeks apart depending on the severity of the problem and location. Sometimes therapy only involves a visit once every three to six months. The number of sessions and expected results will be discussed at the initial visit.
What Can I Expect Following the Treatments?
There might be pain and soreness during and after the injections. Pain usually is temporary lasting for 24 to 48 hours. This is due to the inflammation caused by the therapy. Anti-inflammatory medications are not to be used during the proliferation period. On the third to fifth day patients usually begin to feel positive results.
Other treatments used together with Prolotherapy
At times, acupuncture is used to compliment the Prolotherapy. This therapy can been performed in between periods of injections and in my experience will enhance the benefits of Prolotherapy.
Traditional Chinese Medicine is based on the principles of meridians and channels. These include pathways in which the blood and Qi (pronounced chee) are circulated. Qi maintains vital activities; blood provides nutrients to bring balance back to the person. Pain syndromes are seen as stagnation or blockage in these pathways. A western or scientific explanation reveals that insertion of needles stimulates release of endorphins, which dulls pain impulses. Acupuncture is safe and carries very few if any side affects.
Trigger Point Injections
In the various types of myalgia (tenderness to a specific muscle area), injections can be made intramuscularly into the most sensitive areas. The use of Sarapin� is very safe and effective. I sometimes combine prolotherapy and trigger point therapy depending on each person�s condition. For example, I use a combination of spinal manipulation, trigger point injections to the upper back and Prolotherapy very successfully for chronic tension headaches.
Supplements used with Prolotherapy
- Restores joint cartilage
- Reduces swelling and pain
- Shown to reduce arthritic pain better than NSAIDs in long term use
- Dosage 1500 to 2000 mg per day in three divided dosages
- Aids in cartilage and connective tissue
- Detoxification in liver
- Enhances mood, works better when depression is a component of pain
- Dosage varies from 200 mg to 1600 mg per day
Timothy Schwaiger, NMD
Dr. Schwaiger graduated from Southwest College of Naturopathic Medicine (SCNM). He holds�a Masters' degree in Health Services Management and has over 24 years health related experience.
He is Associate Professor and Director of the Division of Clinical Sciences at SCNM. He teaches Geriatrics and Physical Diagnosis. He served as Medical Director for the SCNM Clinic in 2004.
He has received training in Prolotherapy from the Hackett Hemwall Foundation in Madison, Wisconsin and the Naturopathic Academy of Therapeutic Injection (NATI).
Hackett Hemwall Foundation