PROLOTHERAPY TREATMENT FOR CHRONIC BACK PAIN
In prolotherapy treatment, often used for chronic back pain, a substance is injected using a slender needle next to the site where soft tissue (ligament, tendon, muscle, fascia, joint capsule) is injured or has torn away from the bone.
The substance used in the prolotherapy injection is a natural irritant agent. Examples include:
• Sugar (dextrose or glucose) alone or in combination with glycerin and phenol
• Sodium morrhuate (a purified derivative of cod liver oil)
During prolotherapy treatments for chronic back pain or other disorders, the agent is typically used with a local anesthetic (lidocaine, procaine, or marcaine).
Prolotherapy involves a series of injections, reportedly ranging from 3 to 30 (average 4 to 10), depending on the back condition and the individual being treated. The prolotherapy injection series may cover 3 to 6 months with injections at 2 to 3 week intervals.
Preparing for Prolotherapy
Most reports suggest physicians recommending prolotherapy provide substantial counseling for their patients to prepare them for both the procedure and the side effects.
Recovery after Having Prolotherapy
To counteract the painful, swollen injection site experienced by most patients for 2-3 days following the procedure, physicians may recommend:
• Take acetaminophen or hydrocodone bitartrate plus acetaminophen for pain, but not aspirin or anti-inflammatory medications which would inhibit the healing response
• Apply ice to the area 3-5 times a day for 20 minutes each as needed
• Do moderate exercise such as walking but avoid strenuous exercise or work with heavy lifting
Follow-up the prolotherapy injections with a good physical therapy program
Current Indications for Prolotherapy?
There are currently no treatment guidelines or protocol for prolotherapy. It is most commonly used for patients with back pain caused by chronic ligament and tendon sprains and strains. Some physicians do use prolotherapy as a first-line therapy.
It is important to note that approximately 90% of people with acute back pain get better with standard conservative (nonsurgical) treatments within 6 to 8 weeks and do not require additional treatment.
Candidates for prolotherapy might include patients with back pain who:
• Take medication on the recommendation of their physician (aspirin, ibuprofen, oral steroids) for ligament, tendon, or joint problems
• Have ligament, tendon, or joint pain or weakness/instability lasting over 6 weeks
• Get only temporary relief from manual or physical therapy
• Have had surgery with no back pain relief
• Experience joint pain that is worse with exercise and better with rest
Relative contraindications for prolotherapy include:
• Unclear diagnosis of the location of the injury (sprains, strains, and weakened ligament do not show up on diagnostic imaging studies)
• Lack of training by the selected physician on the solutions used and how to perform the prolotherapy injections
Potential Risks and Complications of Prolotherapy
The injection technique involved in prolotherapy requires skill and care on the part of the physician. Training and experience are important.
Possible side effects may last a few days to a couple weeks and include:
• Intense pain and stiffness
• Allergic reaction
Reports of more serious complications have been rare, but could include:
• Spinal fluid leak
• Permanent nerve damage or paralysis