Therapies › Prolotherapy

Dr. Santos has treated hundreds of patients using his prolotherapy protocol. Success with prolotherapy is quite high, over 90%. Patients typically experience a resolution of their pain after 3-4 treatments. But very severe cases may need up to 10 treatments. Treatment is performed every 2-4 weeks and improvement in pain should be experienced after each treatment. Please watch the videos on the right column for more information. 

Cure chronic pain with Prolotherapy

One out of three people, at some time in life, experiences spinal disease significant enough to lead to professional treatment. In America alone, $7.4 billion are spent on drugs every year to treat pain originating in the spine. This amounts to an average of $30 for each person, each year. Every day, one out of five people in Western countries (and probably worldwide) suffer from debilitating spinal pain.

The cause of back pain and neck pain is the instability of vertebrae, which results from weakened and/or damaged ligaments. The vertebrae are held in their proper position in relationship to each other by muscles and by ligaments. Muscles alone are not able to do the job. Nevertheless, they can help, and this is the rational basis of exercise as a treatment for an unstable back or neck.

Strong ligaments are necessary for a stable spine. However, instability is not, in itself, the cause of pain. The cause of pain is inflammation. Inflammation happens when vertebrae rub against each other in an abnormal way due to the presence of damaged ligaments. This is why anti-inflammatory agents, including cortisone, can result in temporary relief of pain. However, since the underlying condition is not treated with anti-inflammatory agents, this suppression of symptoms is like putting your finger in a dike. The flood will come sooner or later.

Prolotherapy involves the injection of an "irritant" solution into the area where ligaments are weak and/or damaged. Over the next few days, cells called "macrophages," literally big eaters, are attracted into the area by the presence of this irritant solution. Once they arrive, these macrophages pick up the irritant solution and carry it away for disposal (they are the garbage men of the body). As the macrophages are finishing their job, the body sends in "fibroblasts," literally connective tissue builders, to lay down fibrous tissue wherever they detect damage to connective tissue such as ligaments.

Studies demonstrate it effects marked improvement in 92% of cases and, if properly administered, does not violate the first rule of medicine: do no harm. These claims cannot be matched by standard medical/surgical treatment methods.

What is prolotherapy?

In prolotherapy treatment, 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 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)
• 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 condition and the individual being treated. The injection series may cover 3 to 6 months with injections at 2 to 3 week intervals.

Most reports suggest physicians recommending prolotherapy provide substantial counseling for their patients to prepare them for both the procedure and the side effects.

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 injections with a good physical therapy program

What are 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 it as a first-line therapy.

It is important to note that approximately 90% of people with acute back pain get better with standard conservative 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 pain relief
• Experience joint pain that is worse with exercise and better with rest

Potential risks and complications of prolotherapy

Possible side effects may last a few days include:

• Swelling
• Intense pain and stiffness
• Headache
• Allergic reaction

Reports of more serious complications have been rare, and would have been due to treatment from an untrained physician; these include:

• Spinal fluid leak
• Permanent nerve damage or paralysis
• Pneumothorax

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