Prolotherapy, PRP and Stem Cell

Prolotherapy, PRP and Stem Cell

Regenerative injections aim to stimulate the body to repair itself in areas of degeneration.  They include Prolotherapy, PRP and Stem cell injections and they aim to induce a healing response in the body.  These injections are a safe, non-surgical treatment for chronic injuries, pain and arthritis, using injections to stimulate healing and repair.  They have been used for decades on patients in pain from aging, overuse or injury.  Prolotherapy is defined by Webster’s Third New International Dictionary as “the rehabilitation of an incompetent structure, such as ligaments or tendons, by the induced proliferation of new cells.”  Pain from auto accidents, athletic injuries, the aging process and overuse, often arises from damage to the joints and connective tissues in the body.  If the structures do not heal properly, chronic degeneration and accelerated aging will occur.  Proper treatment will stimulate the body’s healing response to repair, rebuild and strengthen the area.

COMMON CONDITIONS TREATED                                                                                                        

These represent conditions which can often lead to chronic pain. Normally, injured joints, muscles, tendons, and ligaments go through a repair and healing process, which takes about four to six weeks.  What happens when the low back pain, neck pain, and headaches from a whiplash injury do not heal or, the athletic injury that continues to cause nagging pain is preventing the athlete from staying competitive?  Joint pain and arthritis can slow one down and take away the ability to exercise and enjoy life?  Anti-inflammatory and pain medications or steroid injections are often given to treat these injuries, but they may actually slow or stop this healing process.  Surgical options should be a last resort for chronic pain and arthritic conditions due to side effects and failure rates.

In a significant number of cases, despite a reasonable treatment plan & consistent effort from the individual, residual pain & dysfunction may persist. Chronic pain is often quite disabling & may affect job performance, recreational activities & daily living.  It leads to loss of productivity, depression & fatigue which feeds the chronic pain cycle.

These injection techniques have been used to treat pain and injuries for more than sixty years and the results have been consistent and positive. With the advancement in technology and science PRP and Stem Cell injections and changing the way we treat orthopedic conditions.  In several studies conducted on pain patients, up to 90% of patients received good-to excellent results in pain relief and improved function.  Also, the use of pain medications can be greatly reduced or even stopped after treatment, decreasing the patient’s healthcare costs and risks associated with pain medication use.  Treatment produces long-lasting relief through stimulating the body’s natural healing response.  Most other types of treatment provide only temporary relief by covering up the symptoms and not treating the cause.  Surgery is often not needed if the area is treated appropriately by an experienced physician.  Multiple encouraging studies have been published since the Prolotherapy pioneer George Hackett, M.D., proved that strengthening damaged tissue relieves pain.  Every year new and encouraging studies with Prolotherapy, PRP and Stem cell injections confirm what we see in our patients every day.    This is the future of Orthopedic Medicine!

HOW DOES IT WORK? 

When injuries occur, the area may not heal completely due to lack of proper treatment or poor blood supply. For this reason, ligaments, joints and tendons heal very slowly.  If left untreated, damaged ligaments become loose, allowing bones in the joint to shift with excessive movement causing pain, muscle spasms, and eventually arthritis.  Arthritis occurs in the joints and spine as a result of instability in the structures supporting them.  We can intervene by stabilizing the structures and decrease the progression of pain, degeneration and aging.

When stretched, small nerve fibers in the damaged ligaments transmit pain impulses to the brain. Through a subconscious reflex, the surrounding muscles go into a painful spasm in an attempt to stabilize the joint. This causes the region to feel tight, stiff, achy, burning, tingling, numb, fatigued and painful. The individual will often notice painful knots in the surrounding muscles. These muscles become tight and painful as they try to compensate for the weak and damaged underlying structures. Spasm in the muscles decreases the blood flow and nutrient delivery to the tissue, further contributing to the breakdown.  Also, the chronic tension from the muscles in spasm leads to deterioration of the tendon attachments leading to tendonosis (degeneration without inflammation).  Not only is pain felt locally, but is often referred to other areas.

Injecting a stimulating solution at the sites of the tissue breakdown stimulates the body’s own healing mechanism to repair and rebuild.  This regenerative process leads to a stronger and more supportive structure.

When the injured areas are injected, a reaction begins, starting a three-stage healing process (see table above). The injections initiate the first stage (Inflammation).  Stages two (Fibroblastic) and three (Maturation) will follow automatically.  In stage one, the body sends in macrophage cells, which help to clean up the debris and damaged areas. These cells respond as if another injury has occurred, resulting in controlled inflammation and increased blood flow.  This process takes about a week.  In stage two, the body begins the process of repair and healing.  Repair cells called fibroblasts, which are deficient in the injured and degenerated tissue, arrive to the scene during this stage. Fibroblasts increase in number at the sites of injection over the course of four to six weeks, and secrete a substance called collagen, which is a very strong and relatively inelastic substance. This newly formed collagen makes the ligaments thicker, denser and stronger, providing more support to the joints where the ligaments anchor or attach to bone. Studies have shown that the strength of the injected ligaments can increase up to 40% above normal.  Pain and muscle spasm is decreased as stability is increased.  In stage three, the newly formed tissue continues to mature for one to three years. Improvement, therefore, may continue for up to three years after the last treatment. If, during the three stages of the healing process, anti-inflammatory drugs, ice, and/or immobilization are used to reduce pain and inflammation, complete and normal healing will be inhibited.  Most people are taught that inflammation is bad and don’t realize that, without inflammation, no healing will occur.

We can strengthen the joints, ligaments and tendons and decreases the pain by stimulating the body’s own repair and healing process. There is no covering up the pain as tissues heal naturally and become stronger, without forming scar tissue.  Several treatments spaced apart by about two to six weeks are usually required to get the full benefit.  Each treatment builds on the previous until the desired outcome is obtained.

 

WHAT ABOUT THE PROCEDURE ITSELF?  

It is a safe procedure when performed by a trained and highly skilled physician who has an in-depth knowledge of anatomy and experience using this injection technique. The use of needles involves risks, but complications are rare. The solutions used have been shown to be safe and, as stated previously, do not contain cortisone. The most common side effect is discomfort due to the injections, as well as temporary soreness, stiffness, and occasional bruising.  Although injection discomfort cannot be eliminated, it is well tolerated in most cases.  Local anesthetic is used prior to the injections to decrease discomfort.  If necessary, pain can also be reduced by the use of prescription oral medications for pain control and sedation taken prior to the treatment. Most patients prefer not to be sedated because it makes them feel groggy and because a driver is required to and from the appointment.

Depending on the area treated and the number of injections, one may return to usual activities during the next day or two. The actual treatment may last anywhere from a few minutes, if there is only one site of tenderness such as the elbow, to thirty minutes, if a large region such as the back and neck are being treated together. The soreness and bruising that may occur following the injections is normal and gradually lessens over several days.  Approved prescribed drugs or Tylenol may be taken for this discomfort.  However, anti-inflammatory drugs should not be taken during the treatment period because these may interfere with the healing process. This includes medications such as Advil (Ibuprofen), full strength Aspirin (325mg), Aleve (Naproxen), Prednisone, steroid dose packs, and prescription NSAID drugs like Celebrex, Mobic, Daypro, Relafen, Lodine and Voltaren.  Similarly, some herbal supplements such as turmeric or curcurmin can have an anti-inflammatory effect.

CAN IT CURE EVERYTHING? 

It cannot “cure” every painful condition, nor always eliminate 100% of one’s pain.  The vast majority of patients treated   (usually 2 to 6 sessions) will receive at least 50% relief of their pain. Many even report complete resolution of their pain after a series of treatments. These results are excellent, considering that chronic pain is exceedingly difficult to treat by any means.  It is also important to know that treatment only strengthens tissues.  No structures are weakened and no scars are formed.  A good history and a thorough examination are necessary to select the best treatment. Chronic pain problems do not occur overnight and they do not heal that way either.

COMMONLY ASKED QUESTIONS

Do the injections hurt?    The use of a needle is always accompanied by some degree of discomfort. It varies from patient to patient, but is usually well tolerated. It helps to stay very relaxed by not tensing the muscles and focusing on deep breathing.  A local anesthetic is used to numb the skin and decrease discomfort.

Are there any risks?   Anytime a needle is used to penetrate the skin into the deeper tissues, there is always the chance that inadvertent puncture of arteries, nerves, spinal fluid or lung tissue may occur. Complications are rare and are greatly minimized by the skill of the well trained practitioner. However, since it is a procedure with some risk to the patient, all patients are asked to read and sign a consent and waiver form prior to the procedure. Keep the injection sites clean and avoid public hot tubs, swimming pools and lakes for 3 to 5 days following the injection.  Showering the day of the injection or the next day is fine.

Do the injections hurt?    The use of a needle is always accompanied by some degree of discomfort. It varies from patient to patient, but is usually well tolerated. It helps to stay very relaxed by not tensing the muscles and focusing on deep breathing.  A local anesthetic is used to numb the skin and decrease discomfort.

Should I eat before my appointment?     A light meal and plenty of water about 1-2 hours before the procedure and good hydration the day before is recommended. Water improves cell hydration and lessens the discomfort of the injections, while food diminishes the likelihood of dizziness. Patients report less discomfort when they drink water right up to the time of the injections. Eating very clean and avoiding processed sugars and junk food will lead to better healing after the procedure.

How many treatments are needed?      Two to six treatments for a given area is about the average needed.  More with Prolotherapy and less amounts with PRP of Stem cell injections.  A few patients respond quickly to just a treatment or two, but most patients require more to stimulate the healing properly. The longer the duration of the pain and disability and the more severe and widespread it is, the more treatments will be needed to stabilize the joints, ligaments or tendons. After the first session, successive treatments follow at intervals of four to six weeks. Staying on a consistent schedule of treatments will decrease the chance that early benefits are lost.

When will the benefits occur after the injections?     It does not result in immediate relief of pain. Some patients report improvement in as little as two weeks following injections, but it is not expected that any significant relief will be obtained until four to six weeks after the first treatment. Others may not receive much benefit at all until they have had further treatments. As ligament strength and joint stability improve, results become more noticeable with decreased pain and improved function. Improvement may continue for up to three years after the last prolotherapy treatment.

What can I take for the pain during recovery?     Typically, post-injection stiffness and soreness can be expected and is necessary for the healing process to begin. This will last for the first few days. Heat usually soothes the soreness, but ice will slow the healing process.  NO anti-inflammatory (NSAIDs) medications may be used once treatment begins because they interfere with the healing process.  An exception to this is for those who take a baby aspirin for their heart. Regular use of narcotic drugs should be avoided because they will inhibit the immune system and slow the healing. Tylenol may be used for a short period of time. Remember, it is important to treat the source of the pain through strengthening the damaged areas rather than just cover it up with chronic pain medications.

Should I exercise following treatments?    What should I avoid doing? Controlled exercise and mobilization of the treated area promotes tissue healing and results in faster recovery after the treatment. For this reason, movement and exercise are recommended as soon as possible. The amount will depend on one’s level of fitness before and on how many areas were treated. Massage and other similar therapies are compatible with treatment. Massage with lotion or oils should be avoided for 3 days after injections to reduce infection risk.  Physical Therapy can be resumed after the treatment to correct muscular and proprioceptive issues related to the diagnosis.

When should I return to work?      In most cases, depending on the patient’s job, one may return to work or school the same day as your treatment. If, however, the job places a great deal of stress on the treated area or if there is significant post-injection discomfort, one should not return to work the same day. A few days is recommended before returning to strenuous athletic activity.

What is the chance I will get better?    Get worse? How long will it last? Statistics show that 85-90% of all patients treated with prolotherapy receive at least a 50% benefit when treated between two and ten times. There is no evidence of a condition becoming permanently worse from receiving treatments. Also, because actual healing occurs, it is anticipated that long-lasting or even permanent relief of one’s pain can take place. If an area is reinjured, more treatments may be necessary in the future.