integrative care and chronic pain management

What is Prolotherapy?

Prolotherapy treats chronic ligament and tendon weakness by injecting a proliferant solution to help directly stimulate growth of healthy and strong tissue which in turn helps reduce pain by stabilizing the affected area. With advances in medical treatments including regenerative medicine techniques with Platelet rich plasma (PRP) and stem cells, prolotherapy fits along this spectrum of a more natural medical care.

How is Prolotherapy done?

Prolotherapy treatments are done by injecting an irritant type solution consisting usually of dextrose mixed with lidocaine for anesthetic into and around the painful area/joint. PRP (Platelet-rich Plasma) can also be used as a solution that is injected. This causes an inflammatory response, much like an acute/new injury which then stimulates your own body’s immune response to heal by producing collagen and cartilage. This proliferation allows for strengthening and restoration of unstable joints and soft tissue therefore reducing pain.

How is this this different from a steroid injection?

Steroid injections are what is usually offered when you visit a pain management physician to help treat your chronic pain. Steroids treatments usually need to be repeated throughout the year and are sometimes offered to treat multiple different areas of pain in your body (joint, epidural, facet etc). Although steroids temporarily help with pain, it can actually weaken tissue and interfere with the body’s healing process and may even lead to further degradation of the joint and tissues which in turn may worsen pain over time.

Medications to avoid before your procedure

You should not have an injection if you have used non-steroidal anti-inflammatory medications (NSAID’s - examples include Ibuprofen (Advil), Diclofenac (Voltaren), Meloxicam (Mobic), etc in the 7-10 days leading up to your appointment. Also it is recommended to refrain from any steroid medication via mouth or an injection for at least 4-6 weeks.  If you are considering having this injection, please switch to another painkiller such as paracetamol or tylenol for other options, check with your local doctor.

Does Prolotherapy hurt?

Prolotherapy involves injecting into multiple sites along tendon and/or ligaments and may necessitate multiple injections during one visit. Injection may feel like multiple pinches to the skin. If needed, suggest taking your oral pain med prior to injection (DO NOT TAKE ANY NSAIDS-ibuprofen, alleve, meloxicam, advil etc.) however most patients tolerate procedure well and report varying degrees of discomfort from mild to moderate. A topical numbing medication and even local anesthetic or cold spray may also be used to help any discomfort during the procedure.

When will I see results?

Patients usually see varying degrees of soreness and swelling around the injection site for up to 7-10 days after the injection. This is a result of inflammatory substances flooding the area of the body. The inflammatory process and healing process can result in strengthened tissue and usually continues for a few weeks after the first treatment. Heat can help improve some discomfort. AVOID ICE AND NSAIDS. Follow-up evaluation and treatments are recommended every 4 to 6 weeks and allows enough time to start noticing improvement. Residual pain usually reduces after each treatment. IF an acute injury, healing can occur within a few weeks of injection.

How many treatments will I need?

The number of treatments varies from patient to patient as well as extent of injury. Patients with a healthy immune system generally require less treatments! Number of treatments can vary from 4 to 8 sessions every four to six weeks. Many report partial or significant pain relief after one or two treatments. Over time, you will start to feel better and may only require maintenance treatments a few times a year if pain starts to recur

Is Prolotherapy Safe?

Prolotherapy is very safe when done by a trained physician. Dr. Moon is a Board Certified Interventional Pain Management physician and has performed thousands of pain injections and has undergone training in Prolotherapy. Although any medical treatment, including injections, has a risk of adverse reactions and complications, with Prolotherapy the risk is minimal. As with all medical procedures, side effects and risks can occur but rarely: these include increased pain, numbness, and infection, allergic reaction to medication, weakness, headache, pneumothorax, dizziness, nausea and death. The risk and side effects will vary depending on the area being treated.

Who should NOT get Prolotherapy treatments?

  • If you have low Hemoglobin
  • If you have low Platelets
  • Smokers-results may not be as successful
  • Active infection
  • Active cancer

Also this procedure is cautioned in patients with medical diagnosis such as platelet dysfunction syndromes, thrombocytopenias, hypofibrinogenaemia, hemodynamic instability, sepsis, acute and chronic Infections, chronic liver disease, anticoagulation therapy, chronic skin diseases or cancer, metabolic and systemic disorders.