Prolotherapy treatment

Dr B. Chandra Sekhar, sports and shoulder surgeon at Sunshine Hospital talks about proliferation therapy or regenerative injection therapy as an alternative medicine treatment but which requires a lot of clinical evidence to make it as a main line of treatment.

Prolotherapy, also called proliferation therapy or regenerative injection therapy is an alternative medicine treatment that uses injection of an irritant solution into tendon insertion, ligaments and joint space in an effort to relieve pain or address ligament laxity.

Types of prolotherapy include Dextrose Prolotherapy, Platelet Rich Plasma Prolotherapy (PRP) and Biocellular Prolotherapy, in which bone marrow or fat tissue from an individual’s own body containing adult stem stromal cells is used.

Substance used in dextrose prolotherapy injections include natural irritant agents such as dextrose, glucose, glycerin and phenol. Irritants are often used with a local anesthetic to help numb the affected area and injection site. Prolotherapy creates a mild, controlled injury that stimulates the body’s natural healing mechanisms to lay down new tissue in the unhealthy tissue.

Problems treated include low back pain, neck pain,shoulder pain, knee pain, elbow pain including golfers or tennis elbow, foot pain including plantar fasciitis, ankle pain, osteoarthritis or other musculoskeletal pain or injury. Injections are administered every two to three weeks over the course of several months (usually three to six months).

In 2016, an article was published regarding systematic review of dextrose prolotherapy for chronic musculoskeletal pain. The article stated that the use of dextrose in prolotherapy can be for treatment of tendinopathies, knee and finger joint, and spinal or pelvic pain due to ligament dysfunction. This efficacy is more to relieve pain but may not completely cure the condition.

Prolotherapy is a treatment that has been around for a long time, but still lacks definitive clinical evidence for efficacy. The plausibility of an effect is dubious.

There are few high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Further investigation, with high-quality trials, is necessary to determine the efficacy of prolotherapy.

In the last several years new formulas have emerged, including Platelet Rich Plasma (PRP) and autologous (from the same person) adult stem cell sources, typically taken from bone marrow or fat tissue came into clinical use.

In PRP prolotherapy patient blood sample is taken and centrifuged. Platelets are separated and injected in the affected areas. Platelets contain number of proteins, cytokines and other bioactive factors that may initiate and regulate basic aspects of natural wound healing.

Biocellular prolotherapy or stem cell injection therapy which utilises mesenchymal stem cells (MSCs), is a recent development in musculoskeletal medicine. MSCs are self-renewing, multipotent progenitor cells with potential to differentiate into cell types of mesodermal origin, such as adipocytes, osteocytes, and chondrocytes. In addition, MSCs can migrate to sites of inflammation and exert potent immunosuppressive and anti-inflammatory effects through interactions between lymphocytes.

Along with these unique therapeutic properties, their ease of accessibility and expansion suggest that use of MSCs may be a useful therapeutic approach for various disorders.

In the clinical setting, MSCs are being explored in various conditions, including injuries, graft versus host disease following bone marrow transplantation, cardiovascular diseases, autoimmune diseases, and liver diseases.

Although significant progress has been made in stem cell research in recent years, cell therapy with stem cells is far from a mature clinical technology. Because they are free of ethical concerns and have numerous sources, low immunogenicity and no teratoma risk, MSCs are the most commonly used stem cells in current clinical applications.

However, there are still several major hurdles to their widespread utility. Further research is needed on interactions between MSCs and the inflammatory milieu in which they reside and the therapeutic mechanisms of MSCs.

Furthermore, it is still not known which source should be used for which disease, which route of administration is best suited for a particular disease, and possible contraindications to their clinical use.

Till date, platelet injections has shown some benefits in tennis elbow and plantar fasciitis, stem cell therapy has shown some promise in curing cartilage defects in young people but not in osteoarthritis. This procedure is being done in many places.

Even though stem cells therapy suggests promise for future, but as on today it can’t be used as a cure for everything.