Prolotherapy is injection of any substance that promotes growth of normal cells, tissues, or organs. Prolotherapy is performed in all major hospitals but not by the name prolotherapy. An example is injection of red blood cell growth stimulator (erythropoietin) in patients with anemia.
The three types of prolotherapy are:
1. Growth factor injection prolotherapy: Injection of a growth factor (a complex protein) that specifically begins growth of a certain cell line (erythropoietin example). This type of prolotherapy is in early stages of study for arthritis (growing cartilage cells) and sprain and strain (growing fibroblasts) and will advance substantially in years ahead. It will be a more expensive option however than the latter two types.
2. Growth factor stimulation prolotherapy: Injection of something that causes the body to produce growth factors. Non inflammatory (10% or less) dextrose is an example of this. Two double blind studies have now shown that simple 10% dextrose injection is effective in arthritis.(1,2) (Large and small joint) Humans cells exposed to as little as 0.3% dextrose produce growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGFB), epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), and connective tissue growth factor (CTGF).
3. Inflammatory prolotherapy: Injection of something that causes activation of the inflammatory cascade to produce growth factors. These solutions often include dextrose for a growth factor stimulation effect, but the inflammatory signals that result causes a more vigorous growth response. Examples of solutions in current use are 12.5%-25% dextrose, phenol-containing-solutions, and sodium-morrhuate-containing solutions. Double blind studies done thus far have been treatment comparison studies rather than placebo controlled studies(3-5) as the control groups received injection with multiple bone contacts which itself will stimulate growth factor release. Despite this, the inflammatory proliferant groups did better except for one study in which the technique used was questionable.(5) Inflammatory prolotherapy will likely be the most cost effective form of prolotherapy in the future as it is an inexpensive medical technique for stimulation of the natural wound healing cascade.
Since the primary pathology in chronic sprain/strain is best described as connective tissue insufficiency, connective tissue laxity and/or weakness (the term connective tissue insufficiency has been utilized), it will be imperative to correct the primary pathology. The primary pathology in arthritis however, is a combination of too little growth factors and too much disrepair factors, and how to limit disrepair factors is currently under investigation.(6)
1. Reeves, K.D., and K. Hassanein. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Alt Ther Hlth Med, 2000; 6(2): 37- 46
2. Reeves, K.D. and K. Hassanein. Randomized prospective placebo controlled double blind study of dextrose prolotherapy for osteoarthritic thumbs and finger (DIP, PIP and Trapeziometacarpal) joints: Evidence of clinical efficacy. Jnl Alt Compl Med, 2000; 6(4): 311-320
3. Ongley, M.J., et al. A new approach to the treatment of chronic low back pain. Lancet, 1987; 2: 143 – 146.
4. Klein, R.G., et al. A randomized, double blind trial of dextrose-glycerine-phenol injections for chronic low back pain. Journal of Spinal Disorders, 1993; 6: 23- 33.
5. Dechow, E., et al. A randomized, double blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology, 1999; 38:1255- 9.
6. Reeves, K.D., Prolotherapy: Basic science, clinical studies, and technique. In Lennard TA (Ed). Pain procedures in clinical practice (2nd Ed.). Philadelphia; Hanley and Belfus; 2000:172-190.