Prolotherapy - for the joint pain in ME/CFS, Ehlers-Danlos and others?

[Cort]

Interesting article on a very different way to treat muscle and joint pain; one that may perhaps be attuned to the problems in ME/CFS and FM (?)

Treating Musculoskeletal Pain Conditions with Prolotherapy By Jeffery J. Ericksen, MD http://www.pain.com/sections/professional/articles/article.cfm?id=94

Prolotherapy (PrT) is an injection treatment for musculoskeletal pain syndromes that stem from connective tissue injuries or damage from chronic degenerative conditions and overuse syndromes.

PrT derives its name from proliferant therapy and was formerly known as sclerotherapy although research has demonstrated that PrT, done using solutions that induce a localized inflammatory or healing response, are stimulating organized connective tissue regeneration and not scar formation. Most practitioners stopped using the term sclerotherapy in the 1950s. The term “ligament and tendon regenerative injection therapy” has been suggested, but is not yet widely accepted in clinical use.

PrT was championed in the 1950s by Dr. George Hackett who extensively used this treatment in his general surgical practice that focused on treating chronic pain conditions. He injected small volumes of proliferant solutions into painful tendon and ligament insertion sites known as entheses (fibro-osseus junctions) serially, typically for 3-6 treatment sessions over monthly intervals. Dr. Hackett’s book remains the premier discussion of PrT for chronic pain management with proliferant injections [1].

This reminds me of Mike's doctor. He uses prolotherapy but his main focus is homeopathic injections using Neural therapy; the interesting thing to me is that he's using injections of solutions to provoke a healing response in both instances.

There's alot of pain in fibromyalgia and CFS - none of which is usually associated with swelling or redness (inflammation) making it a mystery. But prolotherapy is not treating inflammation - its treating "degenerative connective tissue problems" with 'collagen thinning and fraying'.

The use of PrT for musculoskeletal conditions is based on the growing understanding that most conditions are not due to active inflammation. Histological study, MRI, and ultrasound imaging methods have demonstrated that these tissues manifest few if any inflammatory cells. Instead, degenerative connective tissue fibrils with collagen thinning, fraying, and disruption with immature non-functional blood vessels (neovascularization) has been noted in tendon structures. Thus, the focus of treatment has shifted away from inhibiting inflammation and toward the direction of stimulating tissue recovery or regeneration.

In fact prolotherapy appears to trigger a local inflammatory response - which then, hopefully, builds collagen.

The theory behind PrT is that injections cause local tissue injury, which triggers the release of inflammatory mediators. Ongoing debate centers on the role of the specific solution vs. the role of the tissue injury caused by the needle penetrating tissues that advocates of dry needling argue as the necessary event. Inflammatory mediators then stimulate granulocytes and macrophages to begin activity from growth factors released. Fibroblasts are then stimulated that synthesizes collagen at the injury site followed by maturation of the collagen fibrils to tighten and strengthen the tissue. Recruitment of circulating stem cells is possible from the growth factor release seen in PrT treatment.

They actually inject 'irritants' into these damaged tissues!

Traditional PrT solutions are classified based on their effect on local tissues. Irritant solutions include:

• Phenol
• Particulate solutions (such as ground pumice flour)
• Phenol-quinone urea

These solutions damage cells by oxidizing and alkylating surface proteins which potentially renders cells as antigenic and immediately stimulates the inflammatory cascade and recruits macrophages that secrete growth factors.

They also use "Osmotic shock agents" to provoke a healing response.

• Dextrose
• Glycerin
• Zinc sulfate

Osmotic shock agents create cells via osmotic pressure gradients, glycosylation of surface proteins, and metallation of proteins. This leads to granulocyte and macrophage attraction. Chemotactic agents, such as sodium morrhuate (cod liver oil salt), directly attract inflammatory cells plus fibroblasts. Sodium morrhuate is rich in arachidonic acid acting as a precursor for prostaglandins, leukotrienes, and thromboxanes necessary for inflammation.

Interesting therapy!

Article Created: January, 27, 2009

 

[Michael Dessin]

Prolotherapy

Exactly what my doc does also. He does this with traditional methods, not homeopathics.

This has got to be one of the most incredible treatments I have ever seen!!!!!

My joints/ligaments in the knees and shoulders were destroyed.

When I got healthier I was limping because my knees were such a mess.

Literally within weeks of starting prolotherapy, my knees felt brand new. Even went water skiing last week, no problem!!!

This is an extremely good therapy for chronic back issues as well!

Mike

 

[Sushi]

And Michael and Cort,

Following on my posts on the Ehlers-Danlos thread, I have had successful prolotherapy to tighten the ligaments around my knees. At the time I didn't know the cause of my unstable knees but I had heard that prolotherapy would help and it did.

Sushi

 

[Wayne]

Prolotherapy / Levaquin Tendon Damage

Wow, this sounds like some pretty remarkable therapy. One of my first thought was whether this would be helpful for people who have had significant tendon, ligament and joint damage from Levaquin and other antibiotics in that particular class. I'll report back if I find some testimonials at some point.

Best, Wayne

 

[Michael Dessin]

Sushi/Wayne

Sushi.....Thanks for sharing your success with prolotherapy!!!!!!!!! I think more folks need to know about this treatment.

The only contradiction I seem to see with prolotherapy and neural therapy is with those who have had several surgeries to the injured areas!

These folks seem to be much tougher cases. Than those who walk in with torn ligaments..e.t.c. and have opted out of surgery!!

Also neural with prociane is amazing for pain conditions, as is prolotherapy.

However though, I mentioned earlier, these procedures induce just an incredible amount of rapid healing to the areas of injection, you must be careful in not creating an imbalance in the immune system. Need a very skilled practitioner.

Wayne--you the man, just thought I'd let you know

Mike

 

[jenbooks]

I was thinking of getting prolotherapy for my left knee which has patella femoral syndrome (sp?). It had an acute episode and has healed much but is still iffy on stairs. My doc does prolo.

Mike, my doc also recently added in PRP (platelet rich peptide) which is from your own blood and heals ligaments and joints. Unlike prolo does not use noxious substances to stimulate healing. He does both.

 

[Michael Dessin]

Jenbooks

Nice!!!!!!!!! gonna talk to my doc about the PRP, thanks!!

 

[Wayne]

Mike LOL

Hey Mike,

LOL, got a kick out of your little note at the end of our post. Yeah, I used to occasionally feel like--the man. Not quite as often these days however. I should mention however, that that spirit is still there.

Anyway, thanks for the chuckle. I always appreciate those moments in my day!

Best, Wayne

 

[Michael Dessin]

Wayne

Hey no problem. Sometimes it's hard to smile when we deal with so many health issues.

 

[kolowesi]

prolotherapy irritants

I'm so glad to learn about this!

Recently, I found out I may have had Lyme for 11 years or more. I have lots of tendon pain (and now that I'm on flagyl for cystic form of Lyme, way-bad joint pain) plus the normal aging stuff for someone formerly active. No tears that I know of, but it's a worry.

Anyway, the use of phenol to irritate the cells rang a bell. Long ago, I took a test called "Alcat" that measured lymphocyte response to various chemicals. By far my strongest response was to benzene (try getting away from that!), but I had a lesser response to phenol. It's in tea, which I drink every day, so I'm probably OK with it, though.

Did I read right, that other agents can be used instead? Cod liver oil salts? Hmm.

Thanks so much for this information, it's wonderful news! Love the humor, too.

Kelly

 

[Sushi]

Did I read right, that other agents can be used instead? Cod liver oil salts? Hmm.
Kelly

Hi Kelly,

My doctor used dextrose.

Sushi

 

[desparateavelox]

Wayne, did you find any information on prolotherapy for people with significant post-levaquin/avelox damage?

 

[helsbells]

Thanks eveyone for flagging this up - along with eveything else I have eds and Ive never even heard of prolotherapy, cheers

 

[*GG*]

I was thinking of getting prolotherapy for my left knee which has patella femoral syndrome (sp?). It had an acute episode and has healed much but is still iffy on stairs. My doc does prolo.

Mike, my doc also recently added in PRP (platelet rich peptide) which is from your own blood and heals ligaments and joints. Unlike prolo does not use noxious substances to stimulate healing. He does both.

I asked my doc about prolotherapy the other day, and the guy who does it in his office does work with PRP also. Need to have my hip looked at from surgery 2 years ago, before I knew I had Fibro. Now that I know I have Fibro, I am going to stay away from surgery by all means!

 

[warriorseekspeace]

I am scheduled for prolo of the lumbar spine tomorrow. I am scared. Can anyone think of any questions I want to ask the doctor? I know I want to ask if he will target specific ligaments at the bony junction, rather than just generally sticking the stuff all over in the soft tissue (this is how it appears to be done very quickly and sloppily in some videos online I saw). He was very precise with the SI joints. I have heard it needs to be near the bone. The way I see it, I certainly do not need anything sticking together or inflaming my muscle and fascia, or nerves, for that matter. I have ligamentous laxity and instability, so that is what I want to target.

Have just realized I do in fact have hypermobility syndrome. In the spine, it is the worst the PT who just evaluated me this time has seen "I have not seen anyone with so much hypermobility". He works at a large hospital outpatient clinic and also teaches at the local university.

I have multilevel spondylolisthesis, in the lumbar spine, and the cervical, and recently thoracic vertebrae feel as if they move around too. There is pressure on the nerves in different distributions, depending upon my position of movement, or no pressure, if I align things (pop them back into place).

I've been trying to get appropriate help with my back problems for at least 5 yrs, and have been to multiple doctors and PT's, simply hoping they would team up with me and show me where I've been going wrong.
It's been very round-about getting down to the main cause of my problems, and now I feel it is mostly too late, but I'[m going to do what I can.

I had prolo in one SI joint, 3 times, and it seemed to tighten it, but the sacrum got into torsion anyway, as the other side loosened, and the L4 and other lumbar vertebra must have started to move out of place worse that year (that was last year). I was tortured in a hell on earth - I also had one half-resolved frozen shoulder and on the other side was developing a frozen shoulder, from chronic injury/ hypermobility, and postural instability.

I finally had steroid injections which allows me to scratch my back and pull the covers over myself and lift myself up to move over in bed, however, the spine continues to shift out of place with moving in bed, standing at the counter, or any attempts at exercise.

I haven't even spoken to the injection doc about it. I saw his nurse practicioner, to get in sooner. She ordered another MRI, to see where we were, and it showed antero and retrolisthesis, etc. She said I needed epidural steroid injection, and I asked to start physical therapy (again, at yet another place, to try to get help with proper stabilization exercises and assessment of what the real, root problem is).

I am seeing an osteopath as well, i have been doing alot of reading, now that my brain function has improved, and I have been through a spell of several better weeks vis a vis the ME/CFS. I am now urgently pushing to move forward without further delay, to do as much to stabilize as I can, so I can make rehabilitate (and retrain, as I have virtually lost my profession during the past 3 yrs down with more severe illness) and perhaps salvage enough strength to at least be able to take care of myself independently, clean my house, etc, maybe even be some good to someone else again.

Just thought I'd share this, in case anyone has any tips on what to ask the doc prior to giving the final go-ahead for the injections tomorrow.
Thanks.
WaSP

 

[Lotus97]

I had pain in my knee and hip and it went away after one treatment. However, I had probably a dozen treatments on my hands and feet and they didn't get any better. Spent thousands of dollars. I'm still not too happy about that. I guess it depends on the type of pain and severity.

 

[warriorseekspeace]

So sorry, Lotus, to hear about the disappointing experience with treatment of your hands and feet. Thanks for sharing that, and about the hip and knee. I am lucky I do not have as much problems with the distal joints. I am thinking there must be some sort of unrecognized form which involves mostly proximal/ axial joints, and perhaps things like fingernails (very soft) with the silky skin, uterine and bladder prolapse, GI issues, etc. Although I did have stretched metatarsal ligaments by the time I was 10, so that I already had bunyons and hallux abducto valgus.

I just returned from the injections, lumbar spine. He did say he planned to go for the ligaments at their bony attachments, so I went ahead and did it. He had felt my spine shift around, and said that yes, he thought it was the thing to do, and that it might help.

I am having more trouble now keeping the vertebrae stacked as I sit here, probably because of the marcaine he used to also perform a diagnostic facet block, which means for the next day or so, I have even less ability to sense my position.


Now is the waiting and being careful, and keeping on trying to strengthen the core for stabilization, and visualizing healing. He said eat things I'm allergic to, lol.

I think I'll go lie down now.
WaSP

 

[Lotus97]

One thing I forgot to mention is that I was very sore for many days afterwards and also more susceptibility to injuring the areas treated. I think my doctor was too aggressive on my hands and feet. Maybe if the treatment was done differently it would have worked. He never understood how sick I was (and didn't seem to care either).

 

[Sushi]

I had prolotherapy for my knees--several treatments. It helped but the injections did hurt a lot. I learned to take tylenol beforehand.

Good luck,
Sushi

 

[Lotus97]

The worse your pain is, the worse the injections are going to hurt. Especially if you're doctor is good at finding the right spot (that's one thing my doctor was good at). I think maybe if the pain is very bad it's better to inject around the area that's hurting rather than directly into it. I've gotten bee venom injections, but the prolotherapy injections in my hands and feet were worse. Prolotherapy injections in other parts of my body weren't bad at all though.