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Regenerative Orthopedic Medicine – Prolotherapy

One of the most common complaints why patients seek medical care is joint pain from acute athletic injuries to chronic degenerative osteoarthritis (OA) which effects over 20 millions of American.

Currently, the most common treatment for both acute and chronic joint pain is non steroidal anti inflammatory drugs (NSAIDs) which while effective unfortunately have numerous side effects and are responsible for thousands of hospitalizations annually for gastrointestinal bleeding and death.

At Restorative Health, Dr Safayan provides his patients prolotherapy, a safe and effective non-surgical injection therapy. He uses either Dextrose (sugar water) or PRP (platelet rich plasma) to treat acute and chronic joint pain. In order to understand how prolotherapy works we must first have an understanding of inflammation.

Inflammation plays a role in the repair process

The word inflammation generally carries a negative connotation. However, there is both bad and good inflammation. Bad inflammation is the hallmark of the diseases that affect mankind including cardiovascular disease, diabetes, arthritis and cancer. On the other hand, good inflammation involves regeneration and repair, which is mediated by a number of different factors found in human blood and tissues. Prolotherapy mobilizes these regenerative mediators and initiates the repair process.

By design most joints and their surrounding structures have limited blood supply. Once injury occurs, the delivery of pro-inflammatory and regenerative mediators through the blood is hampered. As a result, the injury prolongs, predisposing some to incomplete repair and repeated injury, chronic joint dysfunction, pain and adjacent muscle tension and fatigue. One of the major sources of pain is damage to the Enthesis, where ligaments and tendons attach to bone.

What is prolotherapy (prolo) and how it works

Prolo involves injecting the Enthesis with a substance that stimulates regeneration and repair. Dextrose solution (sugar water) is one of the original substances used for nearly 70 years. The injection of a small amount concentrated dextrose into the Enthesis forces surrounding tissue to release repair factors into the injured site via an osmotic gradient. What results is an inflammatory response which repairs the Enthesis relieving the joint pain.

Another substance that is used in prolotherapy is PRP, or platelet rich plasma. Research in recent years has shown that more than 20 regenerative repair factors are found in the platelets in our blood. We take about 10 cc of the patient’s own blood. Then in a special centrifuge we separate the platelets in high concentration. These concentrated platelets or PRP are then injected into the injured Enthesis to repair and tighten the loose ligaments and tendons relieving the joint pain.

The difference between dextrose and PRP

Although both prolo solutions can repair and eliminate joint pain, they achieve it in two different ways. Dextrose acts by attracting the serum containing some regenerative repair factors. While PRP directly delivers pro-inflammatory factors to the damaged Enthesis in high concentration.

Using dextrose may require more injections but it is simpler to use and may be more cost effective. PRP on the other hand requires drawing of the patient’s blood, centrifuging it and then preparing it for the injections. PRP may require fewer injections but is more time consuming, involves handing a blood product, and, as a result, is higher cost.

Often times Dr Safayan will start with dextrose and if the desired results are not achieved, then PRP will be used. There are also cases where both dextrose and PRP are used.

Prolothetapy treatment procedures

We begin the process through physical exam by identifying and making the injured Enthesis then cleansing the area to be injected. Then Dr Safayan uses small amounts of Lidocaine anesthetic to numb the skin overlying the injury. Next, he injects small amounts of the prolo solution, dextrose or PRP, into the injured Enthesis. The number of injections is dependent upon the degree of injury and can range from 10-30 small injections of dextrose or 3-10 of PRP per session.

What to expect after the treatments

After each Dextrose prolo treatment there will be a normal amount of numbness and swelling due to the use of anesthetic and the injections. The numbness goes away within 1-2 hours. However, the discomfort from the injections can last 12-24 hours. It’s normal for the swelling around the join to last 48-72 hours causing some degree of discomfort or pain after each treatment. The PRP injections produce more swelling and pain. However, nearly all discomfort or pain resolves after 3-4 days. We usually recommend Tylenol and, on rare occasions, stronger pain medication.

During the first 10 days after a prolo treatment it’s important that patients limit their physical activity to help the regenerative process take effect. Then the patients resume their regular exercise routine starting at 10% capacity and gradually increasing exercise intensity over the next 10 days. It’s important to note the improvement or continued discomfort as it helps determine future treatments and changes in the prolo solution or injection sites.

The number of treatments required for healing

Generally it may takes 4-6 Dextrose or 2-4 PRP treatments 3-4 weeks apart to achieve desired results. Dr Safayan encourages his patients to followup every 3 weeks to gauge their progress and need for further treatments.

The success rate of prolotherapy

The success rate depends on the general health of the patient as well as the severity and chronicity of their condition. Generally Dr Safayan achieves 90% or better success rate with Dextrose and sometimes higher with PRP.

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