Reviewed By: Pramod Kerkar, MD, FFARCSI

Chronic low back pain is a common medical problem and there is no universally effective treatment for this. There are treatment options for the pain; however, it is vital to understand the reason behind every treatment option. Prolotherapy is an injection based procedure that can treat the connective tissue injury of a musculoskeletal system.

This injection provides a healing response in the weakened tissue and the small tears, with the objective of removing the chronic low-back pain. Prolotherapy is also known as sclerotherapy, sclerosant therapy, proliferative injection therapy, regenerative injection therapy, and nonsurgical ligament reconstruction.

Pain Management with Prolotherapy

Prolotherapy is used in pain management and can treat the numerous conditions that include the neck pain and the low back pain because of the spine related conditions including the following:

The theory behind prolotherapy states that back pain occurs is due to the activation of the pain receptors in the ligament or the tendon tissues that are sensitive to pressure, stretching, etc. It is said that the reason for the low-back pain is because of the ligamentous activity. With this prolotherapy process, the substance when injected into the tissue results in an inflammatory response that may cause natural healing and can strengthen the injured or the torn soft tissue and can reduce chronic low back pain.

Causes of Low Back Pain

Almost 90% of chronic low-back pain is mechanical. This kind of low back pain happens because of excessive spraining, straining, bending, or lifting, which gives rise to ligament sprains, disc herniation, and muscle pulls. This pain is a common cause of any disability in people who are below 45 years of age. Though, disc problems may cause low back pain, one important source for this pain is the ligament injury.

Prolotherapy for Chronic Low Back Pain

In prolotherapy treatment, a substance is injected with the slender needle beside the site where the soft tissue such as the tendon, muscle, and ligament has worn out or injured. The substance that is used in this injection is an irritant agent. Some of the examples of these substances include the following:

  • Sugar (glucose or dextrose) either alone or along with phenol and glycerin
  • Sodium morrhuate (a purified form of cod liver oil).

For the prolotherapy treatments for any chronic low back pain or any other disorder, this agent is used together with any local anesthesia (procaine, lidocaine, or marcaine). This treatment includes many injections ranging between 3-30 that depends on the individual patient and the back condition. The injection series usually cover 3-6 months with the injections at an interval of 2-3 weeks.

Outcome of Prolotherapy for Chronic Low Back Pain

The success rate is reported to range between 80%-90% when it is performed by the physicians who are trained in prolotherapy. Most of the reports have anecdotal evidence from the physicians. The anecdotal reports have suggested improvements like the following:

  • Elimination or reduction of chronic low back pain
  • Enhanced strength of tendon, ligament, or joint
  • Reduced occurrence of injury to a treated site
  • Improved normal functioning.

The factors that may result in a successful outcome of prolotherapy for chronic low back pain are the following:

  • Patient willing to go through a follow-up therapy
  • Proper diagnosis of the strain or sprain location
  • Clinical skill of a physician to administer the injection.

However, there is no histology regarding what happens when an injection is placed on the painful soft tissues. Yet, an improvement or reduction in the chronic low back pain is observed.

Recovery After Prolotherapy for Chronic Low Back Pain

For counteracting the pain, if the patients experience a swollen injection site for 2 or 3 days after the injection, the physicians may recommend the following:

  • Apply ice to the painful area for 20 minutes almost 3-5 times in a day
  • Take hydrocodone bitartrate or acetaminophen but not anti-inflammatory or aspirin that can inhibit any healing response.
  • Do moderate exercises like walking but try to avoid any kind of strenuous exercise or heavy-lifting work.

Follow-up with the physician for post therapy programs.

Risks and Complications of Prolotherapy for Chronic Low Back Pain

The injection technique used in prolotherapy needs great care and skills for a physician. Training, as well as experience is mandatory. There may be possible side effects that may remain for a few days and these can include:

  • Swelling
  • Headache
  • Intense stiffness and pain
  • Allergic reaction.

There have been reports of other complications but they are rare. They may include:

  • Paralysis or permanent nerve damage
  • Spinal fluid leak
  • Pneumothorax.

Prolotherapy, when performed by an experienced doctor, is safe and the clinical trials have not reported any major adverse effects. Current data have suggested that it can have a positive effect when compared to the baseline status and when compared to control group. To have a better understanding of this clinical application, it needs further research.

Conclusion

Prolotherapy is a conservative and a reasonable approach for chronic low back pain, sciatica, and disc disease. As this medical condition is the treatment modality, which offers a long-term solution instead of just palliation, it must be considered a suitable treatment in appropriate patients before surgical intervention and the long-term therapy with narcotics.

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: December 4, 2018

This article does not provide medical advice. See disclaimer

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