Prolotherapy and platelet-rich plasma (PRP) therapy

By: Dr. Sean Ceaser Mar 30, 2013

How does prolotherapy work?

They are used to treat arthritis, lower back pain and a variety of pain syndromes related to connective tissue instability.

Prolotherapy and platelet-rich plasma (PRP) therapy are injection therapies that stimulate the body’s own innate repair mechanisms to heal ligament and tendon pathology. They are used to treat arthritis, lower back pain and a variety of pain
syndromes related to connective tissue instability. Prolotherapy is considered an alternative therapy for pain management; however, mainstream medicine is taking notice due to its irresistible draw for both patients and doctors: treatment of musculoskeletal and joint problems without surgery.

How does prolotherapy work?
Prolotherapy derives its name from proliferants, which are used in prolotherapy injection solutions. These proliferants allow for the growth of new ligament tissue in weakened areas. Weakened ligaments/tendons allow for unstable joints with increased mobility; nerve fibres that run through these lax tissues become stretched causing mechanoreceptors to send pain signals (Biedert 1993). Ligament and tendon injuries have been found by pathologists to be degenerative and non-inflammatory in nature (Kader 2002), which may explain the poor results that steroid injections have had in the treatment of chronic sprain/strains (Paavola 2002). Prolotherapy may help degenerative changes, allowing for restructuring of damaged ligaments and tendons.

The standard prolotherapy solution involves the use of 15% dextrose delivered to the fibro-osseous junction. At 15%, the osmotic pressure on surrounding cells exceeds the cells’ ability to compensate and thus, inflammation occurs. Tissue repair is stimulated, which causes platelets, white blood cells and fibroblasts to infiltrate the injected area. These cells release growth factors that stimulate tendon and ligament repair.

Prolotherapy studies and outcomes

Chronic Low Back Pain
One study treated 81 patients afflicted with low back pain for an average of 10 years duration. The experimental group received a proliferant solution containing phenol, glycerine and dextrose; the control group received saline solutions. Spinal manipulation was used in both control and experimental groups. When assessed by disability scores, the experimental group had greater improvement at one, three and six months; more than 50% improvement was noticed in 35 of 40 subjects. Fifteen of 40 patients were free from disability in the experimental group versus four of 41 in the control group (Ongley 1987).

A double-blind, placebo-controlled study, using a 10% dextrose solution, evaluated prolotherapy injections and knee osteoarthritis. Three prolotherapy injections were given spaced two weeks apart; bacteriostatic water was given as a placebo injection. The dextrose-treated knees were given three further injections. The dextrose injections proved to be clinically and statistically superior to placebo with substantial improvements in joint pain (44% decrease), subjective joint swelling (63% decrease), flexion range of motion (14 degree increase) and tendency for knee buckling (85% decrease) (Reeves 2000).

K. Dean Reeves, MD, pursued a study evaluating the effectiveness of treating severe fibromyalgia using prolotherapy. He noted that fibromyalgia classical tender points were over tendon and ligament insertions and that these areas may be primary nociceptors for the condition. All patients had experienced continuous upper body, back and lower body pain for more than six months. Sixteen injection sites were selected and questionnaires were used to evaluate tender point severity. Results showed an average of 32.1% pain reduction in all trigger points. Twenty of 31 patients found that prolotherapy was the only effective treatment or was much more effective than other treatments (Reeves 1994).

How does PRP work? (Prolotherapy and platelet-rich plasma)
This is how I explain the concept: prolotherapy uses dextrose to attract platelets, white blood cells and fibroblasts to the area, so it acts like a foreman calling in the work crew to repair tissue; PRP, however, brings the work crew right to the area as it already has all the needed components to begin cell repair. All components of the injection (platelets, white blood cells and serum) are rich in growth factors that are summarizedas follows:

Platelet concentrate stimulates chemotactic migration and proliferation of human stem cells to the area of injection. An increase of four to seven times the normal platelet count is ideal for PRP injections. A five-time increase of platelets allows for a 227% increase in human stem cell proliferation (Haynesworth 2002). Mesenchymal stem cells play an important part in musculoskeletal tissue repair, and exposure of these stem cells to PRP causes a significant chemotactic effect in a dose-dependent manner (Haynesworth 2002).

PRP therapy studies and outcomes

Shoulder Injury/Rotator Cuff Tears
A clinical trial evaluated patients whom had failed nonoperative treatments such as NSAIDs, physical therapy and corticosteroid injections and all were considering surgical options. After PRP treatment, 12 of 14 patients had statistically significant improvements in their pain scale and their strength and endurance at eight weeks. Six had radiographic evidence of healing of their tendinopathy on MRI at eight weeks (Scarpone 2005).

Tennis Elbow
After PRP therapy, 79% of patients in whom nonsurgical modalities (physical therapy, splinting, anti-inflammatory medication and prior steroid injections) had failed were completely relieved of pain (Edwards 2003).

Sports Injuries
PRP has been shown to diminish swelling, reduce pain and fully regenerate muscle tissue in athletic muscle injuries, allowing for restoration of functional capabilities in half the normal time of recovery (Anitua 2004).

Dr. Ceaser graduated in 1999 from the National College of Naturopathic Medicine, the longest standing accredited Naturopathic College in North America. Prior to this 4 year full time medical program, he obtained a Bachelor of Science degree with honors from the University of Winnipeg (Biology). Training in naturopathic medicine includes biochemistry, anatomy, physiology, lab diagnosis, dermatology, pediatrics and many other medical clinical courses. Naturopathic physicians have extensive training in natural therapies and a holistic approach to treating patients that addresses mind, body and spirit.