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PROLOTHERAPY
     

Q: WHAT IS PROLOTHERAPY?

A: Prolotherapy is also known as proliferation therapy, regenerative therapy or sclerotherapy.  In this treatment injections are done at the attachment sites of ligaments and tendons onto the bones, in order to strengthen and tighten the ligaments or tendons.  Ligaments are structural rubber bands which hold which hold bones together around a joint, so this improves joint stability and reduces pain.  Tendons attach muscles to the bones and the muscles always attach on both sides of the joints, so tendon injections work in a similar manner.  A different type of prolotherapy procedure is done in order to improve cartilage regeneration inside joints.  These injections can be helpful for degenerative arthritis of the commonly injured hip, knee shoulder and finger joints.

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Q: WHAT IS ACTUALLY INJECTED?

A: The injection contains a local anesthetic similar to novocaine, dextrose and possibly other substances.  These substances cause an inflammatory response which attracts certain cells and growth factors to the area, which leads to growth of more ligament, tendon and cartilage. 

Q: WILL IT HELP ME?

A: Most patients do well with this treatment.  In our experience about 50% of patients will have a very good pain relief, about 25% will have a good or partial pain relief, and about 25% will have minimal or no benefit from the procedure.  Most will notice a great improvement in joint stability, especially when they have a history of feeling joints “popping” out of place or requiring frequent manipulation.  Most will notice improved functional results including being able to work better, do more physical activities and more social activities.  Some of the keys to our obtaining these results are careful assessment of who is a good candidate for this procedure and careful performance of this procedure.

Q: DO YOU USE FLUOROSCOPY (X-RAYS) DURING THE INJECTION?

A: Sometimes, especially in areas of the body in which it is difficult to feel where the injection should go.  Most prolotherapy injections do not require fluoroscopy.

Q: WILL IT HURT?

A: Most patients feel a brief sting when the skin is first numbed up and usually a sting when the needle contacts a sensitive ligament or tendon or is injected into the joint.  We usually need to inject a few different areas to get all of the weak and painful ligaments or tendons around the joint.  Some patients prefer to receive some pain medication prior to the injections.

Q: WHAT SHOULD I EXPECT AFTER THE INJECTION? 

A: You might feel some numbness and slight weakness after the injection.  It is probably safest to have someone else drive you home after the procedure unless we inject just a very small area.  Most patients are mildly sore afterwards but a few are quite sore for several days after the procedure.  Tylenol, ice and occasionally stronger pain medications are helpful.  Please note: Do not take anti-inflammatory medications before or after the injections, they will block the effect of the treatment!!  This includes Motrin, Ibuprofen, Advil, Aleve, Celebrex, Bextra, Naprosyn aspirin, etc.  You can continue to take baby aspirin if you are taking it for heart conditions or strokes.

Q: WHAT SHOULD I DO AFTER THE PROCEDURE?

A: We advise patients to take it easy for the rest of the day after the injections.  Some people choose to return to work immediately afterwards, but it is probably best to plan on the rest of the day off after the first injection and then see how you do.  If you don’t have too much pain after the first one than you plan on most likely being able to go straight back to work after the rest of the injections.  If you receive intravenous sedation you will need to have a ride home and will not be able to work the next day.

Q: HOW MANY INJECTIONS DO I NEED TO HAVE?

A: Usually three to four are planned to start off.  If you get relief we will tend to wait and see how well you do and maybe not need to do anymore, but most people will get better improvement with from four to six injections.  Some will need as many as ten injections or occasionally even more to get their best response to the treatment.

Q: WHAT ARE THE RISKS?

A: There are minor common risks such as soreness after the procedure.  Another risk is that the treatment might not help you, as mentioned above about 25% of patients do not get much relief from this procedure.  There is also an extremely rare risk of infection or nerve injury as with any other injection.  Another very rare risk is a collapsed lung when we inject over the ribs or the chest.  Careful technique keeps these risks to a minimum.

Q: WHAT CAN I DO TO IMPROVE MY CHANCES FOR SUCCESS?

A: You can do a lot to help yourself.  Above all, do not take any anti-inflammatory medications during the course of this treatment.  Smoking also strongly limits your healing response, so smokers usually need more of the injections and often do not get as long lasting results from this treatment.  We will be glad to work with you to help you quit smoking in advance of the injections if you wish.  A fitness program also helps increase healing by improving circulation and it also helps stabilize ligaments and tendons.  The same exercises which strengthen muscles also build stronger ligaments and tendons.

Q: WHERE CAN I FIND MORE INFORMATION ON THE PROCEDURE?

A: Three good web sites are www.prolotherapy.com, www.aaomed.org and www.acospm.com.  Please feel free to ask us if you have any further questions.

Q: WILL MY INSURANCE PAY FOR THIS?

A: Most insurers do not cover this procedure even though it has a long history of success and good research to back up its value.  We will discuss our fees with you ahead of time to help you make your decision.

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