Marc Darrow MD,JD

Prolotherapy (RIT-Regenerative Injection Therapy) is the injection technique that we still but rarely utilize to help a patient with their back pain. The reason that we rarely use or recommend the treatment to our patients is that of the three regenerative medicine techniques that we use, including Platelet Rich Plasma therapy and stem cell therapy, Prolotherapy or dextrose injections is the weakest of the three proliferants (regenerative injections), and takes many more treatments to create enough tissue regeneration to advance healing.

Prolotherapy is still a successful method of treating pain and injury. For those researching the technique you may have come across different names describing this technique. The term Prolotherapy itself is a term derived from proliferation (prolo for proliferation) therapy. The treatment is also referred to as regenerative injection technique or therapy (RIT). This
name is derived from the details of this procedure. As the name implies, the treatment is designed to regenerate soft tissue, requires injections, and is therapeutic.

RIT begins with an initial series of injections. These injections tend to contain two compounds. The first is an anesthetic that works to numb the area, decreasing pain during injection. The other is an irritant, which can be dextrose (sugar water), or a chemical agent. The idea in this treatment is to irritate the area that is being treated so that the immune system will bring healing cells to the area and repair the old damage.

The difference between Prolotherapy and PRP treatments is that PRP has has growth factors and natural irritants. The difference between Prolotherapy and Stem Cell Therapy is that stem cell therapy has irritants, growth factors, and the actual stem cells that divide and morph into new tissue.

What goes into your specific injections will depend on different factors, including your condition, medical history, and severity of the patient’s pathology.

All three of these RIT injections are designed to create a series of inflammations in the injured area. This stimulates the body’s natural healing processes, using your own immune system to heal the damage. When an inflammation occurs in the body there is slight swelling although this is rarely seen. This is representative of the extra blood that is being brought to that area, and the extra nutrients that are being carried with it.

The injections work to create collagen and cartilage, strengthening the soft tissues of the body. As the injured area grows stronger and more tissue regenerates, the pain typically is reduced or eliminated.

The regenerative injection technique has been successfully used to treat many conditions. The most common issues that respond to RIT are sprains and strains, tendon and ligament tears, loose joints and arthritis, tendonitis, and other types of musculoskeletal pain.

Typical treatment regimens require anywhere from three to six visits, but will vary on a case-by-case basis. Some people feel results after their first injection, while others may never heal. Most patients that don’t heal quit too soon. Since the medical profession is locked into surgery as the answer, patients are told by their doctors that Prolotherapy in any of its forms cannot possibly work.

Side effects of the regenerative injection technique are limited, making it a popular alternative to invasive surgery. The success rate of RIT is estimated at 80 to 90 percent. After receiving injections some patients complain of stiffness or soreness, but that is typically for one to three or four days with the injection techniques we use. More serious side effects include infection, and per a study, back and neck procedures contain the same risks associated with other spinal injection procedures.

Prolotherapy for back pain

Many people have questions when it comes to Prolotherapy. In fact, lots of patients who end up being Prolotherapy advocates had never even heard of the procedure before they took the plunge and gave it a try for themselves. Many of these individuals were people who had exhausted all other options—and once they found out how effective and safe Prolotherapy actually is were astounded it had never been suggested to them earlier.

But this doesn’t necessarily answer the single biggest question that most people have when it comes to Prolotherapy—namely, what is it, and why is it effective?

Prolotherapy is a way of alleviating or even eliminating muscle, ligament, bone, joint, and tendon pain without the use of pills or surgery. Many people who have these sorts of injuries or ailments like arthritis, feel that they’re limited either to going under the scalpel, taking medication for the rest of their lives, or simply living with oftentimes debilitating pain.

Doctors know that patients with sacroiliac joint dysfunction have significant impairment in their quality of life. It is one of the most common causes of low back pain that we see in our office.

Sacroiliac joint dysfunction treatment

Prolotherapy works by strengthening and thickening the ligaments and connective tissue that holds the pelvis, spine, and ribs together. Typically a few injections are needed during a few visits to stabilize the area and bring pain relief through healing. Prolotherapy has shown positive clinical outcomes for 76% of patients with sacroiliac pain.(1) And provides significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections.” (2)

Treating Lumbar Spinal Stenosis

Doctors sat down and in preparing their research on determining a clear cut preferred method of treating lumbar spinal stenosis, they found that there was no clear cut standard of treatment.26

This asks the question then, in lumbar spinal stenosis who should get a fusion and who should not?

This question was recently addressed by researchers. Doctors know that lumbar spinal stenosis is mostly caused by osteoarthritis, or spondylosis. The symptoms of patients can be categorized into two groups: regional (low back pain, and stiffness) or radicular (spinal stenosis mainly presenting as neurogenic claudication, or pain down the arms or legs depending which part of the
spine is affected). Both of these symptoms usually improve with appropriate conservative treatment. However, in advanced cases, surgical intervention may be indicated. In the patients who primarily complain of radiculopathy (pain radiating down the limbs) with a stable spine, a decompression surgery may be recommended by some doctors. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc
disease, and adjacent segment disease, lumbar fusion may also be recommended.27

Lumbar Spinal Stenosis is a narrowing of the space in or between vertebrae where the spinal cord and the spinal nerves travel. It is a diagnostic term with symptoms of lower back pain with or without weakness and loss of sensation in the legs. It is a common condition brought on mostly by aging and the accompanying degeneration of the spine. Discs compress, muscles, ligaments, and tendons weaken. With the spine weakened, the boney structures of the vertebrae begin to overgrow (osteoarthritis) as a means to stabilize the structure. The new boney mass begins to encroach on the openings in the spine that the nerves and spinal cord pass through. As the openings begin to narrow, the spinal canal and nerves may be squeezed against bone, causing irritation, inflammation, and the symptoms of stenosis mentioned above.

Many patients come into our office with a date for surgery or far more unfortunately, a diagnosis of failed back surgery.

There are two main choices for surgery. One is a decompression procedure where the surgeon will shave and cut away the bone narrowing the spinal canals. The second is a fusion procedure to limit the movement between two vertebrae and hopefully stop the compression of nerves. Surgery for spinal stenosis should always be considered only after other conservative therapies have
been exhausted.

It may not be as successful as hoped and may lead to a new diagnosis of “failed back surgery syndrome,” where symptoms continue to deteriorate. It is important to note that in instances where stenosis is so severe that the patient has lost feeling or strength in the legs or bladder control—a surgical consult should be made immediately.

In cases of Lumbar Spinal Stenosis, regenerative Prolotherapy, Platelet Rich Plasma Therapy and Stem Cell Therapy work in a completely different way. Regenerative therapy stabilizes by strengthening the often forgotten and underappreciated spinal ligaments soft tissue around the spine. It has been estimated that 70% of lower back pain can be traced to problems of the
ligaments. Why then aren’t most therapies geared to treating the ligaments? Because most physicians do not believe that the ligaments can be successfully treated, or worse yet that they are not the issue.

Research over the last 70 years has shown that Prolotherapy, the introduction of an irritant solution into the spine through injection, strengthens ligaments and tendons and stabilizes the spine by accelerating the body’s natural healing response—regrowth of tissue through control and rapid inflammation.

Failed back surgery patients 

A 2019 study (3) showed that some patients with failed back surgery achieved significant pain relief from Prolotherapy injections. This is the summary of this research:

“Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome may be inevitable. . .Dextrose (Prolotherapy) is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and (this study) aimed to present and evaluate the outcomes of 5% dextrose for the treatment of failed back surgery syndrome.

A total of 79 patients with failed back surgery syndrome, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre- and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting.

Results: There was statistically significant difference between repeated VAS and ODI measurements. These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for failed back surgery syndrome patients before giving a decision of revision surgery.”

1. Cusi M; Saunders J; Hungerford B; Wisbey-Roth T; Lucas P; Wilson S. The use of prolotherapy in the sacroiliac joint. Br J Sports Med 2010;44: 100-104.
2. Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. J Altern Complement Med. 2010 Dec;16(12):1285-90. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.
3 Solmaz İ, Akpancar S, Örsçelik A, Yener-Karasimav Ö, Gül D. Dextrose injections for failed back surgery syndrome: a consecutive case series. European Spine Journal. 2019 Jul;28(7):1610-7.

Do you have questions? Ask Dr. Darrow

 

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.


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