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Fight Pain With Platelet Rich Plasma (PRP) and Prolotherapy
As Dr. Thomas Ravin, a radiologist and instrumental prolotherapist for more than 30 years noted at a recent prolotherapy conference in Denver, “If you’re only allowed to take one medicine for injury rehabilitation, there is no better medicine than prolotherapy.”
The left image shows a damaged anterior cruciate ligament. After prolotherapy treatment done under X-ray guidance, the image on the right shows ACL fibres tightly arranged from the bottom left to the upper right. The fibres have a denser appearance (darker in image).
Aside from surgery, there is really no way to regenerate structural integrity in ligaments, tendons and joints that have become loose due to acute strain or longstanding injury. Over a certain degree of strain (in certain tissues, as little as four to six per cent) the body does not have the tools to regenerate the tensegrity these tissues once enjoyed. The result: chronic pain and structural compensation. Ultimately, other tissues inadequately fill the role of the damaged tissues, which reveals itself as bone misalignment, muscle pain and further joint instability. Platelet Rich Plasma (PRP) and Prolotherapy fill this therapeutic void for those suffering from longstanding injuries that may not be an ideal candidate for surgery or are seeking a less-invasive alternative. And, while we often reach for the Ibuprofen, Tylenol or, once at our rope’s end, an injection of cortisone, PRP and prolotherapy not only rehabilitate all sorts of injuries of the joints, tendons, ligaments and fascia, but also helps rehabilitate an important medical paradigm. This is the paradigm that pardons inflammation, embracing it as a necessary and important mediator for facilitating injury recovery. This is juxtaposed to the antiquated idea that we ought to mitigate inflammation in the body with anti-inflammatories such as Aspirin, Ibuprofen, cortisone and even icing an injury. After all, blocking the immune cells with an anti-inflammatory blocks the body’s repair mechanism. So, while for an undetermined amount of time we can control the symptoms of chronic pain or an injury with anti-inflammatories, we cannot rebuild damaged tissues with them. With PRP and prolotherapy we are able to consolidate and amplify the immune system’s efforts in repairing damaged tissues.
Prolotherapy and PRP have earned a reputation, both in the literature and from the doctors using it, as one of the most important medical therapies for pain management and injury rehabilitation. PRP and prolotherapy made their appearance in the 1940s with Dr. George Hacket discovering the value in the treatment of complex joint pathologies. Since then, PRP and prolotherapy have steadily found favour among the medical profession. Used by both medical doctors and naturopathic doctors; it has grown new branches, displaying itself as the treatment of choice or an important ancillary therapy for tendinopathy, ligament laxity, fascial imbalance, back pain, osteoarthritis, shoulder instability, knee pathologies and torn or damaged ligaments and tendons.
Exciting Treatment for Chronic Pain
Early last year I attended a seminar led by Dr. John Lyftogt. In that seminar, he reported that severe chronic pain could be treated with injections under the skin of 5% dextrose, the fluid contained in ordinary Intravenous solutions.
I have been using injection therapy in my practice for the past 8 years, including deep muscle/trigger point injections using neural therapy and even deeper ligament/tendon/joint injections with prolotherapy. I was curious how these tiny superficial injections under the skin could have such a dramatic effect on pain.
My first clinical experience was just one of many successes using this new injection technique. He was a patient with debilitating low back and right leg pain who only a year prior had been actively involved in hockey, soccer, and running. When he came to see me he had stopped all physical activity and was taking high doses of GABA pentin (a drug for neuropathic pain) just to get through his day.
After 3 weeks of treatment not only was he off all medication but had returned to playing hockey and reported 80% improvement in pain. I just ran into him yesterday and he is back to all regular activity and all of his pain is resolved
How could the injection of simple sugar water under the skin provide such pragmatic results?
Dr. Lyftogt explains that for every square millimeter of nerve tissue there are 8,000 nerve fibers which are wrapped in a covering called the myelin sheath and 30,000 other nerve fibers that have no covering. Among these fibers are ones called C fibers. Every group of cells in the body is supplied with these tiny C nerve fibers. Their goal: optimizing cell function.
When there is no injury, they never transmit pain signals. When part of the body is injured, the role of these nerve cells is to kick-start the body’s repair mechanism, to help bring back normal function to the injured body part.
Part of this process is the release of a molecule called substance P (yes, P for Pain). Substance P causes blood vessels to open up, which will make the injured area red, and to leak, which will cause swelling, the first phase of inflammation. When the nerves are injured they swell, causing them to get trapped in the holes that they pass through. This constriction injury can cause ongoing damage to the nerves, which causes the swelling to persist and explains why people who suffer whiplash or sudden jolting injuries have such persistent pain.
By blocking the receptors on the C fibers would result in blocking the release of substance P, and the transmission of pain signals by the C fibers. Sugar (dextrose) has been shown to block these receptor. Once the receptor is blocked, substance P stops being produced, and the painful message which substance P transmits to the brain disappears in a few seconds. The nerve is no longer swollen and easily crosses the small opening in the fascia. It regains its normal function, which is to maintain cell health.