Prolotherapy is an excellent tool for stimulating repair of damaged connective tissue, such as ligaments and tendons. But if natural processes produce healing, why didn’t the tissues heal right the first time, right after the original injury? The answer is complex and evolving as new research studies have shown. The immune system protects the organism from tumors and infections, and is also instrumental in promoting healing of injured tissues. Nutrition and hormonal balance are key factors in the process of healing and directly affect the immune system and collagen repair. There are a number of different hormones which play a role in healing, including thyroid hormones, Testosterone, DHEA, Growth Hormone and Progesterone. All must be considered and assessed when injured tissues do not heal well, especially if a response to Prolotherapy is less than expected.
A 27 year-old muscular male presented to our clinic with chronic neck pain and shoulder pain. He enjoyed weight-lifting and could bench press over 300 lbs. He had significant fatigue since a viral infection when he was 13. Noting his history (and despite his physical appearance and apparent strength), we checked his Free Testosterone level, which was well below normal. Testosterone supplementation was provided to reach normal blood levels. Over 6 months, all of his pain resolved, and he remains pain-free, lifting substantially greater weight, and feeling healthier than he has ever felt to his memory.
A 47 year-old male presented with lateral epicondylosis (outer elbow pain). He was taking hydrocodone 6-8 each day. Over 6 sessions of Prolotherapy was provided with limited and inconsistent benefit. During treatment he developed Plantar Fasciitis (heel pain) without any trauma, and general fatigue. His heel pain did not respond to prolo over 2 sessions, nor did his elbow pain improve. Now suspicious of an underlying systemic deficiency, we tested for and found a substantial DHEA-s and Free Testosterone deficiency. Supplementing both hormones, initiating a low carbohydrate diet, and continuing Prolotherapy, his response has been excellent and his heel pain resolved in 2 sessions. His elbow pain is 95% improved and very rarely affects him. His energy is much improved, and he has begun to lose weight. He has decreased his opiate usage substantially, using this only occasionally.
Recent studies have demonstrated that chronic use of opiate pain medications(codeine, propoxyphene, hydrocodone, oxycodone, among many others) produces a functional deficiency of Testosterone. This was first noted in patients with implantation of a pump that injects opiates directly into the spinal fluid for chronic intractable pain. A recently presented study (Elizabeth S. Miller, PharmD, 2003 Annual Meeting, American Academy of Pain Medicine) has demonstrated that this effect commonly occurs with all tested forms of chronic opiate usage. Many patients who take these medications for their pain will develop limited libido, lowered initiative, reduced tissue healing, reduced exercise tolerance, and other negative effects. Their response to Prolotherapy may even be substantially reduced. Noting this effect, many physicians educated in Prolotherapy are now evaluating androgenic hormone deficiencies, and supplementing these as needed to induce a more consistent tissue repair response.
Opiate medication may be needed to help a patient endure their pain. This may perpetuate the pain by inhibiting the natural healing processes, however. If Testosterone or other androgenic hormones become deficient secondary to the opiate usage, supplementation may then allow consistent healing from the stimulation of Prolotherapy, which then will allow the patient to ultimately discontinue their pain medication. The sooner one discontinues opiate pain medication and anti-inflammatory medication, the sooner their natural healing capacity will prevail. Once these medications are discontinued, the hormones will likely rebound to more normal levels, and the hormone supplementation may potentially be discontinued as well.
In our experience, Prolotherapy rarely fails to provide benefit. When limited gains are seen, and the pain can be reproduced by a careful examination by an experienced Prolotherapy doctor, a thorough nutritional and hormonal assessment may yield the clues to turn a seemingly failed procedure into the successful procedure that Prolotherapy has proven to be in over 70 years of clinical practice.