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● ARIZONA
PHOENIX
Fred Arnold, DC, NMD

Kent L. Pomeroy, M.D.


SCOTTSDALE
Michael Cronin, N.D.
David Tallman, DC, NMD.


TEMPE
Robb D. Bird, NMD


TUCSON
Jorge B. Cochran, ND.NMD

● ARKANSAS
Merl B. Cox, D.O.

BRITISH COLUMBIA
Christoph Kind, N.D.

CALIFORNIA
ANAHEIM AREA
Hanson Wong, M.D.
Howard Rosen, M.D.

AUBURN
Rodney Van Pelt, M.D.

BAKERSFIELD
Payam Kerendian, D.O.


BEVERLY HILLS
Behzad Emad, M.D.
Payam Kerendian, D.O.


CLOVIS
Kevin Wingert, M.D.

GARDEN GROVE
Howard Rosen, M.D.

GLENDALE
G. Megan Shields, M.D

IRVINE
Allan Sosin, M.D.

Los Angeles
Donna Alderman, D.O.
Marc Darrow, M.D
Hanson Wong, M.D.


Los GATOS
Joshua M, Donaldson, N.D.

Marin County
Paul Handleman, D.O.
John Monagle, NMD


Monterey
Howard Rosen, M.D.


SAN DIEGO
Andrew Kulik, D.O.

Gary Matson, D.O.

SAN FRANCISCO EAST BAY
Donna Alderman, D.O.

SAN FRANCISCO NORTH BAY
Paul Handleman, D.O.
John Monagle, NMD


San Ramon

Richard I. Gracer, M.D.


SANTA BARBARA
Allen Thomashefsky, M.D.


SANTA CRUZ
Joshua M, Donaldson, N.D.

SANTa monica

Peter Fields, M.D.,D.C.

SANTa
ROSA
Justin Hoffman, NMD

Temecula
Edward A. Venn-Watson, M.D.

UKIAH AREA
Rodney Van Pelt, M.D.

● COLORADO
BOULDER
Gary Clark, M.D.


BROOMFIELD

Christopher J. Centeno, M.D.
John R. Schultz, M.D.


COLORADO SPRINGS
Mary Harrow, D.O,

DENVER
Joel A. Berenbeim, D.O.
Thomas Ravin, M.D.

FORT COLLINS
Mark Kelley, N.D. LAc

LITTLETON
Jo Ann Douglas, M.S.,D.O

PARKER
John A. Littleford, D.O.

STEAMBOAT SPRINGS
Jon Freckleton, D.O.

● CONNECTICUT
AVON
Valley Sports Physicians & Orthopedic Medicine
Paul Tortland, D.O.
Albert Kozar

WEST REDDING

Perry M. Perretz, D.O.

● DELAWARE
SOUTHERN NJ
Scott R. Greenberg, M.D.
SOUTHERN PA
Brian J. Shiple, D.O.

● FLORIDA
ORLANDO AREA
Nelson Kraucak, M.D.


ORMAND BEACH
Hana Chaim, DO

Clearwater
Felix Linetsky, M.D.

PLANTATION
Alvin Stein,M.D.

SARASOTA/TAMPA BAY
Mark Walter, M.D.
Wellington Chen, M.D.
Matthew Burks, M.D.

TAMPA BAY AREA
Felix Linetsky, M.D.
Robinson Family Clinic

● GEORGIA
WARNER ROBINS
E. Glynn Taunton, D.O.

MARIETTA
Robert C. Shuman, M.D.


● HAWAII
HAIKU
Kevin Davison, N.D.

HILO

Liza Maniquis-Smigel, MD

Honolulu, Hawaii
Liza Maniquis-Smigel, MD

● ILLINOIS
CHICAGOLAND

Ross Hauser, M.D

PEORIA
Yibing Li, M.D.
Jay Harms, M.D.

WESTERN ILLINOIS
Anwer Rasheed, M.D.

● INDIANA
CLARKSVILLE
Steven M. Johnson, D.O.

LAFAYETTE

Carolyn G. Kochert, M.D.

Mishawaka
Mark S. Cantieri, D.O.,

● IOWA
CLINTON
Anwer Rasheed, M.D.
IOWA CITY
John Macatee, DO.
WEST DES MOINES
Jacqueline M Stoken, D.O

● KANSAS
KANSAS CITY AREA

K. Dean Reeves, M.D.

TOPEKA
Doug Frye, M.D.

● KENTUCKY
LOUISVILLE
Steven M. Johnson, D.O.

● LOUISIANA
NEW ORLEANS AREA
Thomas K. Bond, M.D.

● MARYLAND
Rockville
Ingrid Gheen, M.D.

● MASSACHUSETTS
MALDEN
Albert V. Franchi, M.D.
WORCESTER

Jon Trister, M.D.

● MICHIGAN
Howell

Jerald Gach, DO
SHELBY TWP
Robert Krasnick, M.D.
Southfield

Jerald Gach, DO
WARREN

Robert Krasnick, M.D.

● MINNESOTA
EXCELSIOR/Menahga
Mark T. Wheaton, M.D.


MINNETONKA
George H. Kramer, M.D.


● MISSOURI
KANSAS CITY
Edward McDonagh, D.O

ST. Peters
Michael J. Adams


● MONTANA
HAMILTON
Mark Kelley, N.D. LAc

● NEVADA
CARSON CITY

Alfred N. Grimes, M.D.


RENO
Andrew C. Wesely, M.D.

● NEW JERSEY
BLAIRSTOWN
Walter R. Grote, D.O

CENTRAL NJ
Edward Magaziner, M.D.

WAYNE/NORTH NJ
Robert Kramberg, M.D.

SOUTH NJ/
PHILADELPHIA
Scott R. Greenberg, M.D.
(Cherry Hill)

Joseph P. Mullane, M.D.
(Hamilton)


Brian J. Shiple, D.O.
(Springfield PA)

● NEW MEXICO
Albuquerque

R. Dean Bair, D.O.

James E. Baum, D.O.
SANTA FE
James E. Baum, D.O.

Jonas R. Skardis, DOM

● NEW YORK
B
ALDWIN
Pandu Tadoori, M.D.

BUFFALO AREA
Timothy L. Speciale, D.O.
BROOKLYN
Neil Raff, MD, CNS
David Zirkitev, P.A.
EAST MEADOW

Christopher Calapai, D.O.

FLUSHING
Neil Raff, MD, CNS
HICKSVILLE
David Borenstein, M.D.

MANHATTAN
Richard Ash, M.D.
David Borenstein, M.D.
John H. Juhl, D.O.
Robert Kramberg, M.D.
NEW YORK METRO AREA
Perry M. Perretz, D.O.
Edward Magaziner, M.D.
Scott R. Greenberg, M.D.
ORANGE
Neil Raff, MD, CNS
ROCKLAND
Neil Raff, MD, CNS
WESTMINSTER
Neil Raff, MD, CNS

● NORTH CAROLINA
ASHEVILLE AREA

Stephen Blievernicht, M.D.
CARY

Catherine Duncan, D.O.

Huntersville
Dr. Mark Hines

● OHIO
AKRON/CANTON
Vladimir Djuric, M.D.
BLUFFTON

L. Terry Chappell, M.D.
CENTERVILLE
Rick Buenaventura, M.D.
CINCINNATI
Michael J. Bertram, MD

TOLEDO AREA

Jay W. Nielsen, M.D.

● OKLAHOMA
BROKEN ARROW
Shirley J. Welden, M.D.

● OREGON
ASHLAND
Allen Thomashefsky,M.D.
EUGENE
Thomas Peterson, M.D.
HILLSBORO
Kevin C. Wilson, N.D.

LAKE OSWEGO

Noel S. Peterson, N.D.

MEDFORD
Carl Osborn, D.O.
OREGON CITY
Joanne Gordon, ND,MS,PT

PORTLAND

Rick Marinelli, N.D.

Chiaoli Lu, ND. LAc. DAOM.
Patrick Chapman, N.D.
Joshua David, N.D.
REDMOND
E. Payson Flattery, D.C.,N.D.
SALEM
Donald McBride, Jr, ND


● PENNSYLVANIA
BALA CYNWYD
Harvey Kleinberg, D.O.
BETHLEHEM
James F. Frommer, M.D.
ELKINS PARK
Kab S. Hong, M.D.
JEANNETTE
Martin P. Gallagher, M.D., D.C.
MEADVILLE
Paul Peirsel, M.D.
PITTSBURG

Paul S. Lieber, MD
SOUTHERN NJ - PA
Scott R. Greenberg, M.D.
Allan Magaziner, D.O
Edward Magaziner, M.D.
SPRINGFIELD
Brian J. Shiple, D.O.
WOMELSDORF
Peter J Blakemore, D.O,

● SOUTH CAROLINA
GREENVILLE/SPARTANSBURG 
Robert Schwartz, M.D.
CHARLESTON
Marc N. Dubick, M.D.
MOUNT PLEASANT
Patrick Lovegrove, D.O.

● TENNESSEE
BRENTWOOD
Mark L. Johnson, M.D.
CLARKSVILLE
Rafael Prieto, M.D.
JACKSON
Marcus E. Meekins, M.D.
MEMPHIS
Marcus E. Meekins, M.D.
NASHVILLE
Mark L. Johnson, M.D.

● TEXAS
AUSTIN
Mihnea Dumitrescu, M.D.

David K. Harris, M.D.
Brad Fullerton, M.D.
DALLAS
Michael Ellman, M.D.

DENTON
Carlos J. Garcia, M.D.
FORT WORTH
Gerald Harris, DO
Dennis E. Minotti II, D.O
David E. Teitelbaum, D.O.
HOUSTON
Robert Battle, M.D.
Adam Weglein, D.O
HOUSTON AREA

Joseph G. Valdez, M.D

John P. Trowbridge
MESQUITE
Michael Ellman, M.D.
PARIS
Gregg Diamond, M.D.
Norberto Vargas, M.D.
PLANO
Michael Ellman, M.D.
RICHARDSON
Gregg Diamond, M.D.
Norberto Vargas, M.D.

SAN ANTONIO
Annette M. Zaharoff, M.D.
SHERMAN
Gregg Diamond, M.D.
Norberto Vargas, M.D.
SUNNYVALE
Gregg Diamond, M.D.
Norberto Vargas, M.D.

TOMBALL
Shaun Lehmann, M.D.
Curtis Fandrich, D.O.


● UTAH
PARK CITY
Harry Adelson, N.D.
Kenneth Hurwitz, M.D.
SALT LAKE CITY
Harry Adelson, N.D.
E. Alan Jeppsen
SPANISH FORK
David Taylor Roberts, M.D

● VERMONT
WINOOSKI
Jonathan E. Fenton, D.O

● VIRGINIA
ALEXANDRIA
Robert H. Wagner, M.D.
BLUEFIELD
Lenny Horwitz, DPM
FAIRFAX
Mayo Friedlis, M.D.
McLEAN
David Wang, D.O.

VIRGINIA BEACH
Lisa Barr, M.D.

● WASHINGTON
ISSAQUAH
Jena Schliiter., M.D.

SEATTLE AREA
Richard A. Sandler, M.D.
JoAnna Forwell, N.D.

Adam R. Geiger, N.D.


● WEST VIRGINIA
MORGANTOWN

Nori Onishi, D.O.


● WISCONSIN
EAU CLAIRE
Deborah Raehl, DO

WAUWATOSA
Neal Pollack, D.O.

MILWAUKEE
William J. Faber, D.O.
 

CAN ANY RESEARCH DEFINITELY PROVE
THAT PROLOTHERAPY WORKS?

Ross Hauser, M.D.


Before double-blinded studies, doctors would ask patients if they felt better. If patient after patient told the physician they felt better, than it was presumed and accepted that the therapy was effective. If it was a new therapy, then it was taught doctor to doctor and eventually it was taught in medical schools. If this was still the standard upon which medical therapies were judged, then clearly Prolotherapy would be taught in all the medical schools, but it is not. Why not?

Modern allopathathic medical research demands that therapies be proven by double-blinded methods. This means that neither the patient nor the physician knows which therapy is used. For medications this is easy because the pills can be made to look alike and a sugar pill used as the placebo is presumed to have no therapeutic value. Unfortunately for certain procedures, like
Prolotherapy and most surgeries, there is no adequate placebo. 

Prolotherapy involves multiple Prolotherapy injections into the ligament/bone interface and joints where a person is experiencing pain. Prolotherapy induces a mild inflammatory reaction that helps proliferate fibroblasts which make the collagen tissue which makes up ligaments, tendons, and most joint tissue.

Once enough collagen is made, that ligament, tendon, or joint structure will improve its strength enough to eliminate the person's pain. Current researchers typically use saline solution as a placebo in
Prolotherapy studies instead of one of the ‘normal’ Prolotherapy solutions

In other words, the technique of the
Prolotherapy injections versus the placebo injections is exactly the same. The placebo injections involve piercing the skin and injecting the saline solution into the bone/ligament interface or into the respective joints. The problem with this method is that sticking needles into areas of pain as the placebo, is not a placebo, it is called acupuncture. It has been shown that just dry needling an area of pain can help diminish or eliminate the pain.1 Acupuncture is an accepted medical treatment. On top of that, to diminish the pain of the Prolotherapy shots, researchers will often inject lidocaine or anesthetics into the skin, but this again is an active treatment for pain. Intradermal injection (injection into the skin) is another method practitioners can use to eliminate pain. Another fact is that saline injections into areas of pain is also an effective therapy to eliminate pain. For example, in a controlled, double-blind comparison of mepivicaine injection versus saline injection for myofascial pain, the group receiving saline tended to have more relief of pain, especially after the first injection. In this study, 28 patients with acute, localized muscle pain received four local injections of mepivicaine (anesthetic) and 25 patients with the same type of pain received local injections of an equivalent volume of physiological saline. Considerable improvement or freedom from symptoms was reported in 48% of patients treated with physiological saline and 42% in the mepivicaine group. 

The conclusion was that physiological saline is considered to be a more appropriate fluid for injection therapy than local anaesthetics since it is less likely to produce side-effects. The study, therefore, raises questions about the mechanism by which local injections into muscles relieves pain, since there is the possibility that a similar effect might also be achieved by merely inserting a needle into the trigger point.2 One wonders if the reason saline helps with muscle pain is because it induces a mild inflammatory reaction. Such a reaction deems the therapy then Prolotherapy. There have been other studies also to show the pain-reducing effects of saline or just plain sterile water injections.3,4 Also, what worse back pain can there be than labor pain? Subcutaneous injections of sterile water into the area of back pain in women in labor can significantly reduce their pain.5,6,7 

In summary, sticking a needle through the skin eliminates pain (acupuncture), sticking a needle through muscles eliminates pain (dry needling), sticking a needle into the skin and injecting water into it eliminates pain, and saline injections into muscles eliminates pain. So if one was to do a Prolotherapy study it would be impossible to have a placebo group because the placebo group even if they were injected with nothing would still be getting a treatment that eliminates pain.

The reason I went through this whole explanation is that the latest study on Prolotherapy used saline injections as the placebo group. The study was printed in Spine and was entitled Prolotherapy Injections, Saline injections, and Exercises for Chronic Low-Back Pain: A Randomized Trial.8 The null hypothesis was that Prolotherapy injections and exercises would be no more effective than the control treatment. 

The authors did a good job to assure that their null hypothesis would be true because the control treatment was a treatment. In other words, the control group in this case involved the person getting the exact same shots as the person getting ‘Prolotherapy’ except the solution was different. The Prolotherapy group received injections of hypertonic
dextrose and the control group received injections of saline. How much different of an inflammatory reaction do you think would occur between the two. Not too much, but some. The results showed that at 12 months, the proportions achieving more than 50% reduction in pain from baseline by injection group were glucose-lidocaine: 0.46 versus saline: 0.36. The conclusion of the study was that in chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises.

So in summary, ligament injections work to eliminate the pain. Since the ‘Prolotherapy’ solution did not significantly eliminate pain better than the saline group in this study, some are reporting that this study shows that Prolotherapy doesn’t work. 

I wrote to the primary author Dr. Michael Yelland and he wrote me back and said, “Our results may be interpreted as negative by those who focus solely on the lack of significant differences between groups and choose not to notice the sustained and significant reductions in pain and disability lasting two years.9 I let him know that the results of this study in regard to the
dextrose Prolotherapy group are far inferior to what Hackett-Hemwall Prolotherapy doctors achieve (50% pain reduction in this study, versus 75% cure rate with Hackett-Hemwall Prolotherapy!). I encouraged him or his colleagues in Australia to contact me about getting additional Prolotherapy training for him or his colleagues but haven’t heard back.

In this study the amount of solution injected was far less than is used in a typical Prolotherapy treatment by a Hackett-Hemwall Prolotherapy doctor (30cc versus 80cc). In this study the deep sacroiliac ligaments were not injected routinely whereas in Hackett-Hemwall Prolotherapy they are typically included in a comprehensive low back treatment. In this study, injections were performed through an anesthetized wheal of skin over each site. Thus, an intradermal injection of anesthetic was done over the area of pain in both the Prolotherapy group and the control group. As I alluded to above, this is an active treatment for pain. It has been shown in various studies to decrease pain, so the ‘placebo’ group in this study was an active treatment group. In this study if no improvement was noted by the fifth session of injections, the deeper interosseous
sacroiliac ligaments on the affected sides or sides were also treated. Again, this area is typically done at all visits with Hackett-Hemwall Prolotherapy. 

So what did this study show? At 12 months, the proportions of all participants who rated their pain and disability as better than at enrollment were 76% in the Dextrose-Prolotherapy group and 68% in the Saline-Prolotherapy group. I am calling it Saline-Prolotherapy group because the technique of Prolotherapy was used. In other words, a needle was used to inject solution into the bone-ligament interface and such a ‘trauma’ would induce a mild inflammatory reaction. At 12 months, the proportions of participants who achieved at least a 50% reduction of pain in each group were glucose-lidocaine Prolotherapy of 46% and Saline- Prolotherapy 36%. 

SUMMARY

The latest study on Prolotherapy once again showed that Prolotherapy works at eliminating pain. The study looked at two different solutions: hypertonic dextrose and saline. Hypertonic dextrose eliminated pain slightly better than saline but it was not statistically significant. 

In this study, and others regarding Prolotherapy, the difficulty lies in the fact that there is not a placebo group that can satisfy the true requirements of a placebo. A placebo is to have no biological effect. Studies have shown that sticking a needle into an area of pain with or without injecting a substance into the area has a biological effect and helps eliminate the pain. As such, Prolotherapy studies can just compare one solution to another. As long as the studies show that both solutions work, as the latest study has, instead of allopathic physicians claiming Prolotherapy doesn’t work (because the Prolotherapy solution group did not reduce pain significantly more than the control injection group), they should accept the fact that simple solutions can eliminate people’s pain as long as the technique of Prolotherapy is used. Injecting sugar or saline-type solutions into the ligament/bone interface eliminates chronic pain. This is consistent with the current thinking among Prolotherapy physicians that the chronic pain that people suffer from is at the ligament/bone interface called the
fibro-osseous junction. Prolotherapy by inducing a mild inflammatory reaction in the area helps it to repair. Once this interface is strong the person's chronic pain is eliminated. 

1. Garvey, T. A prospective, randomized, double-blind evaluation of trigger point injection therapy for low back pain. Spine. 1989; 14: 962-964.
2. Frost, F. A control, double-blind comparison of mepivicaine injection versus saline injection for myofascial pain. The Lancet. 1980; March 8, pp. 499-501. 
3. Jenson, M. Improved patient compliance after trigger point injections using a 0.9% sodium chloride compared to bupivacaine 0.025% for patients with myofascial pain syndrome. The Pain Practitioner. 2001; Fall, pp. 4-6.
4. Byrn, C. Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. The Lancet. 1993; 341: 449-452.
5. Trolle, B. The effect of sterile water blocks on low back pain labor pain. Am J Obstet Gynecol. 1991; 164: 1277-81.
6. Ader, L. Parturition pain treated by intracutaneous injections of sterile water. Pain. 1990; 41: 133-8.
7. Byrn, C. Subcutaneous sterile water injections for chronic neck and shoulder pain following whiplash injuries. The Lancet. 1993; 341: 449-452.
8. Yelland, Michael. Prolotherapy injections, saline injections and exercises for chronic low back pain: a randomized trial Spine; 2004: 9-16.
9. Personal email correspondence 3/22/04. 
 

 

Prolotherapy
Information and Research
Prolotherapy
Prolotherapy
How Does Prolotherapy Work?
Why Does Prolotherapy Work?
How Prolotherapy Helps?
Indications - Contraindications
Introduction to Prolotherapy
Why Get Prolotherapy?
What is Prolotherapy?
How Does Prolotherapy Work?
Are You A Prolo Candidate?

Ligament Reconstruction
How Safe Is Prolotherapy?
Finding a Prolotherapy doctor
When Prolo May Not Work
20 Questions - Prolotherapy
The History of Prolotherapy
Curing Chronic Pain
Sclerotherapy?
Turning to Prolotherapy
Prolotherapy and Chronic Pain
Proof Prolotherapy is Working
Creating Collagen
How To Support Treatment

· Platelet Rich Plasma PRP

Prolotherapy and Inflammation

Prolotherapy In The News
 


Prolotherapy
Videos Online

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· Prolotherapy Information sites

The Journal of Prolotherapy


Prolotherapy Research at
The Journal of Prolotherapy




 

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