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Find A
Prolotherapy Doctor
Physicians Add Your
Listing
● 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
BALDWIN
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
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Platelet Rich Plasma PRP
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Prolotherapy
and Inflammation
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Prolotherapy
In The News
Prolotherapy
Videos Online
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Prolotherapy to the knee
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Back and Spine treatments
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Shoulder treatments
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Prolotherapy Information sites
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