In simplest terms, Prolotherapy (also known as “Regenerative Injection Therapy” or RIT) is the injection of a hypertonic solution containing local anesthetic directly into damaged connective tissue with the purpose of triggering a healing response in order to allow the body’s natural healing mechanisms to take place. The mechanisms of action of RIT are very clearly described in Linetsky’s, Miguel’s, and Saberski’s comprehensive article in the textbook of the American Academy of Pain Management, intended for clinicians, as well as the various books written by Dr. Hauser, intended for the lay public. RIT is of particular interest, because it is believed that it directly addresses the cause of pain, and allows the body to naturally heal itself.
A growing practice in RIT/Prolotherapy is the addition of glucosamine sulfate (GS) to the injected solution in the treatment of OA. GS taken orally has been shown to be effective in the treatment of the pain associated with OA of the knee as well as in the delay of the progressive degeneration. Glucosamine, formed in the body as glucosamine6-phosphate (G6P), is the most fundamental building block required for the biosynthesis of glycolipids, glycoproteins, glycosaminoglycans, hyaluronate and proteoglycans. GS’s mechanism of action in reversing joint degenerations appears to be due to its ability to act as an essential substrate for, and to stimulate the biosynthesis of, the glycosaminoglycans and the hyaluronic acid backbone used in the formation of the proteoglycans found in the structural matrix of the synovium. After an oral dose, glucosamine concentrates in the liver, where it is either incorporated into plasm proteins, degraded into smaller molecules, or utilized for other biosynthetic processes. Although absorption is very high, a substantial quantity of the absorbed glucosamine is probably modified or degraded to smaller compounds, such as H2O, CO2, and urea.
Glucosamine sulfate injections
From these data, it seems intriguing to clinicians to inject GS directly into the osteoarthritic joint – to put the medicine right where it is needed. Klein et al. conducted a pilot study to test the potential effectiveness of intradiscal injection therapy using an RIT solution which included GS in the treatment of intervertebral disc disease. Thirty patients with chronic intractable discogenic low back pain took part in the study. Affected lumbar intervertebral discs were injected with a solution of glucosamine and chondroitin sulfate combined with hypertonic dextrose and dimethlysulfoxide (DMSO). Assessment of pain and disability was completed before treatment and 12 months after the last treatment. Although the results were statistically significant for the 30 patients as a whole, 17 of the 30 patients (57%) improved markedly with an average of 72% improvement in disability scores and 76% in visual analogue scores. The other 13 patients (43%) had little or no improvement. Patients who did poorly included those with failed spinal surgery, Spinal Stenosis and long-term disability. Derby et al. also conducted a pilot study where they compared “Intradiscal Restorative Injections” containing GS to Intradiscal Electrothermal Treatment (IDET) in the treatement of discogenic disc pain and found restorative injections to be slightly more effective than IDET in reported pain 6-18 months post procedure and much improved in cost-benefit ratio.
Of interest, is that Doctor of Veterinary Medicine (DVMs) have been injecting GS into elite race horses for over 20 years. My experience has been that if you want to know what the most cutting edge alternative treatments are yet to come, look at what the vets are doing. They are a very pragmatic group. They are interested in what works, and further, what works inexpensively.