How to Optimize Response to Prolotherapy

Ross Hauser, MDRoss Hauser, MD

In my opinion there are many ways to effectively optimize the success of Prolotherapy in patients suffering from chronic pain.

The following is a guideline:

To effectively optimize Prolotherapy you must:

1. Receive Prolotherapy in the Amount, Solution, and Time Frame That Will Give You Your Best Results!

To effectively cure most chronic pain, Prolotherapy takes, on average three to six treatments. While some people receive outstanding results after one treatment, not all patients do. Chronic long standing pain or excessive damage to the affected joints may require a few visits.

I estimated that upwards of 10% of Prolotherapy patients end their treatments after the first visit because they believe it has failed! If you have chosen Prolotherapy as your choice of treatment for chronic pain, please allow it the opportunity to work, and that is usually three to six sessions.

Prolotherapy is also a flexible treatment that can be made more effective by individualized adjustments. This can mean increasing the solution strength, changing a person’s diet, and implementing the other recommendations in this article.

The typical inflammatory reaction with Prolotherapy generally follows a series of stages which occur over many months. The initial stage is the inflammatory stage which lasts about a week. After this stage is the proliferative phase (where the word “Prolo” comes from, meaning to proliferate) which lasts for six week. After this comes the remodeling phase, which can take up to 18 months.

In regard to Prolotherapy, it is important to get treatment at about six weeks to maximize the effect of the inflammatory and proliferative phases of healing. We have chosen to treat people every four to six weeks for this reason. When a person gets treated more frequently (which we recommend in people with severe injuries or who are treated during their athletic season) we maximize the inflammatory phase and some of the proliferative phase in that we treat them every one to two weeks. This speeds up healing, but you lose some of the proliferative phase healing. For the athlete in the middle of his/her season, we have no choice other than to use really strong proliferants (cause more inflammation) so the inflammatory phase and proliferative phase is accelerated.

2. Get Prolotherapy From an Experienced Prolotherapy Doctor

Not all Prolotherapy doctors are created equal. The vast majority of people that come to Caring Medical from other Prolotherapy practices do so because they are not responding to treatment and believe that Prolotherapy may be more successful delivered by a more experienced practitioner.

Prolotherapy is not “one shot and you are better.” We typically give 30 shots per joint while certain neck or back treatments may be 70-80 shots at one visit. IF YOUR Prolotherapy doctor needs to do the injections under fluoroscopy, gives you just a few injections, or takes a long time per injection, these can often be a sign that the doctor is not a very experienced Prolotherapy doctor (there are exceptions, of course).

3. Get All the Painful Areas Treated With Each Visit

Our bodies are made up of a network of nerves and connective tissue. Patients sometimes want to treat just one area when they have six areas causing them pain. This can prevent true healing. While seemingly unlikely, your shoulder pain can indeed affect how quickly your knee pain resolves! Perhaps the shoulder pain (Prolotherapy to the shoulder video) makes sleep difficult and thus you don’t get repairative sleep and thus your knee pain (see Prolotherapy research paper) does not go away. Many patients receive whole body treatments because they understand it can be their fastest route to pain resolution.

4. Obtain a Good Night’s Sleep

Without deep sleep, you lose your ability to repair damage to your joints because it is during deep sleep that our bodies secrete human growth hormone, which helps connective tissues regenerate and repair.

Prolotherapy may fail if the problems of sleep are not addressed. At Caring Medical we use herbal remedies, along with other modalities such as Xyrem, which is the sodium salt of GHB (gamma hydroxybutyrate) a natural substance that induces deep sleep to give Prolotherapy a chance to work as intended. Do not let poor sleep convince you that Prolotherapy is not working!

5. Prolotherapy Works By Inflammation – Don’t Stop It!

This means you should not be taking any anti-inflammatories or Narcotic medications, which inhibit the immune system and inflammation. Tylenol, acetaminophen, muscle relaxers, and Ultram are okay. These help decrease pain, but do not inhibit the inflammatory response. Herbs, enzymes and vitamins are also very helpful, but avoid ginger as this inhibits prostaglandin synthesis which is needed for proper inflammation.

6. Stretching and Yoga

Do not engage in so much stretching or yoga as to stretch the ligaments inappropriately. If you are stretching and a joint (such as the knee or hip) is hurting, then you are probably stretching the ligament and thus, potentially undoing the Prolotherapy strengthening to the ligaments. Light stretching is fine.

Certain exercises (those that avoid creating high impact or stress on recently treated ligaments) and massage are great after Prolotherapy. These loosen muscles without stretching ligaments.

What about exercise? Ask the doctor about specific activities you want to do after Prolotherapy.

7. Avoid “High-Velocity” Chiropractic Adjustments or Manipulations

Do not get areas that have received Prolotherapy manipulated because you may stretch or damage the very ligaments Prolotherapy is trying to heal and tighten.

8. Eat Well

For the person wanting to maximize the healing after Prolotherapy, it is essential to eat a healthy diet.

The person getting a sugar load several times a day is walking around in an immunosuppressed state. The immune system is what proliferates the tissue after Prolotherapy. So stop eating sugar and junk food and start eating healthy. It’s all part of the program. You need the building blocks to build new tissue.

9. A Positive Thought Has a Positive Effect on the Body

We all know intuitively that a positive thought has a positive effect on the body and a negative thought has a negative effect on the body. This is why I discourage people from reading the newspaper and watching the news. It is way too negative, especially for a person struggling with pain. Such a person does not need more doom and gloom. What a person in pain needs is positivity. That is what Prolotherapy and all the above recommendations are about. Getting the body healthier and stronger. Getting the body in the healing mode. Now we need to get the mind in the healing mode. In other words, a person who is positive about getting better and getting Prolotherapy is going to heal quicker and better with Prolotherapy than a person who doesn’t believe in the therapy and is negative all the time. For the person who tells me all of their horror stories about previous care (some of which led to the chronic pain), I tell them that is in the past. When those negative thoughts come up (like “why did I get that surgery or why did I take all those anti-inflammatories?), I tell them to put a positive spin on it and pray about something very important to them. I also tell them the prayer has to be about something not related to themselves, such as praying for another person. Once a person continues to put a positive spin on the negative thoughts, then the negative thoughts cease or dramatically lessen. Just by stepping into a Prolotherapy doctor’s office means you want to get better. There is no reason not to be positive!