Prolotherapy for back pain is a non-surgical injection procedure that is somewhat controversial. It is also called proliferation therapy, sclerotherapy, sclerosant therapy and non-surgical ligament reconstruction. There are no drugs used in prolotherapy, only natural irritants. These substances are injected into the painful area with the intention of eliciting a natural healing response.
While prolothrapy is a step forward in medical thought, embracing a holistic and self-healing philosophy, it is often used for inappropriate diagnoses and may do nothing at all to provide any benefit for some patients. In other cases, patients have claimed complete symptomatic resolution from prolo-injections. It is surely worth investigating for many patients with unresponsive chronic pain.
Prolotherapy is a treatment mostly used for soft tissue injuries. It is typically used to target ligament laxity in the lumbosacral region. This small area in the lower spine contains several sets of ligaments that are often suspected causes of unresolved chronic lumbar back pain.
The lumbosacral ligaments connect the lumbar spine to the sacrum. The sacrum is joined to the ilium and the iliac crest by the sacroiliac ligaments. The lumbar spine is connected to the iliac crest by the iliolumbar ligaments. These 3 sets of ligaments are often blamed for conditions such as sciatica, sacroiliac joint dysfunction (SJD) and general lower back pain.
More recently, I have seen prolotherapy used to treat all manner of back pain diagnoses, including those which seem unjustifiable. There are prolo disc pain treatments, arthritis treatments and various unspecific injections for general back ache. Prolo may make sense in some cases, but in others, seems far-fetched and downright illogical.
A ligament is a sinuous connective tissue that joins 2 bones together. Ligaments are weakest where they actually attach to the bone. These attachments are the most common place for an injury to occur.
It is this close proximity to the actual bone that causes many cases of misdiagnosed back pain to occur. The actual bone or joint is sometimes blamed for pain that is actually coming from a torn or strained ligament.
In prolotherapy treatment, a natural irritant, such as purified cod liver oil or sugar solution, is injected into the injured connective ligament. This irritant stimulates a natural wave of healing in the tissue. New collagen is formed which stiffens up the laxity in the damaged ligament. The ligament is strengthened and tightened, causing the reduction or elimination of the chronic pain. The injection is fast and relatively painless. It can be done by a trained doctor as an outpatient procedure.
For other diagnoses, the procedure is the same, usually with the hope that an irritant will increase circulation, promote cellular activity and speed organic healing. In some patients, this may occur, depending on the nature of the painful complaint. However, in others, the injections may be a waste of time and money and be just another way doctors take advantage of the naiveté of some patients who are desperate for relief at any cost.
Prolotherapy is now used in many locations of the body for soft tissue pain relief. It can be used in ligaments, tendons and joint capsules to encourage the structure to heal from inside, using the body’s own curative power. The idea of prolotherapy is a good one, yet very little definitive evidence exists if it is truly effective as a cure for back pain. There is positive anecdotal evidence from treatment providers, but not many large scale research projects that show whether prolotherapy truly works at all.
There can be side effects and risks to the procedure. Infection is possible and can be serious in the lower back region. The recuperation period is often rather painful, since the goal of the therapy is to irritate the area. Irritation can be agonizing in an already sensitive and traumatized ligament.
I like the idea of prolotherapy conceptually. I think it has potential to eliminate several causes of unresolved physical back pain. The lower back ligaments are often injured and the damage might be difficult for the body to heal. Prolotherapy for back pain gives the body some extra incentive to promote full healing in the damaged ligament. Ask your doctor about prolotherapy. It might just be the answer to your soft tissue-related back pain question. However, be wary of doctors who use the treatment for other diagnoses, such as herniated discs, spinal arthritis, facet syndrome and other spinal abnormalities. Be even more cautious with doctors who suggest the therapy when no diagnosis has even been made. This amounts to risky guessing and you really do not need to seek care from such an unenlightened provider.