State of the Art: Prolotherapy Regenerative Medicine

Author: Donna D. Alderman

Prolotherapy is a method of regenerative injection treatment that stimulates healing. This therapy has been in practice for decades in the treatment of musculoskeletal pain and osteoarthritis, and has evolved to include the use of platelet rich plasma (PRP) and autologous adult stem cell sources, such as bone marrow and adipose (fat) stem/stromal cells. Chronic musculoskeletal pain is the most common medical complaint in the United States, and one of the most common reasons for primary care visits. The American Academy of Orthopedic Surgeons estimates that 1 in 2 adults—126.6 million people—are affected by a musculoskeletal condition, comparable to the total percentage of Americans living with a chronic lung or heart condition, costing an estimated $213 billion in annual treatment, care and lost wages. Osteoarthritis (OA) is also a major health issue, and the most common joint disease, affecting millions of people in the United States. Typical medical recommendations for these conditions include prescription medications, which offer temporary relief but may have addiction potential or other unwanted side effects; cortisone, which sometimes helps but can have adverse effects on joints and joint tissue; hyaluronic acid joint injections, which are only temporary; physical therapy, osteopathic or chiropractic treatments, which may help, but not in every case; and of course surgery, which is not always indicated, has additional risk and may fail. In May 2016 Orthopedics Today reported a high incidence of pain 1 year after total knee replacement. Surgeons themselves are questioning whether surgery is always the best answer. A 2016 journal article compared surgery to other more conservative treatments for knee OA and concluded: “Surgery has historically been considered the final solution for treatment of knee osteoarthritis,” however, “there are increasing concerns regarding the lack of randomized controlled studies to support this opinion.” Therefore the need for a safe and effective nonsurgical treatment for musculoskeletal pain and OA is evident. Prolotherapy is low risk and has a high success rate. The newer, more biologic formulas, such as PRP and stem cell sources, allow treatment of more severe chronic, as well as acute issues, while use of musculoskeletal ultrasound for diagnosis and injection guidance improves accuracy and precision.

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