Mind & Body • 27 May 2020

Regenerative Injections for Pain

By uci_admin

Regenerative Injections for Pain

 By Anne Zuzelski, MD

Susan Samueli Integrative Health Institute

UCI Susan and Henry Samueli College of Health Sciences

Pain can be a debilitating and disabling condition.  Whether acute from a new injury, or chronic that has been present for many years, pain can affect relationships and make life and work activities difficult to accomplish.  According to the 2016 National Health Interview Survey (NHIS) data, an estimated 20.4% (50.0 million) of U.S. adults had chronic pain and 8.0% of U.S. adults (19.6 million) had high-impact chronic pain1.  Traditional treatments for pain include oral and topical medication, physical therapy, chiropractics, steroid injections and surgery.

At the Susan Samueli Health Institute (SSHI), we offer other injection therapies when the above treatments have not been successful in managing pain.  A class of newer type of treatments to assist pain and healing is termed regenerative therapies.  It is so named because in addition to improving pain, the goal is to help the body restart the healing process and regenerate tissue in a natural way.  Two of the treatments, prolotherapy and platelet rich plasma (PRP), are offered at SSHI, and can be a helpful addition to the other parts of the treatment plan.

Prolotherapy is an injection for injured tendons, ligaments, muscles and joints.  Its name was coined as the therapy causes proliferation of tissues treated.  It has been in use for over 100 years but current practices were made popular in the 1950’s by surgeon Dr. George Hackett, one of the first physicians to practice prolotherapy in the U.S.  Through dedicated research, Dr. Hackett discovered patterns of pain related to musculoskeletal structures and treatment protocols that helped not only improve pain, but stabilize and regenerate tendons, ligaments and joints.  His protocols have evolved over the years and prolotherapy now encompasses a variety of treatments, all aimed at healing musculoskeletal tissue.

Prolotherapy works by injecting an irritant (typically dextrose) into tissues.  This causes inflammation, which causes blood to flow to the area, platelets to release their growth factors, and stem cells to be recruited to the area to restart the healing response.  Prolotherapy can assist the body with restarting the natural response.  Typically, injuries take several treatments performed monthly, before pain has resolved.

Platelet Rich Plasma (PRP) is another regenerative therapy which has been around for the last 20 years.  Blood is drawn from a patient, spun in a special centrifuge, and the platelets are separated from the rest of plasma to be reinjected into the injured site.  This therapy can be more powerful than prolotherapy, as it is providing a super concentrated amount of platelets, more than what the body would provide in a natural healing response.  The platelets release many different growth factors which aid in the healing response, and which recruit stem cells to come to the area.  Again, PRP usually requires more than one treatment depending on the severity of the injury and is typically performed monthly.

Research evidence for regenerative therapies has been increasing over the past several years.  In a 2013 randomized controlled trial, prolotherapy was found to be superior to saline injections for knee osteoarthritis, with effects lasting up to 2.5 years2.  PRP has been found to be effective in knee osteoarthritis and even equivalent to bone marrow derived stem cell treatment in one study5, 6.  Regenerative injections have shown benefits in treating tennis elbow, with prolotherapy showing positive results up to a year7,8 and a blinded randomized controlled trial found PRP to be superior to anesthetic injection at 6 months9. Several other studies showed patients with temporomandibular joint dysfunction (TMJ) improving after 3-4 treatment sessions of prolotherapy, with pain relief lasting up to 4 years3, 4.  PRP has also been found to be equivalent to steroid injection in the short term, but superior to steroid in the long term in low back conditions, such as facet and sacroiliac pain10, 11.

SSHI is proud to be able to offer regenerative therapies for patients seeking pain relief.  Please contact us today to schedule an evaluation to see if you are an appropriate candidate.

References:

  1. Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmwr.mm6736a2external icon
  2. Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, Zgierska A. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial.  Ann Fam Med. 2013 May-Jun;11(3):229-37. doi: 10.1370/afm.1504. Erratum in: Ann Fam Med. 2013 Sep-Oct;11(5):480
  3. Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years’ follow up. Br J Oral Maxillofac Surg. 2017 Jun;55(5):465-470. doi:10.1016/j.bjoms.2016.12.002. Epub 2017 Apr 29.
  4. Louw WF, Reeves KD, Lam SKH, Cheng AL, Rabago D. Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover. Mayo Clin Proc. 2019 May;94(5):820-832. doi: 10.1016/j.mayocp.2018.07.023. Epub 2019 Mar 14.
  5. Belk JW, Kraeutler MJ, Houck DA, Goodrich JA, Dragoo JL, McCarty EC. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2020 Apr.
  6. Anz AW, Hubbard R, Rendos NK, Everts PA, Andrews JR, Hackel JG.Bone Marrow Aspirate Concentrate Is Equivalent to Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis at 1 Year: A Prospective, Randomized Trial. Orthop J Sports Med. 2020 Feb 18;8(2):2325967119900958
  7. Yelland M, Rabago D, Ryan M, Ng SK, Vithanachchi D, Manickaraj N, Bisset L. Prolotherapy injections and physiotherapy used singly and in combination for lateral epicondylalgia: a single-blinded randomised clinical trial. BMC Musculoskelet Disord. 2019 Nov 3;20(1):509. doi: 10.1186/s12891-019-2905-5.
  8. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med. 2008 May;18(3):248-54. doi: 10.1097/JSM.0b013e318170fc87
  9. Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014 Feb;42(2):463-71. doi: 10.1177/0363546513494359. Epub 2013 Jul 3
  10. Wu J, Zhou J, Liu C, Zhang J, Xiong W, Lv Y, Liu R, Wang R, Du Z, Zhang G, Liu Q. A Prospective Study Comparing Platelet-Rich Plasma and Local Anesthetic (LA)/Corticosteroid in Intra-Articular Injection for the Treatment of Lumbar Facet Joint Syndrome. Pain Pract. 2017 Sep;17(7):914-924. doi: 10.1111/papr.12544. Epub 2017 Feb 22.
  11. Singla V, Batra YK, Bharti N, Goni VG, Marwaha N. Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain. Pain Pract. 2017 Jul;17(6):782-791. doi: 10.1111/papr.12526. Epub 2016 Dec.

 

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