Prolotherapy

[marti124]

It appears that the clinical evidence currently available doesn't support the use of prolotherapy.

http://www.aetna.com/cpb/medical/data/200_299/0207.html
http://www.quackwatch.org/01QuackeryRelatedTopics/prolo.html

David, I've read the Blue Cross and UHC statements on Prolotherapy and am well aware of them. In my posting, I provided this paragraph:

By the way, Dr. Hauser has a great critique on the established insurance companies and medical critics of Prolotherapy who use "placebo" studies to show that the statistical significance is slight (bottom line: Prolotherapy is so close to a placebo technique anyway so to say that both placebo and prolotherapy benefits patients 30-35 % in missing the significance that 65% of the patients got better! Think of prolotherapy as akin to accupuncture with tiny needle liquid injections -- it's as much operative from the accupuncture puncturing/stimulating of nerves/blood flow as it is from the injection liquid (we're talking conventional prolotherapy where the liguids are benign materials anyway--not PRP nor Stem Cell Prolotherapy). See Hauser's comments here: http://www.caringmedical.com/media_a...e_It_Works.htm and http://www.caringmedical.com/media_a...EBO_EFFECT.htm and http://www.caringmedical.com/videos/...le-blind-study

If PRP Prolotherapy and Stem Cell Prolotherapy was not effective, I don't think you'd see people like Tiger Woods and the nearly hundred other professional atheletes and others use the treatment form. Follow some of the links. You'll also note that the criticism of Blue Cross was that the effectiveness of the treatment depends upon the skills of the provider, which is one of the reasons they don't approve it yet nationwide. It is effective if done right by skilled practitioners, but it's not something that takes just one session. Some of the critiques did their analyses using only one session of prolotherapy. You have to remember the saying "follow the money". Conventional Orthopedics, which by the way has horrible statistics in its effectiveness in restoring the knee to its pre-injury state, uses far more expensive methods. These surgeons do not want their societies approving methods that are far less expensive.

 

[David Metsky]

If PRP Prolotherapy and Stem Cell Prolotherapy was not effective, I don't think you'd see people like Tiger Woods and the nearly hundred other professional atheletes and others use the treatment form.

I'll just say that professional athletes are notoriously poor judges of medical efficacy. There may be something useful on prolotherapy, but IMO it hasn't been proven yet.

 

[marti124]

I'll just say that professional athletes are notoriously poor judges of medical efficacy. There may be something useful on prolotherapy, but IMO it hasn't been proven yet.

I won't disagree with your wording, "proven". But that doesn't mean it's not worthwhile to try. If everyone took your approach, we'd never get new advances proven.

It takes people like me, and the professional athletes and amateur athletes, and the medical doctors and researchers, and capitalists who are backing Orthobiologics (that is what this field is called) to advance it to a state where it is "proven". But I'll tell you what is basically proven, conventional Orthopedic surgery rarely gets a person's knee back to it's pre-injury state and has a statistically significant risk of subsequent orthopedic surgery and/or knee replacement years afterwards. The most I have to risk going to a world renowned prolotherapist (coincidentally, this coming Tuesday in Chicago, is just wasting my money. The risk of further knee complications is near zero.) Even Blue Cross and Aetna recognize that.

 

[DougPaul]

It appears that the clinical evidence currently available doesn't support the use of prolotherapy.

http://www.aetna.com/cpb/medical/data/200_299/0207.html
http://www.quackwatch.org/01QuackeryRelatedTopics/prolo.html

I gave the refs a quick read and agree with Dave's summary.

Doug

 

[DougPaul]

If PRP Prolotherapy and Stem Cell Prolotherapy was not effective, I don't think you'd see people like Tiger Woods and the nearly hundred other professional atheletes and others use the treatment form.

I'll just say that professional athletes are notoriously poor judges of medical efficacy. There may be something useful on prolotherapy, but IMO it hasn't been proven yet.

Not only are professional athletes not good judges of medical efficacy, they are often paid for testimonials (whether they use the product or not).

The gold standard is a randomized double-blind study comparing the proposed treatment to a control treatment published in a peer-reviewed journal. The number of subjects must also be large enough to achieve statistical significance. If the control is a placebo (sham treatment) the study tests for efficacy and if the control is an established treatment then the study is attempting to see which treatment is better (Commercial (eg drug) companies often avoid comparative studies because they might show someone else's product to be better...)

Anything less than such a study is at best suggestive or at worst unsubstantiated rumors, hearsay, and/or advertising (a major component of snake oil...).

Lots of misinformation, medical and otherwise, has been spread over the back fence. (The internet is just a bigger "back fence"...)

Remember: it is up to the proponents to prove the efficacy (and that it is better than conventional treatments) beyond a reasonable doubt, not for the opponents to disprove it.

Maybe there is some value to prolotherapy, maybe not. But I'd wait for some real evidence before using it. In this case at least, it appears that the risk of damage is low.

Doug

 

[marti124]

I gave the refs a quick read and agree with Dave's summary.

Doug

Doug, did you hear the counterpoint or are you only listening/reading half the debate? I'm referring to the below paragraph.

By the way, Dr. Hauser has a great critique on the established insurance companies and medical critics of Prolotherapy who use "placebo" studies to show that the statistical significance is slight (bottom line: Prolotherapy is so close to a placebo technique anyway so to say that both placebo and prolotherapy benefits patients 30-35 % in missing the significance that 65% of the patients got better! Think of prolotherapy as akin to accupuncture with tiny needle liquid injections -- it's as much operative from the accupuncture puncturing/stimulating of nerves/blood flow as it is from the injection liquid (we're talking conventional prolotherapy where the liguids are benign materials anyway--not PRP nor Stem Cell Prolotherapy). See Hauser's comments here: (I see my original post of these links are dead, did not realize you can not copy and paste from posted message to reply of a VFTT link, you have to go back to the original post, go to the link, and copy the URL), so my original posting above in this thread obviously no one has read. Here goes: http://www.caringmedical.com/media_articles/Can_Any_Research_Definitely_Prove_It_Works.htm and http://www.caringmedical.com/media_articles/MRIs_NOCEBO_EFFECT.htm and http://www.vftt.org/forums/showthread.php?p=358974#post358974

In any event, I fly in 30 minutes to go have this procedure done today. I'll be more in the know as time goes by. What I find odd is the support for a procedure that statistically never brings the knee back to its pre-injury state and statistically is significant that the operated upon knee will get worse over the post-operative years.

 

[una_dogger]

In any event, I fly in 30 minutes to go have this procedure done today.

You feeling better and getting back to your activities is what really matters.

Please report back -- I have an open mind to new and alternative therapies (especially those that are non/low invasive) and would like to hear how you make out.

 

[Peakbagr]

Good luck, Roleigh, we're all pulling for you. Pls keep the thread updated on your recovery.

Alan

 

[DougPaul]

Doug, did you hear the counterpoint or are you only listening/reading half the debate? I'm referring to the below paragraph.

I listen to evidence. Not baloney.

By the way, Dr. Hauser has a great critique on the established insurance companies and medical critics of Prolotherapy who use "placebo" studies to show that the statistical significance is slight (bottom line: Prolotherapy is so close to a placebo technique anyway so to say that both placebo and prolotherapy benefits patients 30-35 % in missing the significance that 65% of the patients got better! Think of prolotherapy as akin to accupuncture with tiny needle liquid injections -- it's as much operative from the accupuncture puncturing/stimulating of nerves/blood flow as it is from the injection liquid (we're talking conventional prolotherapy where the liguids are benign materials anyway--not PRP nor Stem Cell Prolotherapy). See Hauser's comments here: (I see my original post of these links are dead, did not realize you can not copy and paste from posted message to reply of a VFTT link, you have to go back to the original post, go to the link, and copy the URL), so my original posting above in this thread obviously no one has read. Here goes: http://www.caringmedical.com/media_articles/Can_Any_Research_Definitely_Prove_It_Works.htm and http://www.caringmedical.com/media_articles/MRIs_NOCEBO_EFFECT.htm and http://www.vftt.org/forums/showthread.php?p=358974#post358974

Yawn! (You are repeating yourself.)

A placebo is a sham treatment. The statement "prolotherapy is so close to a placebo technique" says that prolotherapy is no better than a sham treatment...

The reason that placebos appear to work (to some degree) is that many conditions heal on their own and the psychology of being given a "medical" treatment can increase healing rates. (Even a doctor's choice of words can also affect outcomes...) The patients erroneously assign the cause of the cure to the placebo.

IMO, the use of placebos is not a problem if 1) they are cheap (ie pose no financial burden on the patient and give no profit to the supplier), 2) they pose no risk to the patient, and 3) they are not used in place of an evidence-based treatment. (There may be some ethical problems for the doctor because he knows that he is lying to the patient when he suggests that the placebo may be helpful.) Doctors of old used to have a stock of variously sized and colored inert pills to give in situations where they had no treatment...


Good luck at getting the problem under control.

Doug

 

[marti124]

day 5 since I had a Bone Marrow Stem Cell Prolotherapy treatment for my torn meniscus

This is day 5 since I had a Bone Marrow Stem Cell Prolotherapy treatment for my complex torn meniscus. Full report in another thread on this board.

 

[marti124]

I listen to evidence. Not baloney.

Doug,

Consider this position paper.

Position Paper Regenerative Injection Therapy (RIT): Effectiveness and Appropriate Usage By The Florida Academy of Pain Medicine (FAPM)

http://www.myctm.org/articles/q4-2006-oa-rit-position-paper.pdf

excerpt:


FINDINGS

From 1937 through 2000, more than forty authors reported case studies, retrospective, prospective and animal experiment studies that evaluated the results of treatment with RIT. The calculated number of patients reported in those studies exceeded 530,000. Improvement in terms of return to work and previous functional/occupational activities was reported in 48% to 82% of the patients. The resolution of pain symptomatology was evaluated differently in various studies and ranged from zero to 100%. Complications included 28 pneumothoraces, two requiring chest tubes, 24 allergic reactions, one grand mal seizure, and one aseptic meningitis.

The findings of the FAPM committee substantially contrast with the position of the Department of Health and Human Services (DHHS), Florida Workmen’s Compensation, and Medicare guidelines. The committee recommends consideration of the use of RIT as a type-specific treatment for post-traumatic degenerative, overuse and painful conditions of the musculoskeletal system related to pathology of the connective tissue.

For decades, a small group of allopathic and osteopathic physicians has been practicing the methodology known as Regenerative Injection Therapy (RIT), also known as known in the past as prolotherapy. Pilot, retrospective, open face prospective, and double blind placebo controlled studies have clearly indicated RIT’s effectiveness in the treatment of chronic musculoskeletal pain arising from post-traumatic and degenerative changes in connective tissue such as ligaments, tendons, fascia, and intervertebral discs. (4, 5, 8-10, 12, 14-17, 20-22, 26-28, 35-36, 38-69, 73-83, 88-99, 101-104, 106-111, 113-118, 120-122, 124-128, 133-135)

Clinical and experimental electron microscopic studies have proven that structurally the newly formed connective tissue had biomechanical properties similar to those of normal ligaments and tendons. (78, 94, 99, 110) Preliminary results of clinical prospective trials for chemonucleo-annuloplasty with proliferation-causing substances show significant promise. (35, 36, 81, 97)

The literature dealing with RIT has been evaluated. This information, in association with extensive clinical experience has found RIT to be an effective therapy for a number of chronic pain conditions. This position paper reviews the clinical and pathophysiological aspects of RIT. The Florida Academy of Pain Medicine endorses RIT when utilized appropriately for the treatment of specific chronic pain entities.

 

[daxs]

Interesting though when you look at the references many are quite old dating back to the 1950's and older. There is not really any recent research listed. I am not sure how "rigorous" research criteria were 20 or 30 years ago.

 

[marti124]

Interesting though when you look at the references many are quite old dating back to the 1950's and older. There is not really any recent research listed. I am not sure how "rigorous" research criteria were 20 or 30 years ago.

The median value year of all the footnotes is 1989 with the max value 2001. In human health studies, longitude and persistence over decades is a valuable input to a medical society taking a consensus opinion on a practice. The min value is 1930. The scientific method goes back hundreds of years. The ability to measure efficacy of medical procedures is not something brand new.

 

[una_dogger]

Prolo is being widely Used in veterinary medicine as a non surgical approach or augmentation to surgery (integrative medicine) for such injuries as anterior cruciate ligament tears and hip and elbow dyslplasia with good success. It's something I would certainly consider for my pets and for myself.

Can we get an update from the OP?

 

[marti124]

Can we get an update from the OP?

I presume you're asking how my knee is doing. I've only had the one Stem Cell Prolotherapy session done (Oct 18). I am 100% satisfied with the results, and as the doctor informed me, he suspects I'll need to have the procedure done 3-4 times. Personally I think I'll only need it done 3 times. I get the second procedure done January 10, 2012. My cost for each procedure is $1,100 or $1,150 (I forget which). The plane flight is on top of that (about $200). I'll keep this thread updated with the results of each procedure.

My knee now feels 80% better than it did before the surgery. I suspect though the last 20% (to get back to pre-injury state) will require minimally 2 more procedures, the immediate next being January 10.

I found since a great prolotherapy clinic 2 hours away from Albany in CT:

http://www.jockdoctors.com/
Valley Sports Physicians & Orthopedic Medicine, Inc.
54 West Avon Road
Suite 202
Avon, CT 06001

The doctors' credentials are amazing:
http://www.jockdoctors.com/page.asp?id=38&name=Our Staff&link_id=48

They have the best brochure that explains prolotherapy out I've seen:
http://www.jockdoctors.com/library/documents/Prolotherapy.pdf

 

[daxs]

In the medical field 20 years ago is a long time. Advancements in technology and medicines can make research obsolete. Some of the articles mention things like facet joint injections (actual joint is not injected usually the median branch nerve to the joint is anesthetized) and discography. Not sure if those articles address prolotherapy. I did prolo when I worked in pain management with mixed results. Of course what is being injected now is different from what i used. And that was only 10 years ago.

 

[marti124]

In the medical field 20 years ago is a long time.

By definition, if the median is 1989, then there are as many research articles since 1989 as there were before 1989, making (basically) half the data much more recent. Looking at their footnotes, there are 34 articles with a median of 1997; there 17 articles with a median of 2000. The paper was published in 2001.

If one looks at the National Library of Medicine, you'll find far more recent research going on. You can search The National Library of Medicine and use the term “Prolotherapy” or alternative search terms (“PRP Injections”, “Regenerative Injection Therapy”, “Platelet Rich Plasma Injections”).

A professional Journal, The Journal of Prolotherapy, is completely devoted to research advancements in the field.

Carol, are you retired now? Did you continue to do Prolotherapy up until retirement?

 

[una_dogger]

I presume you're asking how my knee is doing. I've only had the one Stem Cell Prolotherapy session done (Oct 18). I am 100% satisfied with the results, and as the doctor informed me, he suspects I'll need to have the procedure done 3-4 times. Personally I think I'll only need it done 3 times. I get the second procedure done January 10, 2012. My cost for each procedure is $1,100 or $1,150 (I forget which). The plane flight is on top of that (about $200). I'll keep this thread updated with the results of each procedure.

My knee now feels 80% better than it did before the surgery. I suspect though the last 20% (to get back to pre-injury state) will require minimally 2 more procedures, the immediate next being January 10.

Thanks and glad to hear its working out for you :

 

[daxs]

No not retired.Wish, I colud hke more. i'm a physician assistant who is still working. i just got burned out doing pain management (4 yrs) and went into a different specialty. i'm now doing family practice. honestly, i encourage my patients to try alternative/different treatments; especially when the more conventional treatments have failed. they can be very very successfull. I've done some myself; I had an friend who was an osteopathic physician who did adjustments to help with backpain, i've done the Supartz injections for my knee (I guess those are pretty mainstream now) with excellent results. I have another physician friend who does accupuncture who has helped me with muscle spasm in the shoulders and helped to increase range of motion in an ankle that I never rehabbed properly from a sprain. she just gone done a pretty comprehensive course of accupuncture and likes to practice. We have "accupuncture parties" lol. However, I am cautious when patients want to do different herbal supplements. Just because its "natural" does not mean its safe.

Its great the injections are working for you. Hopefully it will be one and done so yo do not need to keep on paying out of pocket.

 

[marti124]

Its great the injections are working for you. Hopefully it will be one and done so yo do not need to keep on paying out of pocket.

Thanks, Carol. With insurance the way it is these days, I have a $5,000 deductible, and pay the first $5000 out of pocket with pre-tax dollars using my Health Savings Account (but my company puts in $1,000 into that HSA account each year), where a procedure is covered by insurance or not is pretty much meaningless as long as your total bill for the year is under $5000. Mine is.