This page explains both Prolotherapy and Perineural injection therapy (PIT)

What is Prolotherapy / Prolozone?

Prolotherapy is a treatment that triggers proliferation of connective tissue for the purposes of regenerating damaged or weak ligaments, tendons, joints, and bones. Prolotherapy as a treatment using sugar solution (dextrose) was first published in 1937 by osteopathic physician Earl Gedney, who discovered the therapy in treatment of his own finger injury. Read about the history of prolotherapy here.

Prolozone is a variation of prolotherapy using ozone gas that was pioneered by emergency medicine physician Frank Shallenberger, MD. Ozone can be used as an additional proliferation causing agent (proliferant) which works through a variety of different mechanisms related to oxidative stress, triggering an anti-inflammatory and pain relieving effect. Read the 2011 journal article by Frank Shallenberger here.

Treatments at our office combine prolotherapy and prolozone, using first the prolotherapy dextrose solution (medically pure sugar water), which is injected into the ligament, tendon, muscle, or joint capsule. Then ozone is added to the injection as an additional proliferant agent. These together cause a localized inflammation that increases blood supply and flow of nutrients while stimulating the tissue repair mechanisms.

Conditions and Symptoms that HAVE beEN Improved WITH PROLOTHERAPY IN OUR OFFICE

Degenerative arthritis (osteoarthritis)
Chronic low back pain, such as spondylolisthesis
Chronic or acute neck pain, such as from whiplash injury
Herniated or damaged intervertebral disc disease
Unstable, loose, or hypermobile joints
If prolonged manipulation is necessary this is an indication of joint instability and prolotherapy may be helpful in addition
Failed surgeries - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573860/
Decreased strength and endurance
Pain with activity, such as repetitive motion injury (eg. tennis elbow)
Temporomandibular joint disease
Various conditions such as osteoporosis with compression fractures, muscular dystrophy, and spinal defects such as scoliosis.
Sports injuries or other traumas

Sports Injuries?

Prolotherapy can help the injured athlete with chronic injuries, such as sprains, strains, tendinopathy, and tendinitis. Chronic knee and ankle injuries such as found in football and basketball players respond well to prolotherapy and prolozone. Chronic rock climber shoulder injuries and tennis elbow are also ideal candidates for prolotherapy, usually responding very quickly.

How long will it take to complete a course of treatments?

The response to treatment varies depends upon the individual healing ability, based on factors such as poor sleep, toxicity, malnutrition, and chronic stress. Some people may only need a few treatments while other may need 10 or more. The average number of treatments is 4-6 for an area treated. Once you begin treatment, we can get a better sense of how are you responding and give you a more accurate estimate. There are many other tests and treatments that may be recommended for you based on your individualized need.

Prolotherapy is not experimental:

According to The American Academy of Orthopaedic Medicine, prolotherapy is no longer an experimental therapy. Click here to discover what they mean by this (.pdf downloaded directly from their site). For more information from the American Academy of Orthopaedic Medicine, visit their overview by clicking here: http://www.aaomed.org/prolotherapy

There is a long list of other professional, medical organizations that endorse prolotherapy and neural therapy, found here: http://www.journalofprolotherapy.com/organizations-that-promote-prolotherapy/

The scientific evidence for prolotherapy:

Here are some recent examples of scientific support for prolotherapy: (click on the title to download .pdf). There is MUCH more research in the last 4 years showing a growing momentum of medical providers offering prolotherapy.

How does prolotherapy work? Can we regrow cartilage?

Many mechanisms have been proposed for how prolotherapy works, with a rapidly growing body of evidence each year. For example, just recently (2016) dextrose prolotherapy has been shown to directly regrow cartilage when directly looking into the knee joint (by arthroscopy).

Click here to download the original 2016 article mentioned above.

Prolotherapy on TV

Prolotherapy explained briefly on the television show, The Doctors.

What is Perineural Injection Therapy (PIT)?

Perineural injection therapy (PIT), formerly known as neural therapy or neural-prolotherapy, has a history of use in traditional prolotherapy procedures with subtle but distinct and significant differences to prolotherapy. The goal of PIT is to reduce hyperexcitability of specific peripheral nerves that are overactive, with an emphasis on resolving chronic neurological inflammation that results in neuropathic pain.

Conditions and Symptoms that HAVE beEN Improved WITH PERINEURAL INJECTION THERAPY IN OUR OFFICE

PIT is most commonly used to treat chronic persistent pain syndromes such as peripheral neuropathies, neuralgias, complex regional pain syndrome, and post-injury neuropathic pain. These include specifically

Chronic injury related pain such as from scar tissue or degenerative arthritis
Radiating pain from diseases such as osteoarthritis
Pain related to degenerative disc disease
Tendinopathy, resulting from tendinitis lasting more than 6 weeks
Chronic sinusitis that is resistant to standard treatments or recurring
Trigeminal neuralgia
Complex regional pain syndrome
Dysautonomia due to upper cervical instability
Failed surgeries or post-surgical pain syndrome

How does perineural injection therapy work?

PIT has the potential to resolve chronic nerve inflammation and facilitate nerve repair. You can read more detail on this at another website, click this link here. When nerves are injured they may create a metabolic state that perpetuates and prolongs nerve inflammation, resulting in hyperexcitability of pain pathways and abnormal tissue function. The epigenetic mechanisms involved in the propagation of neuropathic hyperexcitability include the expression of the neuro inflammasomes, specifically NLRP3, which is a DNA response that causes inflammatory changes in the metabolism and excitability of nerves. NLRPs can be triggered by a number of things including direct compression injury and systemic inflammatory diseases such as infections or autoimmune disease.

PIT uses a mild sugar solution (pharmaceutical buffered 5% dextrose injectable solution) to be administered around an into the peripheral nerve to produce anesthesia and initiated a metabolic shift through downregulation of neurological inflammatory hyperexcitability. By placing the weak sugar solution in and around the nerve, the inflamed and overactive nerve is safely anesthetized and more importantly the TRPV4 receptor is triggered.

The importance of a holistic approach

Medications/Supplements that may support perineural injection therapy also support the metabolic and hyperexcitability of nerves. Specifically these medications reduce nerve inflammation, help to resolve the neuroinflammasome expression, increase potassium in the nerve reducing excitability, and enhance mitochondria and membrane function. These include:

Ketone salts, such as Go-BHB containing products
Specialized pro-resolving mediators (SPMs) such as Resolvin D1
Omega-3 fatty acids
Medium chain triglycerides, especially C8-10
NT factor lipids energy chewables
Berberine
Cannabidiol
Low dose naltrexone

How long will it take to complete a course of treatments?

The response to treatment varies depends upon the individual healing ability, based on factors such as poor sleep, toxicity, malnutrition, and chronic stress. Some people may only need a 1-2 treatments while other may need 10 or more, and severe patients are sometimes happy with the results to continue treatments while other options are explored. The average number of treatments is 4-8 for an area treated. Once you begin treatment, we can get a better sense of how are you responding and give you a more accurate estimate. There are many other tests and treatments that may be recommended for you based on your individualized need.

The scientific evidence for PERINEURAL THERAPY:

There is a clear scientific understanding underlying PIT. The founder of perineural injection therapy, John Lyftgoft, MD has listed 5 randomized control trials (RCTs) showing efficacy, which can be found here.

Also referred to as “Neural Prolotherapy,” this treatment is more fully explained in the Journal of prolotherapy (with reference to many more articles) at the following link: http://journalofprolotherapy.com/neural-prolotherapy/