Scar Away Your Pain? Some Docs Back Prolotherapy

Feb. 4, 2008— -- In college Barry Taft could bench-press a maximum of 225 pounds.

But over time the strain of weight lifting led Taft to severely injure the rotator cuff in his left shoulder.

"Boy, it just really hurt after that," Taft said. "For weeks and weeks it would not get any better." Taft could no longer take the 45-pound bar off the rack, let alone bench-press it with weights attached.

Eventually he opted for a little-known treatment that involved four sets of injections over the course of a year.

Taft says his muscles are now better than ever.

"I'm much beyond the old level of activity," Taft, 53, said, adding that he can now bench-press a maximum of 275 pounds.

The idea, though it may sound strange to some, is not a new one. In the fifth century B.C., Hippocrates, the "father of medicine," used to treat javelin and discus throwers for shoulder pain by inserting hot needles into their muscles. The resulting scar tissue helped stabilize and heal injuries.

While this painful procedure sounds bizarre, it is the precursor to modern prolotherapy, a treatment for joint pain. The technique utilizes the body's own resources and the inflammatory response to heal itself.

Natural Healing

Between the 1920s and 1950s, doctors modernized and refined prolotherapy. Instead of forcing scarring with hot needles, a concentrated sugar solution is injected in and around the injured area, as close to the tendons and ligaments as possible. The injections irritate the tissues and cause inflammation, which rushes blood, nutrients and cells called fibroblasts to the area.

Fibroblasts help lay down the repair fibers -- namely collagen -- in an injured area, creating a scar.

"In general, in pain, we think of scarring as bad," said Dr. Christopher Chisholm, an anesthesiologist at Scripps Memorial Hospital in La Jolla, Calif. "In prolotherapy, we think of scarring as good."

But prolotherapy is more than just scar tissue, which can form haphazardly. Unlike surgery, prolotherapy allows for movement following the injections. Collagen fibers are laid down in line with the forces of movement, supporting and strengthening the appropriate musculoskeletal fibers.

"All we are doing is copying nature," said Dr. Marc Darrow, a prolotherapist and assistant professor of medicine at the University of California, Los Angeles. "It can help rejuvenate the body and return it to the pre-injury, pre-pain state."

Prolotherapy is strongly endorsed by some doctors and gets quizzical looks from others. The treatment has been touted as a cure for chronic musculoskeletal pain, caused by injury to tendons and ligaments, which hold muscles and bones together.

But a lack of substantial research has prevented prolotherapy from being widely used. New research that attempts to better pin down how prolotherapy works may help move prolotherapy from the nebulous realm of complementary medicine into mainstream medicine.

Doctors who perform the treatments said prolotherapy has a high success rate for patients, particularly those with joint pain, arthritis, bunions and chronic sprains. They say the treatments work to permanently cure musculoskeletal pain for about 80 to 90 percent of their patients. And compared to the lengthy recovery period and physical therapy needed after surgery, prolotherapy acts within months to cure chronic pain.

No Verdict Yet

But the jury is still out on whether the treatment has consistent benefits, according to Dr. Ricardo Cruciani, an anesthesiologist at Beth Israel Medical Center, in New York City.

He pointed out that, in a handful of studies, about half have shown that patients benefit from the treatments, while the other half showed no benefit in either pain or quality of life. Cruciani said more research is necessary for prolotherapy to become a mainstream pain relief technique.

While most doctors do not deny that prolotherapy can work for some patients, unless it receives a tried-and-tested seal of approval, the treatment is unlikely to gain wide use, much less insurance coverage.

Michael P. Sullivan, a spokesman for CareFirst, Blue Cross Blue Shield, said prolotherapy is generally not covered because it is considered experimental. He cited that, among other criteria, a treatment requires conclusive scientific evidence and appropriate government approval before it can be considered for coverage.

Thus far, prolotherapy has been practiced more widely than it has been clinically studied. Dr. Ronald Glick is the principle investigator of an NIH-funded study on prolotherapy to determine if it is the liquid irritant, the pressure from the fluid, or simply the deep needle insertion that promotes healing.

"It is up to the academic community to study this and support that it works," said Glick, director of the Center for Integrative Medicine at the University of Pittsburgh Medical Center. "We are trying to pin down, What really is prolotherapy?"