Q: What is Sclerotherapy/Prolotherapy?

A: Sclerotherapy, also know as prolotherapy (proliferative therapy), ligament reconstruction therapy, and fibro-osseous injection therapy, is a recognized orthopedic procedure that stimulates the bodys nature healing processes to strengthen joints weakened by traumatic or over-use injury. Joints when ligaments or tendon attachments are stretched , torn, or fragmented, become hypermobile and painful. Traditional approaches with surgery and anti-inflammatory drugs often fail to stabilized the joint and relieve this pain permanently. prolotherapy, with its unique ability to directly address the cause of the instability, can repair the weakened sites and produce new fibrous tissues, resulting in permanent stabilization of the joint.

Q: How does prolotherapy work?

A: With a precise injection of a mild irritant solution directly on the site of the torn or stretched ligament or tendon, sclerotherapy creates a mild, controlled injury that stimulates the bodys natural healing mechanisms to lay down new tissue on the weakened area. The mild inflammatory response that is created by the injection encourages growth of new ligament or tendon fibers, resulting in a tightening of the weakened structure. Additional treatments repeat this process, allowing a gradual buildup of tissue to restore the original strength to the area.

Q: What is in the solution that is injected?

A: The prolotherapy injections contain anesthetic agents and natural substances which stimulate the healing response. There are numerous substances, and each treating physician tailors the selection of substance according to the patients need. At Central Coast Pain Institute, the physicians will generally use a mixture of local anesthetic, dextrose (sugar) and sodium bicarbonate.  In rare cases, stronger solutions may be required to achieve a good result.

Q: Is the prolotherapy treatment painful?

A: Patients are offered a sedative to reduce anxiety and to make the procedure more comfortable.  Local anesthesia is employed over any area to be treated. Any pain involving an injection will vary according to the structure to be treated and the skill of the physician administering the injection. Dr. Li and Dr. Rosen have trained with all four major prolotherapy groups to achieve the highest possible skill.  Those groups are the American Academy of Orthopedic Medicine, American College of Osteopathic Pain Management & Sclerotherapy, The Hemwall/Hackett  Foundation and the American Academy of Musculoskeletal Medicine.  The treatment may result in mild swelling and stiffness. The usually the discomfort is mild and passes fairly rapidly and can be reduced with pain relievers such as Tylenol. Anti-inflammatory drugs, such as aspirin and ibuprofen, should not be used for pain relief because their action suppresses the desired inflammatory process produced by the injection. Baby aspirin may be continued if needed for medical reasons such as cardiac conditions.

Q Which sedatives are offered?

A We offer the "blue pill" or another oral sedative for patient's wishing to be sedated.  Intravenous sedation is offered if the procedure is performed at a surgicenter.

Q: Can prolotherapy help everyone?

A: Each patient must be evaluated thoroughly with patient history and physical exam. X-ray exam, and full laboratory work up may be needed before treatment will be administered. With this information, your physician can evaluate your potential success with this therapy. Success depends on factors which include the history of damage to the patient, the patients overall health and ability to heal, and any underlying nutritional deficiencies that would impede the healing process.

Q: What areas of the body can be treated?

A: This form of therapy can be used to treat disc problems of any level of the neck, thorax, and back, any pain joint such as the shoulder, elbow, wrist, knee, ankle, foot, hand, arthritis, Temporal Mandibular Joint dysfunction, and Carpal Tunnel Syndrome, and disc problems at any level of the spine. The therapy affects only the area treated and does not cause any problem in any other area.

Q: How often do I need these treatments?

A: The treatments should be administered every two, three or four weeks, as determined by your treating physician.

Q How many treatments will I need?

A. Smaller joints generally will need less treatments and larger joints will need more treatements. For example, wrist tendons may need 2-3 treatments. Back treatments may need 3-7 treatments.  Occasionally, if the patient is greatly improved but there is still some pain, more treatments can be employed.

Q: Is this form of therapy really new?

A: Sclerotherapy/prolotherapy has been used successfully as early as 500 B.C. when Roman soldiers with shoulder joint dislocations were treated with hot branding irons to help fuse the torn ligaments in the shoulder joint. Advances in medicines greatly improved on this process, and led to the modern techniques of strengthening the fibrous tissue rather than producing scarring to fuse tissues. In 1926, a group of physicians met with great success using injection therapy to treat hernias and hemorrhoids. Earl Gedney, D.O., a well-known Orthopedist, decreased his surgical practice and began to inject joints with these newer injectible medicines in the 1940s and 1950s. Also, in 1950, George Stuart Hackett, M.D., wrote a book on injection therapy. His work is still used today in training physicians. In the years since this early work, techniques and medications have advanced to move from a scarring or fusing effect to a strengthening effect, which restores the weakened joint to its original level of stability.

Q Which insurances pay for prolotherapy?

A With approval Worker's Compensation Insurance and motor vehicle insurances will pay for prolotherapy. Private insurances, Medicare, and TriCare do not pay for prolotherapy.

Q How much does prolotherapy cost?

A This will depend on the area or areas to be treated.  Unlike surgery the cost will be in the hundreds of dollars not thousands of dollars.