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Regenerative Injection Therapy (Prolotherapy) Deborah Angersbach, ND Chronic musculoskeletal pain is one of the main causes of disability in America and the leading reason for patient visits to their physician. Treating musculoskeletal pain can be difficult, and conventional treatment options are, at times, insufficient to reduce pain and restore function. Physical therapy, exercise, chiropractic manipulation, medication, corticosteroid injections, and surgery can be beneficial in many circumstances. However, when they are not successful, patients may be left without options. Regenerative Injection Therapy (RIT), also known as Prolotherapy, is a treatment for joint pain that has been studied and practiced by physicians since the 1930’s. RIT is performed by orthopedic, osteopathic and naturopathic medical doctors. Many clinical studies have been done on RIT using more than 500,000 patients so far, with current studies being done at the National Institute of Health, among others. Over time, knowledge of RIT has increased and it is now being used at Yale University Hospital, The Mayo Clinic in Rochester, and Scripps Institute in California. The American Academy of Pain Management endorses RIT for chronic unresolved musculoskeletal pain. RIT gives ligaments and cartilage a second chance at healing and is often described as “anti-aging medicine” for the joints. When a joint is injured, ligaments and tendon insertions are strained, causing an inflammatory response - a critical part of healing. Inflammation at an injury site clears dead cells, promotes capillary growth and restores damaged tissue. However, not all sprains and strains will heal completely. In fact, after an injury ligaments and tendons may retain only 50-70% of their pre-injury strength. When ligaments have been overstretched, joints become unstable and degenerative changes occur, which cause osteoarthritis. For example, if one of the ligaments in the knee were injured, that joint may be predisposed to early onset of arthritis. Because RIT gives the ligament and cartilage a second chance and healing, the ligament is strengthened, the joint is stabilized, and the course of arthritis is stopped. Commonly, NSAIDS or cortisone shots are used for joint pain. These do reduce inflammation in acute injuries, but chronic pain is degenerative, not inflammatory, so steroids often don’t resolve the problem. Also, studies show that NSAIDS interfere with healing of injured tissues if used repeatedly. In comparison, RIT triggers the body’s natural healing response allowing for regeneration of damaged tissue. RIT is defined as: “tissue regeneration and repair leading to restoration of elasticity, tensile strength, increased mass and greater load bearing capacity of the affected connective tissue.” RIT treats degenerative or overuse conditions of the musculoskeletal system associated with problems in the tendons, ligaments, or cartilage. Indications for use are: chronic pain secondary to sprains or strains; osteoarthritis of the hips, knees, shoulders, hands, wrists, ankles, feet, and spine; overuse injuries known as “repetitive motion disorders”; rotator cuff injuries; chronic postural pain of the spine; spinal pain that improves only temporarily with manipulation; and sacroiliac pain. RIT may be the treatment of choice if the patient fails to improve with physical therapy, manipulation, steroid injection, surgical intervention, medications, or if these treatments are contraindicated. To determine if a person is a candidate for RIT a complete history and physical exam are done along with laboratory tests and x-rays, as needed. The joint is evaluated and the problem area is determined. If there are no contraindications, a solution of dextrose, procaine, and B12 is introduced to the ligament or the joint. Dextrose is a type of sugar and stimulates the healing response. Procaine is an anesthetic that increases circulation, and B12 is nutritive and healing to injured tissues. The healing cascade is launched leading to deposition of new, better organized collagen and restoration of tissue health and function. An average patient requires 3 treatments spaced one month apart – some problems require more treatments and some less. After treatment the patient is instructed to continue gentle exercise and stretching and avoid anti-inflammatory medications temporarily. Optimizing nutrition and hydration are extremely helpful. Contraindications to RIT include: allergy to procaine, Novocain or dextrose; autoimmune types of arthritis, use of the medications Coumadin, warfarin, Plavix, or other bleeding disorders, uncontrolled diabetes, metal in the joint to be worked on, suppression of the immune system, and needle phobia. Smokers, those over 85 years old, and patients with poor tissue healing may have less than optimal responses. These people may benefit from a course of nutritional repletion prior to treatment with RIT. Clinical success rates for RIT are 85% for resolution of chronic pain and dysfunction. This makes RIT a treatment with great potential benefit for many. Please contact Yellowstone Naturopathic Clinic at (406) 259-5096 or see our website at www.yncnaturally.com for more information, or to schedule an appointment for evaluation.