Wednesday, August 6, 2014

Proliferative Therapy (PRP & Prolo): How it works and Why it’s worth it!



Many people with musculoskeletal pain are familiar with corticosteroid (i.e. “cortisone”) injections, which are meant to reduce inflammation.  However, inflammation is not necessarily a bad thing, as it recruits the body’s own natural healing factors. 

Another approach is to deliberately induce inflammation, stimulating the body’s own healing mechanisms to repair damaged tissue.  This is called proliferative therapy.  This method may be a longer-term method of musculoskeletal treatment, and may be a great alternative to the more well-known cortisteroid injections.  The subtypes of proliferative therapy that Drs. Hyman and Chimes perform are prolotherapy and platelet-rich plasma injections (PRP).

Prolotherapy was originally “discovered” in the 1930s by osteopathic surgeon Dr. Earl Gedney, who injected his own injured thumb with an irritating solution, and in doing so promoted the healing and regeneration of the tissue. This is based on the concept that lingering, chronic issues are often because the collagen in the damaged tissue is poorly organized.  However, because of the chronicity of the injury, the person’s body has stopped attempting to heal the chronic injury.  Proliferative therapy aims to re-stimulate the body’s natural healing response, either by inducing inflammation (prolotherapy) or placing healing factors there directly (PRP).   

During prolotherapy, a sugar solution, usually dextrose, along with an anesthetic (such as lidocaine) is injected into the affected area, resulting in low-grade inflammation to the injured area, “tricking” the body into initiating a new healing cycle cascade.   

The other method of proliferative therapy that our physicians utilize is platelet-rich plasma injections.  This technique is based on the same principle as dextrose prolotherapy explained above, but instead the solution used is a high concentration of a person’s own platelets, which contain healing factors that stimulate the body’s healing mechanisms.  Platelets, when activated, secrete a number of different growth factors that stimulate and regulate inflammation in the damaged tissue, resulting in a natural healing response. The blood is drawn from the patient at the time of the visit, placed in a centrifuge where it is spun in order to separate and concentrate the platelets from the rest of the blood, and this “platelet-rich plasma” is then injected into the injury site.  The aim is to inject healing growth factors directly into the damaged area, providing the patient’s body with the tools needed to naturally heal itself. 

The two methods listed above are a means of strengthening ligaments and tendons, providing longer-term relief for a multitude of chronic musculoskeletal problems including, but not limited to, lower back pain, knee pain, hip pain, shoulder pain, osteoarthritis, and different varieties of joint pain.  We have had great success using proliferative therapy in many of our patients, but because it is a newer class of injectable, the scientific literature has not reached a consensus on which injuries do best with proliferative therapy.  Therefore, insurance companies have deemed proliferative therapy to be “experimental” and they do not cover either of the procedures listed above.  Patients  who have invested money in their own care, however, find that proliferative therapy may provide them long-lasting relief and help them to avoid future visits, ultimately lowering their medical bills.  

Because we respect the time and money of our patients at Lake Washington Sports & Spine, we take several measures to optimize the patient’s experience when having proliferative therapy performed. These include:
1.       An initial consultation, to make sure that proliferative therapy is the right choice for the patient
2.       A discussion about which form of proliferative therapy (prolotherapy or PRP) is the best choice for the patient
3.       Always using ultrasound-guidance to make sure we are placing the proliferative therapy in the correct location
4.       Coordinating the patient’s care team, including physical therapists, chiropractors, personal trainers, physicians and other clinicians
Drs. Hyman and Chimes hope that by utilizing these cutting-edge, non-surgical techniques they can help their patients overcome chronic issues that impede their ability to live an active and healthy lifestyle!  

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