DOCSLIB.ORG

Prolotherapy: a Nontraditional Approach to Knee Osteoarthritis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prolotherapy: a Nontraditional Approach to Knee Osteoarthritis ® Priority updates from the research literature PURLs from the family Physicians inquiries network Andrew H. Slattengren, DO; Trent Christensen, MD; Shailendra Prasad, Prolotherapy: A nontraditional MBBS, MPH; Kohar Jones, MD North Memorial Family approach to knee osteoarthritis Medicine Residency, University of Minnesota, Minneapolis (Drs. Dextrose injections into the knee can reduce pain and Slattengren, Christensen, and Prasad); Department improve a patient’s quality of life. of Family Medicine, The University of Chicago (Dr. Jones) PURL s E D i tor Kate Rowland, MD, MS Department of Family PRACTICE CHANGER acid, and corticosteroid injections. Cost, ef- Medicine, The University Recommend prolotherapy for patients with ficacy, and safety limit these therapies.3 of Chicago knee osteoarthritis (OA) that does not re- Prolotherapy is another option used spond to conventional therapies.1 to treat musculoskeletal pain. It involves repeatedly injecting a sclerosing solution STRENGTH OF RECOMMENDATiON (usually dextrose) into the sites of chronic B: Based on a 3-arm, blinded, randomized musculoskeletal pain.4 The mechanism of controlled trial (RCT). action is thought to be the result of local tis- Rabago D, Patterson JJ, Mundt M, et al. Dextrose prolotherapy for sue irritation stimulating inflammatory path- knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11:229-237. ways, which leads to the release of growth factors and subsequent healing.4,5 Previous studies evaluating the usefulness of prolo- ILLUSTRATIVE CASE therapy have lacked methodological rigor, a 59-year-old woman with OA comes to your have not been randomized adequately, or office with chronic knee pain. She has tried ac- have lacked a placebo comparison.6-9 etaminophen, ibuprofen, intra-articular cortico- steroid injections, and physical therapy without significant improvement in pain or functioning. STUDY SUMMARY She wants to avoid daily medications or sur- Prolotherapy reduces pain gery and wonders if there are any interventions more than exercise or placebo that will not lead to prolonged time away from Rabago et al1 randomized 90 participants to dex- work. What would you consider? trose prolotherapy, placebo saline injections, or at-home exercise. Participants had a ≥3 month Additional options needed for knee OA history of painful knee OA based on a self- More than 25% of adults ages 55 years and reported pain scale, radiographic evidence of older suffer from knee pain, and OA is an knee OA within the past 5 years, and tenderness increasingly common cause.2 Knee pain is of ≥1 or more anterior knee structures on exam. a major source of morbidity in the United Sixty-six percent of participants were fe- States; it limits patients’ activities and in- male. The mean age was 56.7 years and 74% creases comorbidities such as depression were overweight (body mass index [BMI], and obesity. 25-29.9) or obese (BMI ≥30). Participants chose Conventional outpatient treatments for to have one or both knees treated; 43 knees knee pain range from acetaminophen, non- were injected in the dextrose group, 41 re- steroidal anti-inflammatory drugs, glucos- ceived saline injections, and 47 were assessed amine, chondroitin, and opiates to topical in the exercise group. There were no significant capsaicin therapy, intra-articular hyaluronic differences among groups at baseline. 206 The Journal of family PracTice | aPRIL 2014 | Vol 63, no 4 Participants in the prolotherapy and saline group increased 13.91 points, compared with groups received injections at 1, 5, and 9 weeks, 6.75 (P=.020) in the saline group and plus optional injections at 13 and 17 weeks per 2.51 (P=.001) points in the exercise group. At physician and participant preference. Injections 52 weeks, the dextrose group showed an im- were administered both extra- and intra-artic- provement of 15.32 points compared with 7.59 ularly. Intra-articular injections were delivered (P=.022) in the saline group and 8.24 (P=.034) using a 25-gauge needle with a mixture of 25% in the exercise group. Fifty percent (15/30) of dextrose, 1% saline, and 1% lidocaine for a to- participants in the dextrose group had clini- tal volume of 6 mL. Extra-articular injections cally meaningful improvement as measured were delivered with a peppering technique by an increase of ≥12 points on the WOMAC, with a maximum of 15 punctures over painful compared with 34% (10/29) and 26% (8/31) in ligaments and tendons around the knee. The the saline and exercise groups, respectively. extra-articular solution was similar to the intra- At 52 weeks, the dextrose group had sig- articular except 15% dextrose was used, with a nificantly decreased KPS knee pain frequency total maximum volume of 22.5 mL. scores compared with the saline group (mean The placebo injection group received in- difference [MD], -1.20 vs. -0.60;P <.05) and ex- jections in the same pattern and technique, ercise group (MD, -1.20 vs. -0.40; P<.05). Knee but the solution was the same quantity of 1% pain severity scores also decreased in the lidocaine plus 1% saline to achieve the same dextrose group compared to the saline (MD, volume. The injector, outcome assessor, pri- -0.92 vs. -0.32, P<.05) and exercise groups Prolotherapy mary investigator, and participants were (MD, -0.92 vs. -0.11; P<.05). There were no for knee OA blinded to injection group. significant differences in KPS score decreases reduced pain In the exercise group, a study coordina- between the saline and exercise groups. frequency and tor taught participants knee exercises and severity more gave them a pamphlet with 10 exercises to What about patient satisfaction? effectively than perform at home. Adherence to at-home ex- At week 52, all participants were asked, exercise or ercises was assessed with monthly logs that “Would you recommend the therapy you re- saline injections. participants mailed in for the first 20 weeks of ceived in this study to others with knee OA the study. Seventy-seven percent of partici- like yours?” Ninety-one percent of the dex- pants reported doing their at-home exercises. trose group, 82% of the saline group, and 89% The primary outcome measure was of the exercise group answered “Yes.” change in composite score on the Western All participants who received injections Ontario McMaster Universities Osteoarthri- reported mild to moderate post-injection tis Index (WOMAC), a validated question- pain. Five participants in the saline group and naire used to evaluate knee-related quality 3 in the dextrose group experienced bruising. of life that features subscales for pain, stiff- No other side effects or adverse events were ness, and function.10 The minimal clinically documented. According to daily logs of medi- important difference in change in score on cation use in the 7 days after injection, 74% this 100-point instrument is 12 points; high- of patients in the dextrose group used acet- er scores indicate better quality of life.11 The aminophen and 47% used oxycodone, com- secondary outcome was change in score on pared with 63% and 43%, respectively, in the the Knee Pain Scale (KPS), a validated ques- saline group. The study authors did not com- tionnaire that uses a 4-point scale to mea- ment on the significance of these differences. sure pain frequency and a 5-point scale to measure pain severity; higher scores indicate worse symptoms.12 WHAT’S NEW A randomized study improvements seen in both scores provides support for prolotherapy Using an intention-to-treat analysis for all This study is the first to adequately demon- groups, WOMAC composite scores im- strate improvement in knee-related quality proved at 9 weeks and remained improved of life with prolotherapy compared with pla- through 52 weeks. At 9 weeks, the dextrose cebo (saline) or exercise. Family physicians JfPonline.com Vol 63, no 4 | aPRIL 2014 | The Journal of family PracTice 207 PURLs® can now add this therapy to their “toolbox” ing training in the technique. The prolo- for patient complaints of OA pain. therapy knee protocol can be performed in an outpatient setting in less than 15 minutes, but the technique requires training. Prolo- CAVEATS therapy training is available from multiple Efficacy is unknown in patients organizations, including the American As- with certain comorbidities sociation of Orthopaedic Medicine, which Of 894 people screened, only 118 met initial requires 100 course hours for prolotherapy eligibility criteria. This study did not include certification.4 No formal survey on the num- patients who were taking daily opioids, had ber of prolotherapists in the United States diabetes, or had a BMI >40, so its results may has been conducted since 1993,13 but Raba- not be generalizable to such patients. go et al1 estimated that the number is in the Also, while the study demonstrated hundreds. no side effects or adverse events other than z insurance coverage frequently is a bruising in 8 patients, the sample size may challenge. Most third-party payers do not have been too small to detect less common cover prolotherapy, and currently most adverse events. However, prior studies of pro- patients pay out-of-pocket. Rabago et al1 lotherapy have not revealed any substantial indicated that at their institution, the cost adverse effects.7 is $218 per injection session. Another study Prolotherapy for z Strong evidence for some condi- published in 2010 put the average total cost of knee OA can be tions…not for others. The strongest data 4 to 6 prolotherapy sessions at $1800.14 performed in support the efficacy of prolotherapy for fo- z And from the patient’s perspective … an outpatient cal tendinopathy (lateral epicondylosis) and The multiple needle sticks involved in prolo- setting in <15 knee OA. Evidence supporting prolotherapy therapy can be painful.
Load more

Recommended publications
  • Patients 2011
    BEULAH LAND PRESS JOURNAL ISSN 1944-0421 (print) ISSN 1944-043X (online) o f Doctors PROLOTHERAPY SHARE YOUR EXPERIENCE V OLUME THREE | ISSUE FOUR | DECEMBER 2011 w ww.journalof prolotherapy.com Calling all Prolotherapists! Do you have a Prolotherapy article you would like published in the Journal of Prolotherapy? We would love to review it and help you share it with the world! For information, including submission guidelines, please log on to the authors’ section of www.journalofprolotherapy.com. V OLUME THREE [ JOURNAL of PROLOTHERAPY.COM] [ 708-84 8-5011] | ISSUE FOUR | DECEMBER Patients 2011 TELL US YOUR STORIES | PAGES The Journal of Prolotherapy is unique in that it has a target audience of 737 both physicians and patients. Help spread the word to other people like -848 yourself who may benefit from learning about your struggle with chronic pain, and first-hand experience with Prolotherapy. For information on how to tell your story in the Journal of Prolotherapy, please log on to the contact section of www.journalofprolotherapy.com. B EULAH LAND PRESS [ for Doctors & Patients] CURING SPORTS INJURIES and Enhancing Athletic Performance WITH PROLOTHERAPY Just as the original book Prolo Your Pain Away! aected the pain management eld, Prolo Your Sports Injuries Away! has rattled the sports world. Learn the twenty myths of sports medicine including the myths of: • anti-inflammatory medications • why cortisone shots actually weaken tissue • how ice, rest, & immobilization may actually hurt the athlete • why the common practice of taping and bracing does not stabilize injured areas • & why the arthroscope is one of athletes’ worst nightmares! AVAILABLE AT www.amazon.com www.beulahlandpress.com & IN THIS ISSUE OF THE JOURNAL OF PROLOTHERAPY Table of Contents The Ligament Injury-Osteoarthritis 790 Connection: The Role of Prolotherapy in Ligament The Case for Prolotherapy – Repair and the Prevention of 741 The Opening Argument Osteoarthritis Julie R.
    [Show full text]
  • Prolotherapy: Applications, Mechanism of Action, Controversy and Evidence Boris M
    University of North Dakota UND Scholarly Commons Physician Assistant Scholarly Project Posters Department of Physician Studies 2017 Prolotherapy: Applications, Mechanism of Action, Controversy and Evidence Boris M. Davydov University of North Dakota Follow this and additional works at: https://commons.und.edu/pas-grad-posters Part of the Alternative and Complementary Medicine Commons, and the Musculoskeletal System Commons Recommended Citation Davydov, Boris M., "Prolotherapy: Applications, Mechanism of Action, Controversy and Evidence" (2017). Physician Assistant Scholarly Project Posters. 36. https://commons.und.edu/pas-grad-posters/36 This Poster is brought to you for free and open access by the Department of Physician Studies at UND Scholarly Commons. It has been accepted for inclusion in Physician Assistant Scholarly Project Posters by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. Prolotherapy: applications, mechanism of action, controversy and evidence. Boris M Davydov, PA-S Department of Physician Assistant Studies, University of North Dakota School of Medicine & Health Sciences Grand Forks, ND 58202-9037 Applicability to Clinical Abstract Research Questions Discussion Practice • Contemporary Research • Prolotherapy at a glance Merriam-Webster defines prolotherapy (PROLO) as “an • What are the common MSK disorders that can potentially Since the mid 1980s, research on PROLO effects has What is Prolotherapy is an injection-based complementary and alternative medical (CAM) therapy alternative therapy for treating musculoskeletal pain that be treated with PROLO? accelerated and the number and methodological quality of prolotherapy? for chronic musculoskeletal pain. This treatment aims to stimulate a natural healing involves injection of irritant substance (as dextrose) into a response at the site of painful soft tissue and joints.
    [Show full text]
  • Non Opioid Opions for Managing Pain
    Non-Opioid Options for Managing Pain Canada is in the midst of an opioid crisis. And even with growing awareness of the risks, opioids continue to be used extensively in the management of pain. The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain recommends optimizing non-opioid pharmacotherapy and non-pharmacological therapy rather than a trial of opioids for patients with chronic, non-cancer pain (who are not currently taking opioids). The challenge with this recommendation is knowing what the evidence says about the many different non-opioid options for treating pain. Are they effective? Are they safe? Are they readily available to patients? To help support decisions about managing pain, CADTH has been reviewing the evidence on different treatment options for various types of pain through our Rapid Response service. Here, you’ll find the highlights of many of these evidence reviews — all in one place. For more information on CADTH’s response to the opioid crisis in Canada, visit cadth.ca/opioids. To access all of our evidence and full reports on the management of pain, visit cadth.ca/pain. Non-Opioid Options for Managing Pain 1 Summary of Considerations for Practice Legend: Reasonable amount of evidence (although comparison with opioids may be lacking, making their place in therapy uncertain). Evidence indicates that risk of harms is low and/or side effects are mild to moderate. Some evidence to indicate effectiveness, but it may be conflicting, mixed, or lower quality. p Evidence on harms lacking or unclear. No evidence or evidence shows lack of effectiveness. Limited or no evidence on harms.
    [Show full text]
  • Prolotherapy, Platelet-Rich Plasma Therapy, and Stem Cell Therapy-Theory and Evidence
    Techniques in Regional Anesthesia and Pain Management (2011) 15, 74-80 Techniques in Regional Anesthesia & Pain Manas tt ELSEVIER Regenerative medicine in the fieLd of pain medicine: ProLotherapy, pLateLet-rich pLasma therapy, and stem cell therapy-Theory and evidence David M. DeChellis, DO,a Megan Helen Cortazzo, MDa,b From the "University of Pittsburgh Physical Medicine and Rehabilitation, Pittsburgh, Pennsylvania; and "Physical Medicine and Rehabilitation Outpatient Clinics; UPMC, Mercy-Southside lnterventional Spine and Pain Program; and University of Pittsburgh, Department of Physical Medicine and Rehabilitation, Pittsburgh, Pennsylvania. The concept of "regenerative medicine" (RM) has been applied to musculoskeletal injuries dating back to the 1930s. Currently, RM is an umbrella term that has been used to encompass several therapies. namely prolotherapy, platelet-rich plasma therapy (PRP), and stem cell therapy, which are being used to treat musculoskeletal injuries. Although the specific treatments share similar concepts, the mecha- nism behind their reparative properties differs. Recently, treatments that possess a regenerative quality are resurfacing and expanding into the musculoskeletal field as potential therapeutic treatment modal- ities. RM, in the form of prolotherapy, was first used to treat tendon and ligament injuries. With the advancement of technology, RM has expanded to PRP and stem cell therapy. The expansion of different RM treatments has lead to its increase in the application for ligament and tendon injuries, muscle defects, as well as pain associated with osteoarthritis and degenerative disks. Recently, the use of ultrasound has been added to these therapies to guide the solution to the exact site of injury. We review 3 forms of RM injection: prolotherapy, PRP therapy, and stem cell therapy.
    [Show full text]
  • Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: a Randomized Controlled Trial
    Efficacy of Intra-Articular Hypertonic Dextrose (Prolotherapy) for Knee Osteoarthritis: A Randomized Controlled Trial 1 Regina Wing Shan Sit ABSTRACT 1 Ricky Wing Keung Wu PURPOSE To test the efficacy of intra-articular hypertonic dextrose prolotherapy David Rabago, MD2 (DPT) vs normal saline (NS) injection for knee osteoarthritis (KOA). Kenneth Dean Reeves, MD3 METHODS A single-center, parallel-group, blinded, randomized controlled trial was conducted at a university primary care clinic in Hong Kong. Patients with 1 Dicken Cheong Chun Chan, MSc KOA (n = 76) were randomly allocated (1:1) to DPT or NS groups for injec- Benjamin Hon Kei Yip, PhD1 tions at weeks 0, 4, 8, and 16. The primary outcome was the Western Ontario 1 McMaster University Osteoarthritis Index (WOMAC; 0-100 points) pain score. The Vincent Chi Ho Chung, PhD secondary outcomes were the WOMAC composite, function and stiffness scores; Samuel Yeung Shan Wong, MD1 objectively assessed physical function test results; visual analogue scale (VAS) for 1Jockey Club School of Public Health and knee pain; and EuroQol-5D score. All outcomes were evaluated at baseline and at Primary Care, The Chinese University of 16, 26, and 52 weeks using linear mixed model. Hong Kong, Hong Kong RESULTS Randomization produced similar groups. The WOMAC pain score at 52 2Department of Family Medicine, Univer- weeks showed a difference-in-difference estimate of –10.34 (95% CI, –19.20 to sity of Wisconsin School of Medicine and –1.49, P = 0.022) points. A similar favorable effect was shown on the difference- Public Health, Madison, Wisconsin in-difference estimate on WOMAC function score of –9.55 (95% CI, –17.72 3Department of Physical Medicine and to –1.39, P = 0.022), WOMAC composite score of –9.65 (95% CI, –17.77 to Rehabilitation, The University of Kansas –1.53, P = 0.020), VAS pain intensity score of –10.98 (95% CI, –21.36 to –0.61, Medical Center, Kansas City, Kansas P = 0.038), and EuroQol-5D VAS score of 8.64 (95% CI, 1.36 to 5.92, P = 0.020).
    [Show full text]
  • Prolotherapy for Musculoskeletal Pain
    PPROLOTHERAPYROLOTHERAPY forfor MusculoskeletalMusculoskeletal PAINPAIN A primer for pain management physicians on the mechanism of action and indications for use. By Donna Alderman, DO rolotherapy is a method of injection U.S. Surgeon General, C. Everett Koop,4 known as connective tissue insufficiency.7 treatment designed to stimulate and has even made its way into the pro- When the connective tissue is weak, there healing.1 This treatment is used for fessional sports world.5 In a 2000 issue of is insufficient tensile strength or tight- P 8 musculoskeletal pain which has gone on The Physician and Sportsmedicine, “Are Your ness. Load-bearing then stimulates pain longer than 8 weeks such as low back and Patients Asking About Prolotherapy?” the mechanoreceptors.7 As long as connective neck pain, chronic sprains and/or strains, article starts: tissue remains functionally insufficient, whiplash injuries, tennis and golfer’s “Prolotherapy, considered an alterna- these pain mechanoreceptors continue to elbow, knee, ankle, shoulder or other tive therapy, is quietly establishing itself fire with use.9 If laxity or tensile strength joint pain, chronic tendonitis/tendonosis, in mainstream medicine because of its al- deficit is not corrected sufficiently to stop and musculoskeletal pain related to os- most irresistible draw for both physicians pain mechanoreceptor stimulation, teoarthritis. Prolotherapy works by rais- and patients: nonsurgical treatment for chronic sprain or strain results.2 This is ing growth factor levels or effectiveness to musculoskeletal conditions.” the problem that prolotherapy addresses: promote tissue repair or growth.2 It can The article states that as many as stimulating growth factors to resume or be used years after the initial pain or prob- 450,000 Americans had undergone pro- initiate a connective tissue repair se- lem began, as long as the patient is lotherapy and that some of the patients quence, repairing and strengthening lax healthy.
    [Show full text]
  • The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-Inflammatory Drugs Ross A
    WONDER WHY? THE ACCELERATION OF ARTICULAR CARTILAGE DEGENERATION IN OSTEOARTHRITIS WONDER WHY? The Acceleration of Articular Cartilage Degeneration in Osteoarthritis by Nonsteroidal Anti-inflammatory Drugs Ross A. Hauser, MD A B STRA C T introduction over the past forty years is one of the main causes of the rapid rise in the need for hip and knee Nonsteroidal anti-inflammatory drugs (NSAIDs) are replacements, both now and in the future. among the most commonly used drugs in the world for the treatment of osteoarthritis (OA) symptoms, and are While it is admirable for the various consensus and taken by 20-30% of elderly people in developed countries. rheumatology organizations to educate doctors and Because of the potential for significant side effects of the lay public about the necessity to limit NSAID use in these medications on the liver, stomach, gastrointestinal OA, the author recommends that the following warning tract and heart, including death, treatment guidelines label be on each NSAID bottle: advise against their long term use to treat OA. One of the best documented but lesser known long-term side effects The use of this nonsteroidal anti-inflammatory of NSAIDs is their negative impact on articular cartilage. medication has been shown in scientific studies to accelerate the articular cartilage breakdown In the normal joint, there is a balance between the in osteoarthritis. Use of this product poses a continuous process of cartilage matrix degradation and significant risk in accelerating osteoarthritis joint repair. In OA, there is a disruption of the homeostatic breakdown. Anyone using this product for the pain state and the catabolic (breakdown) processes of of osteoarthritis should be under a doctor’s care and chondrocytes.
    [Show full text]
  • Prolotherapy for Arthritis- a Review
    54 ISSN: 2347-7881 Review Article Prolotherapy for Arthritis- A Review Ranjana Joshi*, Shikha Jain, Kirti Jatwa, Monika Thakur, Anies Shaikh Department of Pharmaceutics, Mahakal Institute of Pharmaceutical Studies, Ujjain, Madhya Pradesh, India *[email protected] ABSTRACT Prolotherapy is a technique which can be used to treat pain and injuries. Osteoarthritis is a disease acquired from daily wear and tear of joints and also due to injury. Prolotherapy is an injection technique which causes inflammation at the site of injection, new blood vessels form and mature, pain subsides and collagen density and tissue strength are increased. It works by stimulating the body’s own healing mechanism at the site of injection leading to long lasting relief of the injured area. This review focuses on the treatment of osteoarthritis using prolotherapy. Keywords: Osteoarthritis, ischemia, Hackett-Hemwall Dextrose Prolotherapy, Regenerative injection therapy INTRODUCTION - Still's disease Arthritis is a form of joint disorder that involves - Ankylosing spondylitis inflammation of one or more joints. Arthritis is a joint disorder featuring inflammation. A joint is Osteoarthritis an area of the body where two different bones Osteoarthritis is the most common form of meet. A joint functions to move the body parts arthritis. It can affect both the larger and the connected by its bones. Joint pain is referred to smaller joints of the body, including the hands, as arthralgia. The causes of arthritis depend on feet, back, hip or knee. The disease is essentially the form of arthritis. Causes include injury one acquired from daily wear and tear of the (leading to osteoarthritis), metabolic joint.
    [Show full text]
  • Prolo Your Pain Away: Curing Chronic Pain with Prolotherapy
    PROLO YOUR PAIN AWAY®, 4TH EDITION CUR NG CHRONICWITH PAIN PROLOTHERAPY Ross A. Hauser, MD & Marion A. Boomer Hauser, MS, RD PROLO YOUR PAIN AWAY! Curing Chronic Pain with Prolotherapy 4TH EDITION Ross A. Hauser, MD & Marion A. Boomer Hauser, MS, RD Sorridi Business Consulting Library of Congress Cataloging-in-Publication Data Hauser, Ross A., author. Prolo your pain away! : curing chronic pain with prolotherapy / Ross A. Hauser & Marion Boomer Hauser. — Updated, fourth edition. pages cm Includes bibliographical references and index. ISBN 978-0-9903012-0-2 1. Intractable pain—Treatment. 2. Chronic pain— Treatment. 3. Sclerotherapy. 4. Musculoskeletal system —Diseases—Chemotherapy. 5. Regenerative medicine. I. Hauser, Marion A., author. II. Title. RB127.H388 2016 616’.0472 QBI16-900065 Text, illustrations, cover and page design copyright © 2017, Sorridi Business Consulting Published by Sorridi Business Consulting 9738 Commerce Center Ct., Fort Myers, FL 33908 Printed in the United States of America All rights reserved. International copyright secured. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form by any means— electronic, mechanical, photocopying, recording, or otherwise—without the prior written permission of the publisher. The only exception is in brief quotations in printed reviews. Scripture quotations are from: Holy Bible, New International Version®, NIV® Copyrights © 1973, 1978, 1984, International Bible Society. Used by permission of Zondervan Publishing House. All rights reserved.
    [Show full text]
  • (Prolotherapy) for Knee Osteoarthritis: Long
    Complementary Therapies in Medicine (2015) 23, 388—395 Available online at www.sciencedirect.com ScienceDirect j ournal homepage: www.elsevierhealth.com/journals/ctim Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes a,∗ a a David Rabago , Marlon Mundt , Aleksandra Zgierska , b Jessica Grettie a Department of Family Medicine University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, United States b Wisconsin Center for Education Research University of Wisconsin, Madison, WI 53706, United States Received 29 May 2014; received in revised form 26 November 2014; accepted 1 April 2015 Available online 8 April 2015 NCT00085722 Summary Objective: Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p < 0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA. Design: Post clinical-trial, open-label follow-up study. Setting: Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled. Intervention and outcome measures: Participants received 3—5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0—100 points), at baseline, 12, 26, 52 weeks, and 2.5 years. Results: 65 participants (58 ± 7.4 years old, 38 female) received 4.6 ± 0.69 injection sessions in the initial 17-week treatment period.
    [Show full text]
  • Prolotherapy for the Treatment of Chronic Musculoskeletal Pain
    bmchp.org | 888-566-0008 wellsense.org | 877-957-1300 Medical Policy Prolotherapy for the Treatment of Chronic Musculoskeletal Pain Policy Number: OCA 3.707 Version Number: 9 Version Effective Date: 04/01/16 + Product Applicability All Plan Products Well Sense Health Plan Boston Medical Center HealthNet Plan New Hampshire Medicaid MassHealth NH Health Protection Program Qualified Health Plans/ConnectorCare/Employer Choice Direct Senior Care Options ◊ Notes: + Disclaimer and audit information is located at the end of this document. ◊ The guidelines included in this Plan policy are applicable to members enrolled in Senior Care Options only if there are no criteria established for the specified service in a Centers for Medicare & Medicaid Services (CMS) national coverage determination (NCD) or local coverage determination (LCD) on the date of the prior authorization request. Review the member’s product-specific benefit documents at www.SeniorsGetMore.org to determine coverage guidelines for Senior Care Options. Policy Summary The Plan considers prolotherapy experimental and investigational for the treatment of chronic musculoskeletal pain or any other condition. It will be determined during the Plan’s standard prior authorization process if the service is considered experimental and investigational for the requested indication. See the Plan’s policy, Experimental and Investigational Treatment (policy number OCA 3.12), for the product-specific definitions of experimental or investigational treatment. Prolotherapy for the Treatment of Chronic Musculoskeletal Pain + Plan refers to Boston Medical Center Health Plan, Inc. and its affiliates and subsidiaries offering health coverage plans to enrolled members. The Plan operates in Massachusetts under the trade name Boston Medical Center HealthNet Plan and in other states under the trade name Well Sense Health Plan.
    [Show full text]
  • A New Treatment Option in Osteoarthritis: Prolotherapy Injections
    al of Arth rn ri u ti o s J Journal of Arthritis Ekinci et al., J Arthritis 2016, 5:3 ISSN: 2167-7921 DOI: 10.4172/2167-7921.1000197 Mini Review Open access A New Treatment Option in Osteoarthritis: Prolotherapy Injections Safak Ekinci1*, Oner Tatar2, Serkan Akpancar3, Hasan Turgut4 and Mehmet Murat Seven5 1Department of Orthopaedic Surgery, Haydarpasa Gulhane Military Medicine Academy, Istanbul, Turkey 2Department of Orthopaedic Surgery, Air Force Academy, Kasımpaşa Military Hospital, Istanbul, Turkey 3Department of Orthopaedic Surgery, Gulhane Military Hospital, Ankara, Turkey 4Department of Orthopaedic Surgery, Bursa Military Hospital, Bursa, Turkey 5Department of Sports Medicine, Gulhane Military Medicine Academy, Ankara, Turkey *Corresponding author: Safak Ekinci, MD, Department of Orthopaedic Surgery, Agri Military Hospital, Agri, Turkey, Tel: 90 5327339850; Fax: 90 472 215 27 47; E-mail: [email protected] Rec date: April 06, 2016; Acc date: April 29, 2016; Pub date: May 10, 2016 Copyright: © 2016 Ekinci S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Osteoarthritis is the most common degenerative disorder, and one of the major causes of physical disability in adults. Unfortunately many people experience arthroplasty or other major surgeries, in spite of improvements of the conservative options. There is a need for efficient treatment methods in this group of patients. Prolotherapy is one of the simple and safe injection-based complementary method and it’s efficiency was proved in the musculoskeletal problems. The aim of this article is to present current perspectives of prolotherapy in osteoarthritis.
    [Show full text]