Regenerative Injection Therapy

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Interventional pain medicine is one of the fastest evolving branches of medical science. Among many interventional techniques in current use, regenerative injection therapy (RIT), aka prolotherapy or sclerotherapy, is a procedure to treat chronic musculoskeletal pain of connective tissues origin. RIT was originally employed to treat painful hypermobility of the peripheral joints secondary to ligament laxity, but fairly quickly evolved to include the treatment of axial joints as well as painful axial and peripheral enthesopathies. Despite arbitrary opposition from insurance carriers, RIT is slowly finding a place in the armamentarium of contemporary pain practitioners because of its effectiveness. Interventional techniques are defined as minimally invasive procedures for percutaneous delivery of therapeutic/diagnostic modalities to targeted areas for the treatment of chronic pain. Based on this definition, RIT is the oldest interventional technique in current use. RIT was originally employed to treat painful hypermobility of the peripheral joints secondary to ligament laxity, but fairly quickly evolved to include the treatment of axial joints as well as painful axial and peripheral enthesopathies. A common feature found in patients with chronic musculoskeletal pain is tenderness on palpation at certain sites, particularly where ligaments, tendons, or aponeuroses attach to bone. This phenomenon attracted the attention of early investigators, who developed a novel model of pathology and injection technique for its treatment. This chapter will emphasize some fundamental high-quality retrospective, prospective, and pilot studies omitted from recent narrow focused reviews, describe the pathogenesis and mechanism of action based on contemporary literature, and emphasize some of the practical clinical utilizations and technical aspects of RIT.