Regenerative Injection Research Articles

Prolotherapy and Low Level Laser Therapy: A Synergistic Approach to Pain Management in Chronic Osteoarthritis.

Regenerative injection therapy and low level laser therapy are alternative remedies known for their success in the treatment and symptomatic management of chronic musculoskeletal conditions. In response to the growing demand for alternative therapies in the face of the opioid epidemic, the authors conduct a literature review to investigate the potential for prolotherapy and LLLT to be used adjunctively to manage chronic osteoarthritis (OA). OA is a degenerative chronic musculoskeletal condition on the rise in North America, and is frequently treated with opioid medications. The regenerative action of prolotherapy and pain-modulating effects of LLLT may make these two therapies well-suited to synergistically provide improved outcomes for osteoarthritis patients without the side effects associated with opioid use. A narrative descriptive review through multiple medical databases (Google Scholar, PubMed, and MedLine) is conducted, restricted by the use of medical subject headings. 71 articles were selected for reading in full, and 40 articles were selected for use in the study after reading in full. A review of the literature revealed good clinical results in the use of prolotherapy and LLLT separately to manage chronic musculoskeletal pain due to osteoarthritis and other chronic conditions. It is also recognized in the literature that prolotherapy works most effectively when used adjunctively with other treatments. Downsides to the use of prolotherapy include mild side effects of pain, stiffness and bruising and potential adverse events as a result of injection. This study is limited by the lack of clinical trials available involving both LLLT and prolotherapy injections used adjunctively, and by the low number of high impact literature concerning the treatment of (specifically) osteoarthritis by alternative methods. The authors suggest that practicing health care providers consider utilizing LLLT and prolotherapy together as a supplementary method in the management of chronic pain due to osteoarthritis, to minimize the long-term prescription of opioids and emphasize a less invasive treatment for this debilitating condition.

The Effects of Prolotherapy (Hypertonic Dextrose) in Recreational Athletes with Patellofemoral Pain Syndrome

Objective: Prolotherapy is recognized as a regenerative injection technique that stimulates the body’s healing processes to strengthen weakened ligaments and tendons. Hypertonic dextrose as an irritant agent which stimulates the healing process agent is widely used in in this technique. The aim of the current study is to assess the efficiency of prolotherapy injections in patellofemoral pain syndrome Methods: The current study was designed as a retrospective clinical study. 44 recreational athletes with unilateral PFPS were enrolled in this study. 10 ml of 15% and 5 ml of 25% hypertonic dextrose were used as extra- and intra-articular injection in the knee with PFPS respectively. Extra and intra articular injections were repeated three times with 21 day intervals according to the tissue repair processing. Results: The knee functional scores, balance and coordination scores were significantly improved in the affected knees at 6 months after treatment (p

P406. Adipose derived regenerative cells injection as a novel method of enterovesical fistula treatment in Crohn's Disease: A case report

P406. Adipose derived regenerative cells injection as a novel method of enterovesical fistula treatment in Crohn's Disease: A case report

Everything old is new again: New developments in prolotherapy

Prolotherapy, or fibroproliferative therapy, is a regenerative injection therapy, first popularized in the 1940s and 1950s. Unfortunately, the combination of “better” surgical techniques and a series of high-profile medical catastrophes by poorly trained providers relegated the technique into the “fringe” arena. However, recent recognition of the failure of surgical interventions, combined with better technology and a burgeoning interest in the continuum of regenerative injection options, has renewed the interest and research into this “old” technique.

Ultrasound-guided Platelet-rich Plasma Prolotherapy for Temporomandibular Disorders

Purpose: Temporomandibular disorder (TMD) is one of the most common diseases causing chronic orofacial pain. Prolotherapy is called ‘regenerative injection therapy’ or ‘growth factor stimulation injection’, and it induces the functional reactivation of tissues such as ligaments and tendons. The aim of this study is to evaluate the efficacy of ultrasound-guided prolotherapy with platelet-rich plasma (PRP) for the patients who had the TMD symptoms, especially in temporomandibular joint (TMJ) pain, restricted mouth opening, and TMJ sound. Methods: Twenty-seven patients visited Chosun University Dental Hospital with the symptoms of pain, restricted mouth opening, and TMJ sound were included in this study. When the patients visited the hospital, we measured; the degree of pain, range of mouth opening (ROM), and TMJ sound, and grouped them according to their chief complaints. TMJ pain and ROM were measured both at the first visit and the fourth week after the PRP injection, and also evaluated the impact of the treatment on their daily activities. Results: After the treatment, the patients in the TMJ pain group showed some improvement (visual analogue scale [VAS] 5.6 to 3.6), and the patients in the restricted mouth opening group exhibited increased ROM (26 mm to 32 mm; p Conclusions: PRP prolotherapy could be effective for the treatment of TMJ pain and restricted mouth opening. However, further studies are still necessary in terms of TMJ sound and longterm effect of PRP prolotherapy.

Structural Basis of Joint Instability as Cause for Chronic Musculoskeletal Pain and Its Successful Treatment with Regenerative Injection Therapy (Prolotherapy)

Joint dysfunctions and associated musculoskeletal pain are among the most common medical complaints presented to clinicians. Ligaments are collagenous fibrous structures that are primarily responsible for maintaining smooth joint motion, restraining excessive joint displacement, and providing stability across the joint. Ligaments also act as sensory organs for the joints and have significant input to pain sensation. When ligaments are subjected to forces beyond their normal range of motion, injury and failure occur, resulting in joint laxity (looseness or instability), and subsequent disruptions in the balance between joint mobility and joint stability. These dysfunctions can result in joint pain and the development of osteoarthritis. Several strategies have been employed over the years in attempts to improve joint instability from ligament injury; however, some of the standard therapeutic approaches (drugs, corticosteroid injections, and surgery) employed to address these problems have not been very effective because they often do not address the underlying cause of the problems, and in fact can inhibit ligament healing and restoration. For these reasons, there is current and growing interest among patients and clinicians in prolotherapy, an alternative therapeutic modality that can reduce or eliminate pain by stimulating the natural regenerative processes in and around the joint to facilitate the restoration of degenerated ligaments and tendons to a healthy state, improving joint support, function and reducing pain. This review presents current evidence from clinical studies demonstrating that prolotherapy is a significant and effective alternative treatment modality for people with ligament-related injuries and resultant joint instability.

Regenerative Injection Therapy (Prolotherapy) for Hip Labrum Lesions: Rationale and Retrospective Study

Background: Acetabular labral tear is a debilitating condition for which there are few effective non-surgical treatment options. A number of studies in humans and in animal models suggest that the labrum may have a capacity for spontaneous healing, and that therapies that seek to exploit and facilitate this process may be beneficial. Regenerative injection therapies have shown promise in the treatment of several musculoskeletal disorders, but have not previously been applied to labral tear. Methods: We present an initial case series of 19 patients with labral tear that were treated in our clinic with intra-articular injections of hypertonic dextrose. Patient-reported assessments were collected by questionnaire between 1 and 60 months post-treatment (mean = 12 months). Results: All patients reported improvements in pain relief and functionality. Patients reported complete relief of 54% of recorded symptoms. Improvements did not show dependence on the time between treatment and follow-up. No adverse events were reported. Conclusions: Regenerative injection therapy (prolotherapy) for acetabular labral tear appears to be a safe and potentially efficacious procedure that merits further investigation as a non-surgical option.

Efficacy of musculoskeletal injections given by primary care providers in the office

Efficacy of musculoskeletal injections given by primary care providers in the office

Prolotherapy: A Non-Invasive Approach to Lesions of the Glenoid Labrum; A Non-Controlled Questionnaire Based Study

Lesions of the glenoid labrum are a common cause of shoulder instability and a frequent finding in patients with shoulder pain. Management of these patients typically involves an attempt to avoid surgery through conservative treatment. However, there is currently a dearth of conservative options that promote labral healing. Regenerative injection therapies, including prolotherapy, have shown promise in the treatment of several musculoskeletal disorders, but have not previously been applied to glenoid labral tear. Here we review several important aspects of these lesions and present an initial case series of 33 patients with labral tear that were treated in our clinic with intra-articular injections of hypertonic dextrose. Patient-reported assessments were collected by questionnaire at a mean follow-up time of 16 months. Treated patients reported highly significant improvements with respect to pain, stiffness, range of motion, crunching, exercise and need for medication. All 31 patients who reported pain at baseline experienced pain relief, and all 31 who reported exercise impairment at baseline reported improved exercise capability. Patients reported complete relief of 69% of recorded symptoms. One patient reported worsening of some symptoms. Prolotherapy for glenoid labral tear appears to be a safe procedure that merits further investigation.

Prolotherapy: A new hope for temporomandibular joint pain

The most common cause of orofacial pain is the Temporomandibular Joint Disorder (TMD), a collective term used to describe a group of medical disorders causing temporomandibular joint (TMJ) pain and dysfunction. As the causes of TMD are varied and run the gamut from mechanical issues, such as disc degeneration and dislocation or erosion of the fibrocartilaginous surfaces of the condyle, fossa, and articular eminence, the treatment approaches for the chronic TMJ case are also quite varied. As surgery is considered a last resort for TMD, it is common for sufferers to seek out alternatives and one of the alternative treatments is 'Prolotherapy,' which is also known as Regenerative Injection Therapy. This article provides an overview of this new alternative therapy.

Regenerative Injection Therapy with Whole Bone Marrow Aspirate for Degenerative Joint Disease: A Case Series

Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation.

Rationale for Using Direct Bone Marrow Aspirate as a Proliferant for Regenerative Injection Therapy (Prolotherapy)

Adult mesenchymal stem cells (MSCs) obtainable from autologous bone marrow aspirates have generated tre- mendous interest in the medical and scientific communities in the last two decades and are currently being investigated by a of interested physicians for use in point-of-care stem cell therapies due to their great potential to differentiate into multi- ple cell lineages such as bone, cartilage, muscle, tendon, and nerve. However, as these stem cells are found in very low numbers in adult tissue, centrifugal concentration or expansion through in vitro culturing has been pursued to obtain higher numbers of efficacious regenerative therapeutic applications. More recently, some physicians and scientists have chosen to explore use for direct injection of un-fractionated, native whole bone marrow aspirate as a strategy in regenera- tive treatment regimes. This review examines the potential merits and disadvantages of using either concentrated and culture expanded MSCs versus native whole bone marrow aspirate as key proliferant in direct regenerative injection ther- apy (RIT). Results from a number of published investigations have clearly shown high potential of various deleterious ef- fects on manipulating MSCs obtained from native bone marrow aspirate either by centrifugal forces or expansion through in vitro culturing; moreover, currently used centrifugal concentration techniques do not significantly concentrate MSCs from bone marrow aspirate, thus, defeating the purpose of this manipulative step. On the other hand, preliminary results and observations of using un-fractionated whole bone marrow injection for treatment of various musculoskeletal joint dis- eases (for example, osteoarthritic joints) suggest that the procedure is safe and potentially efficacious, with no known deleterious effects as yet reported.

Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study

We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Thirty-six patients with chronic knee osteoarthritis. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1±13.9, P=0.11). There was a significant decrease in this groups' WOMAC scores during the last 16 weeks when the participants received RIT (-9.3±11.4, P=0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks.

Greater Trochanteric Pain Syndrome

Disorders causing lateral hip pain are encountered frequently by physicians. Evaluating these problems can be challenging because of the myriad of potential causes, the complex anatomy of the peritrochanteric structures, and the inconsistently described etiologic factors. Misconceptions about the causes of lateral hip pain and tenderness are common, frequently leading to approaches that only provide temporary solutions rather than address the underlying pathology. Trochanteric bursitis is implicated frequently but is seldom the primary cause of pain in chronic cases. It is important to address hip rotator cuff tendinopathy and pelvic core instability. Treatment options include therapeutic exercise, physical modalities, corticosteroid injections, extracorporeal shock wave therapy, and regenerative injection therapies. For recalcitrant cases, surgery may be appropriate. By understanding the anatomy of the peritrochanteric structures, and the pathologic processes most likely responsible for symptomatology and dysfunction, the physician will be prepared to provide effective long-term solutions for this common problem.

Regenerative Injection of Elite Athletes with Career-Altering Chronic Groin Pain Who Fail Conservative Treatment

To obtain multisport and long-term outcome data from the use of regenerative injection therapy on career-threatened athletes. Consecutive enrollment of elite performance-limited athletes with chronic groin/abdominal pain who failed a conservative treatment trial. The treatment consisted of monthly injections of 12.5% dextrose in 0.5% lidocaine in abdominal and adductor attachments on the pubis. Injection of the nociceptive source was confirmed by repetition of resistive testing 5 mins after injection. Seventy-five athletes were enrolled. Seventy-two athletes (39 rugby, 29 soccer, and 4 other) completed the minimum two-treatment protocol. Their data revealed a mean groin pain history of 11 (3-60) mos. Average number of treatments received was 3 (1-6). Individual paired t tests for Visual Analog Scale (VAS) of pain with sport (VAS Pain) and Nirschl pain phase scale measured at 0 and an average of 26 (6-73) mos indicated VAS Pain improvement of 82% (P < 10) and Nirschl pain phase scale improvement of 78% (P < 10). Six athletes did not improve following regenerative injection therapy treatment, and the remaining 66 returned to unrestricted sport. Return to unrestricted sport occurred in an average of 3 (1-5) mos. Athletes returned to full elite-level performance in a timely and sustainable manner after regenerative injection therapy using dextrose.

Regenerative injection therapy for chronic painful tendinosis with polidocanol and ultrasound/Doppler guidance

Regenerative injection therapy for chronic painful tendinosis with polidocanol and ultrasound/Doppler guidance

Case Series on Chronic Whiplash Related Neck Pain Treated with Intraarticular Zygapophysial Joint Regeneration Injection Therapy

Although in clinical use, there is only 1 published case report on the efficacy of intraarticular regeneration injection therapy (RIT) (a.k.a. prolotheraphy). This report supports a rationale for future clinical trials of this technique. To assess the efficacy of intraarticular zygapophysial joint RIT in patients with chronic whiplash related neck pain that failed other conservative and interventional procedures. Patients were treated with intraarticular RIT and reassessed over 1 year. Retrospective case review of prospective data. Eighteen consecutive patients were treated with intraarticular prolotherapy by placing 0.5 - 1mL of 20% dextrose solution into each zygapophysial joint, after confirmation of intraarticular location with radiographic contrast, using 25-gauge spinal needles and fluoroscopic guidance. Solution was prepared by diluting D50W with 1% lidocaine. Fifteen patients completed treatment. Three patients had bilateral treatment, leaving 18 sides for analysis. Mean Neck Disability Index (NDI) pre-treatment was 24.71 and decreased post-treatment to 14.21 (2 months), 13.45 (6 months), 10.94 (12 months). Average change NDI=13.77 (p<0.0001) baseline versus 12 months. Symptoms for 14 patients were from motor vehicle accident, of which 13 were in litigation. Patients attending physiotherapy over the course of treatment had better outcomes than those without physiotherapy. Women needed more injections (5.4) than men (3.2) p=0.0003. Intraarticular RIT improved pain and function in this case series. The procedure appears safe, more effective than periarticular RIT, and lasted as long, or longer, than those patients with previous radiofrequency neurotomy. Concurrent physiotherapy helped reduce post-procedure neck stiffness. Future trials should consider gender when deciding how many treatments to administer. Litigation was not a barrier to recovery.

Prolotherapy (Proliferation Therapy) in the Treatment of TMD

Proliferation therapy, or “prolotherapy,” is also known as regenerative injection therapy (RIT). Since the 1930s, the technique has been used to stabilize injured joints and to relieve joint pain. This article reviews the history and scientific literature regarding prolotherapy and describes the application of the technique to treat injured or unstable temporomandibular joints (TMJ). Alternative medicaments and the likely mechanisms of action are discussed. A brief preliminary summary of a retrospective clinical study of the efficacy of prolotherapy is included. The study shows that prolotherapy can be an effective therapeutic modality that reduces TMJ pain and joint noise in a majority of patients who have reached a plateau with use of an intraoral appliance, physical therapy, and home care.

Regenerative injection therapy for axial pain

Chronic pain is considered epidemic coupled with claims of inadequate treatment. While the understanding of pain, including diagnosis and treatment, is in its infancy, significant progress has been made with diagnostic and therapeutic interventional techniques during the past two decades. Though the structural basis of spinal pain is well established, some patients continue to present a diagnostic and therapeutic challenge. In addition to target-specific fluoroscopically guided techniques, Regenerative Injection Therapy (RIT), also known as prolotherapy, is a viable treatment in managing chronic spinal pain. Proponents suggest effectiveness of RIT in treating musculoskeletal pain, while opponents suggest otherwise. Multiple published studies show (RIT) is effective despite continued controversy. This review will describe various aspects of regenerative injection therapy, technical aspects and clinical effectiveness.

Can the combination of localized “proliferative therapy” with “minor ozonated autohemotherapy” restore the natural healing process?

Regenerative injection therapy (RIT), also known as proliferative therapy, has been used for over 30 years in the USA in patients with spinal and peripheral joint and ligamentous pathologies. It involves the injection of mildly irritating medications onto ligaments and tendons, most commonly at origins and insertions. These injections cause a mild inflammatory response which "turns on" the normal healing process and results in the regeneration of these structures. At the same time they strengthen and become less sensitive to pain through a combination of neurolysis of small nerve fibers (C-fibers) and increased stability of the underlying structures. Oxygen/ozone therapy is a well established complementary therapy practiced in many European countries. The ozone dissolves in body fluids and immediately reacts with biomolecules generating messengers responsible for biological and therapeutic activities. This results in an anti inflammatory response, which also results in a similar trophic reaction to that of RIT. It is logical to expect that combining these two modalities would result in enhanced healing and therefore improved clinical outcomes. Oxygen/ozone therapy, accomplished by autohemotherapy (AHT), is performed by either administering ozonated blood intravenously (Major AHT) or via intramuscular route (Minor AHT). These procedures result in stimulation of the immune and healing systems. Our concept is that the local injection of this activated blood injected directly to the ligamentous areas that are also being treated with RIT will act as a direct stimulation to the healing process. In addition, combining this with intravenous major AHT should stimulate the immune system to augment and support this process. RIT and oxygen/ozone therapy have been extensively studied separately. We propose a study of lumbosacral ligamentous pain to explore this therapeutic combination. We hope that this paper will stimulate general interest in this area of medicine and result in investigation of the "interface" between these treatment modalities.