A technique involving injecting essentially sugar-water into the body seems to be very effective for curing chronic pain in the back, knee, hip and other joints, although few studies exist to support the therapy and many experts remain skeptical.
Doctors who treat patients with the technique, called prolotherapy, claim great success where conventional treatments have failed. Also, patients swear by it and offer testimonials describing how they suffered from chronic pain until they tried prolotherapy.
The procedure involves using a needle to inject a solution of dextrose, water and a pain-killer into joints and near ligaments to create inflammation in the distressed area. The inflammation is supposed to spur blood flow and healing, but the idea runs counter to current medical dogma that holds reducing inflammation itself is the key to healing.
The therapy is very effective, often exceeding a success rate of 80 percent, David Harris, a specialist in physical medicine and rehabilitation who uses prolotherapy in his practice in Austin, Texas, told United Press International.
Harris, who also holds the post of medical director at St. David's Medical Center in Austin, said prolotherapy can successfully treat back pain, arthritis, knee pain and other knee disorders, hip disorders, headaches, ankle problems, foot pain and various other conditions.
Many joint and back problems are caused by ligaments, which normally stabilize the area, that have become weak or injured, Harris explained. Prolotherapy tightens up ligaments and hence resolves many of the problems leading to pain with these conditions, he said.
Patients typically will experience soreness following the injection and usually require five to six treatments before the therapy is effective, he added.
Few studies support the effectiveness of prolotherapy for any condition, however, and despite proponents' and patients' claims of miracle cures, Medicare will not reimburse for the treatment because officials said they have had difficulty locating research on the treatment. The few studies that have been found either contained no evidence prolotherapy was any more effective than placebo or did not include enough patients to be conclusive about whether the therapy offered any benefit, officials said.
Many health insurance companies also do not reimburse for prolotherapy for the same reasons as Medicare.
Harris Gellman, an orthopedic surgeon and co-chief of the hand surgery program at the University of Miami, told UPI although the principle behind prolotherapy is reasonable, "I'm not familiar with any good scientific articles" showing that it is effective.
"Before I would recommend something to a patient, I would like to have some sort of data saying it's valid," Gellman said. The studies should compare prolotherapy to conventional therapies, which for many of these conditions involves injections of cortisone into the joint to reduce inflammation, he said.
Prolotherapy proponents often downplay the effectiveness of cortisone injections, but Gellman noted they have a "70-80 percent success rate for tennis elbow."
The National Institutes of Health also apparently does not place much stock in prolotherapy. "We're not conducting any studies on it or supporting any studies," Kelly Carrington, spokeswoman for the NIH's National Institute of Arthritis and Muscoskeletal and Skin Diseases, told UPI.
NIH's National Center for Complementary and Alternative Medicine also is not funding any studies on the therapy, spokeswoman Catherine Law said.
Felix Linetsky, an orthopedist who administers prolotherapy to his patients, maintained the therapy is effective. He said he has conducted an as-yet-unpublished review of six studies done on prolotherapy to date that have concluded "it does really work."
Despite the lack of proof of benefit, mainstream orthopedists have been quiet about speaking out against prolotherapy. This probably is because there are very few risks and complications associated with it, Gellman said. "If it doesn't work, you haven't lost much because the damage you can cause is probably pretty limited," he explained.
Harris said the person injecting the solution should be skilled and experienced because there is an art to it, although he added he has treated 1,000 patients and has not seen any complications.
Nerve damage is a possibility, but even if this does occur it generally resolves on its own, he said. The biggest risk is puncturing the lung, which can happen when doing injections around the rib cage. Gellman said he has heard of patients trying it and benefiting so there may be no harm for those who have not had much success with other therapies.
Lee Ecuyer represents a typical patient who has benefited from prolotherapy. Ecuyer, 78, damaged cartilage and ligaments in his knee 48 years ago in a skiing accident. Doctors told him the only therapy they could offer him was total knee replacement, Ecuyer told UPI.
He refused and has suffered chronic knee pain and difficulty walking for decades. However, after beginning prolotherapy last year, the pain in his knee "stopped immediately" and he said he now could bend his knee past a right angle where before he had only limited movement.
"It's a wonderful thing," Ecuyer said.
