Dr. Steven Johnson specializes in Integrative and Internal Medicine. He completed his residency as chief resident of Internal Medicine at Memorial Hospital at the University of Massachusetts. He is an internationally respected lecturer, teacher and physician. He has over 15 years of experience in his field. Dr. Johnson has completed the American Holistic Association’s criteria for board certification and the American Osteopathic Associations’ prolotherapy certification.

PROLOTHERAPY for Chronic Back Pain and Ligament Injury
By Dr. Steven M. Johnson, D.O.

Prolotherapy (Sclerotherapy) is an injection treatment for chronic back and joint pain. It is much less traumatic and expensive than surgery, and for many people, it can be the answer for debilitating pain and improving mobility. The procedure is performed by physicians, especially orthopedic and osteopathic physicians, trained specifically in this area. It works by injecting an irritant solution that causes bone-ligament connections to regenerate. Prolotherapy treats many musculoskeletal conditions including arthritis, rotator cuff pain, chronic back and neck pain, sports injury, disc disease, fibromyalgia, whiplash, carpal tunnel syndrome and all ligamentous sprains or tears.

The former Surgeon General, C. Everett Koop M.D., revealed that he personally benefited from Prolotherapy and suggested its use for several of his own patients. Prolotherapy is practiced now in many major medical institutions, including the Mayo Clinic. The low risk of harm makes this an attractive procedure for patients with chronic pain present for greater than six months. Success for increased mobility and reduced pain is above 85% when full protocols are followed. Success for disc surgery is rarely reported above the 60% range.

How Does It Work?
Also known as sclerotherapy, Prolotherapy uses an injection of dextrose and lidocaine into damaged areas of ligament-bone attachments. Sometimes sodium morrhuate (an extract of cod liver oil) is used. These substances act as “irritants” which stimulate the body’s natural healing pathways of inflammation. This creates a chemical and cellular environment similar to a fresh (acute) injury, stimulating a renewed healing response in the body. The optimal result is proliferative growth of new ligament and tendon fibers. This strengthens the muscle, tendon and bone architecture and improves function between joints, tendons and muscle. The pain is reduced as healthy tissue replaces chronically damaged tissue and normal anatomy and motion are restored, which further reduces muscle spasm and ligament pain. It is theorized that the overuse of aspirin and NSAID’s such as ibuprofen may be one of the causes of chronic joint and ligament dysfunction by compromising the body’s natural healing inflammatory response. Alternatives to these drugs are used during Prolotherapy.

What Can I Expect?
Most patients can expect 3-8 treatments over 6-32 weeks. Some patients notice dramatic improvement in as few as three treatments, while other more severe cases require more than 12 treatments. This is an injection technique requiring several well placed injections. Some patients are given medicine to relax before the procedure if needed. As inflammation is caused by the treatment, short term medications such as Tylenol, Ultram, codeine and hydrocodone are given post treatment to relieve inflammatory pain. Long term narcotics are not given as part of the procedure. Anti-inflammatory medications are strictly prohibited. Physical therapy, microcurrent therapy and/or osteopathic manipulation for retraining of chronically injured muscles are recommended by Dr. Johnson for difficult cases. Good nutrition and hydration also contribute to more effective healing. Side effects of Prolotherapy are very low and include short term pain and more rarely nerve damage, vascular damage and infection, which can range from mild to severe. The overall low side effect profile makes this procedure appealing to doctors with a good understanding of anatomy. The extra training osteopathic physicians receive in anatomy make them good candidates to learn and perform this intricate procedure with effectiveness.

The cost of Prolotherapy is not usually covered by insurance. Treatment sessions range from $95 to $250 dollars depending on complexity and the number of regions treated. Osteopathic treatment, trigger point and joint injections sometimes accompany the procedure and are usually covered by insurance. Physical therapy and electrical microcurrent therapy are usually covered by insurance when recommended. An initial office visit for assessment is usually needed. The office visit involves an examination and sometimes laboratory tests and x-rays.

How Is Prolotherapy Viewed In The Medical Community?
Prolotherapy is gaining respect in the medical community, and many traditional medical societies such as the Osteopathic Academy of Sclerotherapeutic Pain Management, the American Association of Orthopedic Medicine and the Chicago Medical Society approve of the procedure and the developing certifications. However, for many physicians, such as Dr. John Renner of the National Counsel for Reliable Health Information, this is still an “alternative treatment” and he recommends further studies to better evaluate the procedure and its safety. Other well known physicians such as C. Everett Koop suggest the main reason it isn’t better known is the slow process of traditional medical societies to accept and review new procedures. Prolotherapy is being used in many well known medical institutions including the Mayo Clinic. Trainings are being offered via the Academy of Sclerotherapeutic Pain Management, which is sponsored by the American Osteopathic Association (AOA) and other orthopedic certifications. Dr. Johnson is a member of the Academy of Sclerotherapeutic Pain Management.