Book Notes: From Fatigued to Fantastic
Chapter 7: Pain Relief for FMS
In this section:
- More Detailed Essential Fatty Acid Information
- Summary on How to Treat Specific types of Pain
- Prolotherapy (from Chapter 23)
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More Detailed Essential Fatty Acid Information
Essential Fatty Acids—For Many Benefits
Essential fatty acids (EFAs) play an important and yet poorly recognized role in human health. They are involved in many functions, including hormone production, immune function, and the regulation of inflammation, blood flow, and the amount and wateriness of saliva, tears, and other bodily fluids produced. EFAs also are part of the makeup the membranes surrounding every cell in the body.
Most Americans get only about 10 percent of the amount of EFAs they need for optimal well-being. This is despite the fact that the average person’s fat intake has increased by about fifty pounds a year in the last century. Unfortunately, food-processing techniques have essentially removed the EFAs from our food supply because oils are expressed at high temperatures and previously healthy vegetable oils are hydrogenated, or saturated, to harden and stabilize them. These processing steps both eliminate the EFAs, and make it difficult for your body to use the EFAs it does get.
Symptoms of EFA deficiency are many and varied, and include fatigue, poor memory, recurrent respiratory infections, gas, bloating, arthralgias (aches and pains), constipation, cracking nails, depression, dry hair and skin, and inadequate saliva, tears, and vaginal lubrication.
Oils and fatty acids are not the same thing. Fats usually refer to saturated fats, which are solid at room temperature. Oils usually refer to unsaturated fats, which are liquid at room temperature. Saturated means that the hooks (bonds) that connect each of the atoms in the fat molecules are all in use, and there is no room for any new atoms to attach. This makes the fat molecules straight and rigid, and thus hard. Unsaturated fats are either monounsaturated or polyunsaturated. Monounsaturated fats have one open hook and polyunsaturated fats have several open hooks where molecules can attach. This makes them more flexible (fluid). If the first open hook (double bond) is six carbon atoms from the end of the fat molecule, it is called an omega-6 fatty acid. Most vegetable oils are omega-6 oils. If the first open hook is 3 carbon atoms from the end, the molecule is an omega-3 fatty acid. Fish oils and flaxseed oil are omega-3 oils.
How your body is able to use the fat depends on whether it is a saturated, omega-3, or omega-6 fatty acid. In many processed foods (for example, margarine) the unsaturated fats are changed from their healthy natural state, in which they are known as cis-fatty acids, to an unnatural unhealthy state, in which they are called trans-fatty acids. These trans-fatty acids can cause heart disease, obesity, immune suppression, and decreased testosterone levels, while worsening fatty acid deficiencies. Despite advertising hype to the contrary, margarine is probably less healthy than butter, and I recommend not using it.
All cells in the body are enclosed in a cell membrane, a balloon-like wall. This wall is made up of fatty acids and a phosphorus molecule, usually choline or serine. This combination is called a phospholipid. The type of fat available to your body when it makes cell membranes (saturated versus omega-3 and -6) is critical. Your body likes to use omega-3 and -6 fatty acids because these are more fluid. When these are not available, your body has to use saturated fats. This results in rigid, poorly functioning cellular walls. Cell membranes perform the critical functions of allowing and keeping in water, minerals, and nutrients. In addition, the regulatory hormones and neurotransmitters—molecules that tell the cells what they need to do—function by fitting into receptors located in the cell membranes. Stiff cell walls can make it hard for these functions to occur properly.
EFAs are also critical for making an important class of body chemicals called prostaglandins. These are an important group of hormones that regulate inflammation, pain, bowel function, fluid balance, mood, allergies, and the production of some other hormones. There are three main series of prostaglandins, designated PGE1, PGE2, and PGE3. Series 1 and 3 prostaglandins, which are made from vegetable EFAs and fish oils, decrease inflammation and improve mood. Series 2 prostaglandins, which are produced from animal fats, increase inflammation. To summarize this:
* Linoleic acid (in safflower or corn oil) produce dihomogamma linolenic acid (DGLA, also in primrose and borage oil) which produce PGE1, which decreases inflammation and improves mood. Making PGE1 also requires vitamin B6, zinc, and magnesium. The process is inhibited by sugar, alcohol, trans-fatty acids, and saturated fats.
* Arachidonic acid (in animal fats) produce PGE2, which promotes inflammation and increases the risk of heart disease.
* Alpha-linolenic acid (in flaxseed oil) produce eicosapentaenoic acid (EPA, also in fish oils) which produce PGE3, which is anti-inflammatory and protects against heart disease.
* To treat possible essential fatty acid deficiency, I recommend taking the following:
* Fish Oil-Use a mercury and toxin free brand which is stabilized so it is fresh. If you would not eat a piece of fish that tastes like the oil, do not use that brand of oil. I recommend Eskimo 3 or Nordic Naturals Fish Oils. Take 1 tablespoon (or 4,000 to 5,000 milligrams in capsule form) daily.
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* If you have PMS, take Evening primrose oil or borage oil. Take 500 milligrams of either one twice a day.
Take these supplements for three months. If pain improves, which is likely, and dry skin, dry hair, dry mouth and/or dry eyes improve, then you probably had an essential fatty acid deficiency. After three months, you can decrease the above regimen to H tablespoon of flaxseed oil or fish oil a day and two to three servings a week of tuna, salmon, or herring. At the same time, decrease your consumption of saturated fats and trans-fatty acids, found in solid fats and processed foods such as margarine, and substitute olive, canola, and/or safflower oil. It is worth buying good brands of oils from a health food store, even though they may be more expensive. Look for a brand that is certified as organic on the label by a third-party source. Healthy oils have a smooth, nutty flavor instead of tasting bland or bitter. It is best if the oil is in an opaque plastic bottle and kept in the refrigerated section of the health food store. When you get it home, keep it in your refrigerator or, if you want to extend its shelf life, your freezer. I would add 1,200 to 2,000 units of vitamin E to any bottle of oil when you open it. This can be done by popping and squeezing the contents of three to five 400-unit vitamin E capsules into the bottle of oil. One highly respected maker of flaxseed oil is Barlean’s Organic Oils (see Appendix J: Resources).
Combined with magnesium, evening primrose oil can be very helpful for PMS. The recommended dose is six to twelve capsules a day and it takes three months to see the effect. You can then drop to six capsules a day for the week before your period. Over time, you can cut back to the lowest dose that maintains the benefit. Depression that does not respond to St. John’s wort or antidepressant medications will sometimes improve with omega-3 fatty acids (flaxseed or fish oils).
Summary on How to Treat Specific types of Pain (Pain Free 1-2-3 Cliff Notes)
For more information and the scientific references for the Information below, I Refer You To My Book “Pain Free 1-2-3”.
Other common painful conditions seen in CFS/FMS
Neuropathic (Nerve) Pain
Diabetic Nerve Pain. Be sure to take the Energy Revitalization System vitamin powder and B complex capsule because vitamins B6 and B12, as well inositol, can be very important for nutritional support. Add lipoic acid, 300 mg, twice a day.
Did the pain follow an attack of shingles/herpes zoster (a linear painful rash on one side of your body)? If yes, consider Postherpetic Neuralgia and treat with Lidoderm® patches and a gel containing a combination of Neurontin® and Ketamine®. If pain persists, take Neurontin® and Elavil® orally with the other medications below as needed.
Nerve Compression. This is often a muscular problem with the tight muscles pinching the nerves. See the treatment of muscle tightness. If the pain is from disc disease, intravenous colchicine, 1 mg once or twice weekly for a total of 6 to 8 doses will usually eliminate this pain
Does pain manifest as horribly severe pain in one hand or foot (often following trauma to that extremity or the associated hip/shoulder) so that you make sure no one touches it?
If yes, consider Reflex sympathetic dystrophy (CRPS). Treat this with Neurontin® (at least 2400 mg daily), Elavil® (25 mg at bedtime), topical gels containing high levels of Ketamine®, and Lidoderm® patches. For refractory cases consider intravenous Ketamine®.
Is the pain excruciating, consisting of attacks of pain in the lips, gums, cheek, or jaw, usually lasting no more than a few seconds or minutes? Do the painful attacks also recur frequently throughout the day and night for several weeks at a time (usually occurring in the middle-aged and elderly)?
If yes, consider trigeminal neuralgia (tic douloureux). Begin treatment with Tegretol®, 100 mg a day (taken with food), and increasing slowly up to 200 mg 4 times a day as needed. This eliminates the pain in 75 percent of patients. Nutritional therapies can also be helpful and I recommend beginning with the vitamin powder and lipoic acid, 300 mg 3 times a day. Several studies have shown that giving niacin (nicotinic acid 100 to 200 mg IV daily for several days) and vitamin B1 intravenously can also help. The other treatments listed below can also be helpful. If these treatments fail, surgical options are available.
General Principles for Treating Neuropathies/Nerve Pain
Many medications can be helpful for nerve pain. Allow them each 2 to 6 weeks to start working. If pain is severe, you may want to begin with Ultram® or narcotics immediately, as well as topical treatments, which will often keep you comfortable while waiting for these other therapies to work. For small areas, begin with the Lidocaine® patch (Lidoderm®). Up to 4 patches can be used at a time, and they can be left on for 12 to 18 hours a day (leave the patch off for at least 6 hours daily). You can add topical gels or use them instead of the patch. Consider putting the patch over the gels. It can take 2 weeks for these to work. For large areas, or if topical/local treatments are not effective, use the oral medications below. They can be tried in the order listed. The Pain Free 1-2-3! book gives detailed information for using each medication. It may take 2 to 6 weeks to see the effect of a given treatment.
If pain is severe, you can try 2 medications at a time so that you can get relief more quickly. This is especially true if you’re combining a topical and an oral medication. It may take a higher dose of medicine to eliminate nerve pain than for other types of pain. Side effects are less likely if you start with a lower dose and work your way up as is comfortable. If the first treatment for any given family (number) is helpful but poorly tolerated, try the next one in the same group. If the medication does not help significantly, skip down to the next numbered treatment (i.e. if medications for level 1A help but have too many side effects, try level 1B. If 1A simply does not help, go to treatment group 2).
Treatment Order for Neuropathies
Begin with the vitamin powder and lipoic acid, 300 mg, 3 times a day. For localized areas add the Lidoderm® patch and pain gels (effects seen in 2 weeks). Begin all these simultaneously as well as:
1A. Neurontin®—may take 2400 to 3600 mg daily for nerve pain
1B. Gabatril®—average effective dose for nerve pain is 16 mg a day
2. Tricyclic anti-depressants, 10 to 50 mg at bedtime
2A. Elavil®
2B. Tofranil®
2C. Nortriptyline®
2D. Doxepin®
3A. Effexor®, 75 mg 3 times a day
3B. Paxil®, 20 to 80 mg per day
4. Ultram®, 50 mg, 1 to 2 tablets up to 4 times a day. Four tablets a day works very well. Above this dose sometimes causes nausea. It can start to work immediately.
5. Topamax® (Topiramate®), 200 to 300 mg a day. Side effects are less if you start with a low dose and work up.
6. Lamictal® (Lamotrigine®), 300 to 400 mg a day. Lower doses are less likely to be effective.
7. Zanaflex®, although more likely to be helpful for muscle pain at a dose of 4 to 8 mg daily, it can help nerve pain in doses of approximately 24 mg a day.
8. Keppra®, 1000 to 1500 mg, 2 times a day
9. Trileptal® (oxcarbazepine), usually requires approximately 150 to 300 mg twice daily
10. Dilantin®, 100 mg, 3 to 4 times day
11. Narcotics
12. Benadryl®, 25+ mg, 3 to 4 times a day
Arthritis
Do not presume that joint pain is arthritis. Joint pain can also come from the muscles, tendons, and ligaments around the joint. This is so even if x-rays are abnormal.
If inflammation is present, consider rheumatoid or infectious arthritis. In these situations, in addition to standard treatments, I recommend adding the antibiotic doxycycline, 100 mg twice daily, and an anti-inflammatory diet low in meat and high in fish oil. It is a good idea to take fish oil (1 to 2 Tbsp daily) as well. Many other nutrients are also critical, so be sure to give the vitamin powder.
I recommend you begin with a natural treatment program, which will decrease inflammation and help to repair the joints. This treatment has four main components:
A. Repair. The joint cartilage can be repaired using a combination of glucosamine sulfate (most important, 750 mg 2 times a day for at least 6 weeks), MSM (3 to 6 grams a day), and Condroitin® (less important). It is also critical that you give the other nutrients present in the vitamin powder to promote wound healing. The powder naturally increases SAMe levels. Increasing these levels has been shown to help arthritis. After 6 weeks, this combination decreases pain.
B. Use other anti-inflammatories to prevent damage and decrease or eliminate pain. I recommend a combination of several natural remedies, many of which can be found in combination. The mix I like the most combines Boswellia, willow bark, and cherry (all present in the End Pain formula). It takes 6 weeks to see the full effect. Begin with two capsules three times a day for 2-6 weeks until the pain is controlled. You can then lower the dose.
C. Restore function with stretching, exercise, weight loss, and heat. Exercise at least twenty minutes a day. Swimming, walking, and yoga are good choices. Use a heating pad or moist heat for up to 20 minutes at a time to give relief.
D. Rule out and treat infections and food allergies that can aggravate arthritis. Most blood tests (except the ones from Elisa Act Technologies) are not reliable. NAET (see http://www.naet.com/) is a wonderful way to test for and eliminate food sensitivities. A related technique called JMT (see www.jmt-jafmeltechnique.com) is also an excellent way to treat rheumatoid and osteoarthritis naturally using energy medicine.
For symptomatic relief, prescription therapies, including NSAIDS such as Motrin®, COX 2 inhibitors like Celebrex®, Tylenol®, Lidoderm® patches and Ultram® can all be helpful.
Headaches
Tension Headaches cause moderate pain on both sides of and across the forehead, tend to both start and fade away gradually, and are the result of muscle tightness in the sterno-cleidomastoid muscles of the neck. If the pain is coming from the suboccipital muscles at the base of the skull, the pain is often behind the eyes and/or on top of the head.
Because tension headaches are muscular, the same treatments discussed that cause your muscles to relax will often eliminate the recurrence of these headaches. Paying attention to structural factors can also help.
Many medications can be used to prevent chronic tension headaches. These include anti-depressants such as Remeron®, 15 to 30 mg, or Elavil®, 10 to 50 mg at bedtime.
To treat the acute pain of headaches, begin with herbal remedies such as the Revitalizing Sleep Formula combined with the “End Pain” formula, which contains willow bark, Boswellia, and cherry. This can be helpful for acute attacks, but it takes 2 to 6 weeks to fully kick in. A physical therapy technique called stretch and spray, which approximately 10 percent of physical therapists are familiar with, is also an excellent and pain-free way to release your muscles and eliminate a tension headache. In addition, there are the old standbys of Tylenol® and Motrin®/Advil®. Other medications that can be quite helpful include Midrin® and Ultram®. I would begin with the natural therapies first, however, as I think these are both more effective and safer.
Migraine Headaches
These headaches can be very severe and usually last for several days. Migraines are often preceded by an “aura,” which may consist of visual disturbances such as flashing lights. And the headaches are often associated with nausea, sweats, dizziness, and light and sound sensitivity.
In the U. S., medications in the Imitrex® family still remain the first choice for the treatment of acute migraines. A combination of indomethacin (a “super-aspirin”), prochlorperazine (for nausea and to enhance absorption), and caffeine in suppository form is commonly used in Italy (it can be made up by compounding pharmacies). Midrin®, which is a mix of three medications, can also be effective. Take two capsules immediately followed by 1 capsule every hour until the headache is relieved (to a maximum of 5 capsules within a 12 hour period).
A fascinating study can guide you on when to use Imitrex® family medications vs. when to go with other therapies. Seventy-five percent of migraine patients get painful sensitivity to normal touch (e.g. from eyeglasses) around their eyes. Studies showed that when participants used Imitrex before the tenderness/pain around the eyes began, it knocked out the migraine 93 percent of the time. If the pain/tenderness around the eyes had already set in, Imitrex only eliminated the migraine 13 percent of the time, although it still helped the throbbing. In other words, if your patients are one of the lucky ones who does not get pain around the eyes, the Imitrex can knock out your migraine at any time. If they are one of those who do get pain/tenderness around the eyes, it is a race against the clock to take the Imitrex before the pain starts. This means take the Imitrex early in the attack (the first 5 to 20 minutes) before the skin hypersensitivity gets established. For example, use it at the earliest warning signs, like painful scalp or discomfort from wearing glasses or earrings or from shaving. If pain has already fully set in before they take the Imitrex, consider using one of the other treatments.
Butterbur is an herb that can both prevent and eliminate migraines. Take 50 mg 3 times a day for 1 month and then 50-75 mg twice a day to prevent migraines. You can take 100 mg every 3 hours to eliminate an acute migraine. In the hospital emergency room or doctor’s office, intravenous magnesium can very effectively and quickly eliminate an acute migraine.
For patients with severe migraines who often need to go to the hospital emergency room, and if the above treatments are not adequate, it is helpful to have a “rescue medication” that can be used at home. ACTIQ (fentanyl lollipops) can be used at home and are as effective as IV morphine. The average dose needed is 800 mcg
Migraine Prevention
Natural therapies can prevent many, if not most, migraines. I would begin by taking the Energy Revitalization System vitamin powder plus 300 mg of Vitamin B2 in the morning, plus 200 mg of magnesium at night. If the cost is not prohibitive, add butterbur, 50-75 mg 2 times day (you can use 100 mg once a day but it is not as effective). Natural approaches can help eliminate even frequent and horribly severe migraine problems, but remember that it usually takes 2 to 3 months to see the effect--so give them time to work.
Avoiding hidden food allergies can reduce or eliminate migraines in as many as 85 percent of patients. The most common reactive foods are: wheat in 78 percent of patients; oranges in 65 percent; eggs in 45 percent; tea and coffee in 40 percent each; chocolate and milk in 37 percent each; beef in 35 percent; and corn, cane sugar, and yeast in 33 percent each. Clinical experience also suggests that the artificial sweetener aspartame (NutraSweet®) can trigger migraines and other headaches, although this is controversial. You may find that instead of avoiding foods that trigger your migraines for the rest of your life, you can eliminate the sensitivities/allergies using a powerfully effective acupressure technique called NAET (see http://www.naet.com/).
Prescription therapies for prevention can reduce the number of headache days per month by an average of 50 percent. These include Neurontin®, beta-blockers (Inderal®—avoid this if you have asthma or fatigue), calcium channel blockers, Depakote®, Topamax®, Elavil®, and Doxepin®.
Other Headaches
Sinusitis is another common cause of headaches. Most cases of chronic sinusitis are caused by fungal overgrowth. Chronic sinusitis routinely resolves when we treat it with Diflucan® and the other yeast/anti-fungal therapies. It is also helpful to use a special prescription Sinusitis Nose Spray that contains anti-bacterials and anti-fungals (from ITC Pharmacy). Use 1 to 2 sprays in each nostril twice a day for 6 weeks and then as needed. Silver spray taken with it can also be effective.
Caffeine withdrawal headaches are common in people who drink a lot of coffee. It is especially common in the morning before people get their coffee “fix” and often occurs approximately 18 hours after the last cup of coffee. Weaning off excess caffeine is the solution.
Back Pain
By eliminating the tissue swelling using intravenous colchicine and nutrients, disc pain can be eliminated well over 70 percent of the time without surgery. Sciatica, or back pain in which the pain goes down the leg, is often a form of disc disease.
Sleep on a medium firm mattress instead of a firm mattress.
Add glucosamine sulfate, 750 mg 2 x day and Chondroitin® sulfate, 2500 mg per day. Give it a 6 to 12 week trial.
Lamictal® and/or Lidoderm® patches can also be helpful
Most other back pain, unless it is coming from chest or abdominal organs (which is rare) is muscular, arthritic, or from ligaments.
Osteoporosis
Taking calcium plays only a modest role in improving bone strength. Give 1000 to 1500 mg per day (with evening meals or at bedtime, and not within 6 hours of taking thyroid hormone).
Also give the vitamin powder, which contains magnesium, boron, folic acid, copper, manganese, zinc, and vitamins B6, B12, D, and C, all of which are important in treating osteoporosis.
Give strontium, 170-340 mg per day as well. This nutrient can markedly increase bone density by 4 to 7 percent a year safely and inexpensively. It can also help osteoarthritis. Take it on an empty stomach in the morning at a different time than the calcium.
DHEA, testosterone, and estrogen replacement can also help.
Fosamax® (Rx), 70 mg and related medications once a week can also help if essential. They tend to be high in side effects though (including jaw bone damage) so I prefer using the treatments above first.
Indigestion and Digestive Enzymes
Indigestion is usually not caused by excess stomach acid. Due to poor digestion or stomach infections, any stomach acid can hurt. Although it helps you feel better in the short-term, turning off stomach acid long-term can markedly worsen digestion and overall health. Food processing (used to prolong grocery store shelf life) destroys the digestive enzymes present in food. This contributes dramatically to indigestion. Coffee, alcohol, and aspirin/Motrin® products can also cause indigestion and ulcers.
To get off of acid blocker medications comfortably do the following for 4 to 8 weeks(see the detailed instruction sheet at www.vitality101.com):
A. Use plant-based digestive enzymes (e.g. Similase or Complete Gest). Taking 2 capsules with each meal will help you digest your food properly. In addition, drink warm liquids with meals, because cold liquids inactivate your digestive enzymes. If the enzymes are irritating to the stomach, switch to a brand called GS Similase until your stomach feels better.
B. Take mastic gum (any brand), 1000 mg twice a day for 2 months, then as needed.
C. Take DGL Licorice, 380 mg (not the sugar-free type) or Rhizinate from PhytoPharmica. Chew 2 tablets 20 minutes before meals.
D. Take Heartburn Free (by Enzymatic Therapies). After your stomach is feeling better, take 1 capsule every other day for 20 days. It may initially aggravate reflux, but 10 capsules can give long term-relief by eliminating the stomach infection.
E. In 4-8 weeks, when the stomach is better, wean off the antacids
Irritable Bowel Syndrome
Also known as spastic colon, this is a condition in which irregular contractions of the intestines results in constipation and/or diarrhea, often alternating, as well as gas, pain, cramping, and bloating. This usually resolves when the bowel infections, especially yeast, are treated. Bacterial overgrowth and parasites also need to be looked for and treated.
Pelvic Pain
Interstitial Cystitis(IC) is a bladder problem characterized by severe urinary urgency, frequency, burning, and pain. Once bacterial infections have been ruled out, I prescribe Elavil®, 25 mg at bedtime plus Neurontin®, 300 to 900 mg at bedtime and perhaps during the day as well. If these are ineffective after 6 weeks, a trial of Sinequan® and the other anti-seizure medications is worthwhile. The medication pyridium, which numbs the bladder (and turns the urine and sweat light orange) and Urispaz®, an anti-spasmodic, can be helpful as well. I also treat the patient for presumptive Candida with oral Diflucan® for 3 months.
It is important to avoid certain foods that aggravate symptoms and to recognize that any vitamins, especially the B vitamins and any nutrients that are acidic (including the vitamin powder), can dramatically irritate the bladder in some patients with IC.
If the above products do not work, try Elmiron®, a 100 mg capsule 3 times a day with water at least 1 hour before, or 2 hours after, eating. In addition, consider adding MSM (Methyl Sulfonyl Methane) at a dose of 6 to 18 grams a day, L-Arginine®, 500 mg 3 times day, and the herbal “saw palmetto,” 160 mg twice a day. These may all take 3 months to work. Interestingly, the bioflavonoid vitamin Quercetin, 500 mg twice a day, has been reported to decrease IC as well as prostate symptoms.
Vulvodynia is defined as chronic vulvar itching, burning, and/or pain that is significantly uncomfortable. In this condition, vulvar/vaginal pain can either occur only during intercourse, or be constantly present. I put almost all women with pelvic pain on tricyclics such as Elavil® or nortriptyline combined with Neurontin®. In my experience, vulvodynia seems to occur as 3 main types:
A. Neuropathic—this pain appears to be caused by nerve irritation and is sharp, burning, and/or shooting (like nerve pain). In this case, apply the treatment principles above on neuropathic pain. Begin with tricyclic anti-depressants (nortriptyline, desipramine, imipramine, doxepin, or Elavil®) at 25 to 150 mg each night and/or Neurontin®, 100 mg to 3600 mg daily, and proceed from there.
B. Inflammatory—this pain type is associated with local inflammation/irritation. In this situation, I would avoid topical creams. I routinely give at least a 3 month trial of oral Diflucan®, 200 mg a day.
C. Muscle pain—if the pain is deep seated and not triggered by touching the outer vagina, it may be coming from spasm of the deep pelvic muscles. In this situation, the pain may occur or be accentuated during the deep thrusting of intercourse. For this pain, the general principles for treating muscle pain apply.
Prostate pain—this pain is fairly common in men. When no infection is found, it is called prostadynia. I suspect that prostadynia often occurs because of subtle infections, and it usually improves when I treat these. Interestingly, the bioflavonoid vitamin Quercetin, 500 mg twice a day, decreases prostate symptoms in both prostadynia and prostatitis.
Mouth Sores
If you have intermittent painful sores in your mouth which last around 7-10 days, these are usually apthous ulcers. In people with CFS/FMS, most of these come from nutritional deficiencies (which the vitamin powder takes care of) and yeast infections. For these, I recommend the prescription Mycelex Troches (oral lozenges). The first day of the attack, suck on a lozenge five to six times a day for ten to fifteen minutes. Then leave the piece(s) sitting right up against the sore(s) for thirty minutes or so, or until you are tired of them being there. This can usually make the pain go away within twenty-four hours instead of the usual ten days. Once you finish the yeast protocol discusses in Chapter 7, the mouth sores will usually stay gone. Recurrence, especially if accompanied by sinus congestion or spastic colon, usually means you have to treat the yeast again.
Prolotherapy (from Chapter 23)
The following chapter on Prolotherapy was written by two wonderful pain specialists from Texas. In addition to helping you understand a very powerful tool, it also offers a broader perspective on how many different effective approaches there are to pain management. If you’d like, it’s okay to simply skip over the technical details, and leave those to the physicians, who will administer the Prolotherapy injections. Many people receive benefit from the technique discussed in this chapter. I think you’ll enjoy reading it.
Prolotherapy: An Orphaned Medical Intervention Repairing Connective Tissue Weakness to Resolve Chronic Musculoskeletal Pain
By Brad Fullerton, M.D. and David Harris, M.D.
Prolotherapy is a proven, safe, cost-effective treatment that can eliminate chronic pain in approximately 80 to 90 percent of sufferers, yet it has been ignored by mainstream medicine for almost 70 years. C. Everett Koop, M.D., former U.S. Surgeon General, credits Prolotherapy with curing his chronic low back pain in the late 1950s. After receiving training in the technique, he practiced Prolotherapy in his office at the University of Pennsylvania for 20 years and has publicly expressed that Prolotherapy should have a prominent place in the modern treatment of musculoskeletal pain. By the end of this chapter, we hope that you understand why Prolotherapy (or “Prolo”) was orphaned in the first half of the 20th century and why it is now on the leading edge of a revolution in medicine.
The conventional model of pain management has the underlying belief that inflammation is at the root of almost all pain problems. This core belief is so well-established that almost no one bothers to question it any longer. It has become part of the common language that we all use. Patients come into our offices almost everyday complaining of “inflammation” rather than pain. We ask, “Where do you feel the pain?” Patients reply, “Well, my elbow is really inflamed.” or “The inflammation started in my low back, now it’s going down my leg.” They have already decided that what they feel is inflammation, not pain. Often, when they describe “swelling,” this is actually a muscle in spasm.
When new diseases were being identified in the 19th and early 20th centuries, the first clue to the problem often came when doctors would look at tissue under a microscope. They would identify “inflammatory cells” in the tissue; these were often the bodies own white blood cells responding to a virus or bacteria. So, if the infection and thus the inflammation were found in the liver, the disease would be called “hepatitis,” meaning inflammation of the liver. If these inflammatory cells were found in the stomach, the disease was initially called “gastritis” or inflammation of the stomach. But of course, the problem wasn’t really the inflammation, it was the infection. The body’s response to the infection was what the researchers were seeing under the microscope.
In the musculoskeletal system, names like “tendonitis,” “bursitis,” and “arthritis” imply that the problem is inflammation in the tendon, bursa, or joint. However, the most common problem in all these tissues is a degeneration or slow breakdown of the tissue over time. If the body does not adequately respond to this degeneration by making new tissue, we get pain and disability that progresses over a lifetime. Our modern medical model is solely focused on the concept of calming inflammation. There are entire shelves of name-brand and store-brand anti-inflammatory medications waiting for you at your local grocer, drug or variety store. If those don’t work, you can respond to the latest pharmaceutical industry ads and “ask your doctor” about the newest name-brand prescription anti-inflammatory, such as Celebrex®, Mobic®, or Bextra®. Or you can go to your family practice, sports medicine, or pain management physician for any of a variety of steroid injections, such as cortisone. Most of us accept these treatments gladly, because they seem to work so well. They temporarily take away the pain; they stop the inflammation.
Yet, we have an epidemic of chronic pain and degenerative arthritis. There is growing dissatisfaction with the current approach because it only works temporarily. We have to come back again and again for the latest anti-inflammatory prescription or another injection of steroids. Or we are offered a lifetime of treatment with anti-depressants, anti-seizure medications, muscle-relaxants, or slow release opiate medications, such as Oxycontin® or Methadone. These medications have their use but have potential side effects, including tolerance, addiction, stomach irritation, kidney damage, and liver damage. Anti-inflammatory medications have become a standard medical treatment, but many studies have demonstrated that these medications actually inhibit the healing process and eventually weaken tissues in the body.
If you are fortunate, your doctor is willing to refer you to a competent and skilled manual/massage therapist, acupuncturist, or chiropractor. Many of these therapies have grown out of a grass roots response to mainstream failures in treating musculoskeletal pain. As these attempts to control pain begin to fail, the next phase of treatment tends to progress towards destructive, expensive, and riskier procedures, such as surgery, implantation of morphine pumps, implantation of stimulating devices to block the sensation of pain, and procedures to destroy the nerves that conduct the sensation of pain. Surgical procedures such as these have their place, but often may be used before attempts have been made to promote a more natural healing and strengthening process for the underlying tissue weakness and injury that is often causing the pain. Many destructive procedures are performed with minimal recognition of the actual source of the pain. The justification for destructive procedures is “there is nothing else that can be done,” a statement usually made by a physician who has never heard of Prolotherapy or who is not skilled in connective tissue repair with Prolotherapy.
What Is Prolotherapy?
A form of Prolotherapy was performed by Hippocrates 2500 years ago, in which an athlete’s shoulder instability was treated by a red-hot needle, initiating healing through inflammation and strengthening of the capsule of the shoulder, and allowing him to ultimately return to his athletic activities. Injections of irritant solutions were performed in the late 1800s to repair hernias and in the early 1900s for TMJ dysfunction before surgery became available. These early attempts at promoting healing were called “sclerotherapy,” implying formation of scar. Older doctors sometimes ask why we would want to create scar tissue around a degenerated spine or joint. The answer is that we don’t. Sclerotherapy is an outdated and inaccurate term. George Hackett, M.D., a surgeon in Ohio, refined the technique and named it Prolotherapy. Over the years it has developed the nickname Prolo. Prolo is short for proliferation, thus Prolotherapy is a series of injections to stimulate proliferation of normal tissue. Since Dr. Hackett’s original work in the 1940s, studies in animals and humans have shown normal tissue formation after Prolotherapy, not scar. High resolution imaging with ultrasound is now confirming Dr. Hackett’s work; the tissue that is regenerated is organized, normal fibrous tissue.
Prolotherapy stimulates the body to repair painful areas. Its effectiveness is wide-ranging and includes pain associated with the back, the neck, all joints throughout the body, arthritis, migraine headaches, fibromyalgia, sciatica, herniated discs, and Temporo Mandibular Joint Dysfunction (TMJ). Chronic musculoskeletal pain is often due to weakness of ligaments and tendons. Joints, such as the knee and shoulder, often develop instability as well as weakening of the internal cartilage surfaces, and these are often improved by intra-articular (inside the joint) injections of dextrose and other irritant solutions.
Prolotherapy involves the injection of a natural solution (something as simple as a sugar or salt solution, cod liver oil, or herbal extract) into the area where the ligaments have either been weakened or damaged through injury or strain. Milder solutions of dextrose (corn syrup, essentially sugar), Lidocaine® (a local anesthetic), and Sarapin® (an herbal extract of the pitcher plant) are often used for the first several sessions. If the response is sluggish, stronger irritants may be used, such as mild concentrations of glucosamine, phenol (an alcohol), glycerin, or cod liver oil extract (known as sodium morrhuate).
The injection is given at the point where the ligament or tendon connects to the bone. Many points may require injection. The injection causes the body to heal itself through the process of controlled inflammation and production of growth factors. In the case of weakened or torn fibrous tissue, this repair results in as much as 30 to 40 percent strengthening of the attachment points.
Prolotherapy treatment sessions are generally given every 3 to 6 weeks to allow time for the growth of the new connective tissue. Patients usually require 4 to 6 treatment sessions for complete recovery, although some experience more immediate results. Many studies over the last fifty years show at least an 80 percent success rate.
Connective Tissue Weakness, Myofascial Pain, Arthritis, and Referred Pain
Pain that fails to respond to the traditional approaches is often caused by an injury to fibrous connective tissues, such as tendons and ligaments. Ligaments connect bone to bone, while tendons connect muscle to bone. Both ligaments and tendons may be damaged by major trauma, or may be exposed to minor repetitive trauma. In most people, these injuries tend to heal over 4 to 8 weeks. However, sometimes the tissue damage is too great, and the repair is not complete. These tissues have poor blood supply and are known to heal poorly compared to other tissues such as muscle. In other cases, patients with conditions such as fibromyalgia and chronic fatigue syndrome have underlying metabolic deficiencies that impair the healing process. These patients will often demonstrate pain and tenderness at the connections of their ligaments and tendons, with referral patterns of pain, numbness, tingling, and other abnormal sensations.
The joints are connected by strong taut ligament tissue, and cartilage lines the joint space. Laxity in the ligament structures may allow too much “play” in the joint, which results in muscle tension as the body attempts to stabilize the weak or loose structures. The muscles become fatigued after a period of time, resulting in myofascial pain. “Myo” refers to muscle; “fascia” is the fibrous tissue that surrounds, supports, and defines muscle and other tissue layers. The muscle may develop small regions of hyperactivity, which on examination show the clinical findings of trigger points and taut bands in the muscle bellies. These trigger points are thought to be neuromuscular junctions, where the smallest nerve fibers connect to the smallest muscle fibers. Normally, the neuromuscular junction is a highly regulated and balanced electrical connection that turns on and off with great precision. However, when trigger points are present, this connection is out of balance as if the neuromuscular junction has a short circuit. So, our muscles go into spasm and/or feel weak. In myofascial pain, some muscles become inhibited from achieving their full strength and become weak. This tends to happen with muscles that move the limbs through space, further away from the center of the body. The muscles closer to the spine whose purpose is to stabilize the body while limb motion is taking place tend to react more with tension and spasm. Thus, it is common to see a combination of weakness and tension in a region of the body, depending on the extent of injury and strain.
In lax joints over time, the body grows larger bony surfaces to support the increased stress and strain, creating the findings of arthritis that the physician notes on x-ray studies. Calcium is deposited in the weakened ligaments. Strengthening the supporting ligaments with Prolotherapy around an arthritic joint does appear to protect the remaining cartilage from further decline in current studies. There is some evidence that cartilage may even be thickened or strengthened, but that is not conclusive. Many physicians believe, and their patients are told, that arthritis is inevitable and irreversible. However, studies show that with Prolotherapy, the supporting ligaments and tendons can be repaired, thus potentially reversing or at least halting this “inevitable” decline.
Myofascial pain also develops from strain at the junction of the muscle tendon where it connects to the bone. There are extensive nerve connections on the outer surface of the bone (the periosteum) where the tendons and ligaments attach, and a strain on the damaged connection points may thus be extremely painful. These nerves provide information to the body regarding the position of the parts of the body, known as proprioception. Pain may be perceived distant from the actual source of the pain, producing the phenomenon of “Referred Pain.” Such pain may not demonstrate abnormalities with nerve testing or any other technique, such as MRI, CT, X-Ray studies, etc., and thus the source of the pain may be difficult to resolve. In such cases, the diagnosis of Reflex Sympathetic Dystrophy (RSD) is often given, when in fact there is a very treatable pain generator in the ligament, tendon, or joint pain generator.
Studies Supporting Prolotherapy
Placebo-controlled, randomized, double-blind studies on Prolotherapy performed with standard techniques have shown statistically significant improvement in pain reduction, stability, increased cartilage growth, improved “arthritic changes” on x-rays, increased range of motion, and greater overall function. It is estimated that over 1,500,000 patients have tried Prolotherapy over the past 70 years, with an extremely low risk and complication rate. Retrospective reviews of large numbers of patients verify a success rate of greater than 80 percent, with success defined as at least an improvement of 50 percent pain reduction. The bibliography attached provides a listing of studies and publications for further review.1
Guidelines for Determining Whether Prolotherapy May Be Useful
* Recurrent swelling or fullness involving a joint or muscular region
* Popping, clicking, grinding, or catching sensations with movement
* A sensation of the “leg giving way” with associated back pain
* Temporary benefit from chiropractic manipulation or manual mobilization that fails to ultimately resolve the pain
* Distinct tender points along the bone at tendon or ligament attachments
* Numbness, tingling, aching, or burning referred into an upper or lower extremity
* Recurrent headache, face pain, jaw pain, ear pain
* Chest pain with tenderness along the rib attachments on the spine or along the front of the chest
* Spine pain that does not respond to surgery or whose origin is not clear from MRI, CT, X-Ray, Myelogram, or other similar studies
Specific Regions Benefiting from Prolotherapy:
Spine Pain (Neck, Mid Back, Low Back)
Most back and neck pain results when weak ligaments and tendons cause the spine to become “unstable.” Vertebrae begin to slip, move, and rotate from their proper position, causing the disks to take on the additional load and producing the familiar “disk bulge” or “disk herniation.” The disk is simply a specialized ligament tissue with the same characteristics as other ligamentous tissues. The disk may be the primary source of pain as well, especially with moderate to severe trauma, which may cause an acute tear; this can be very painful and may cause nerve compression. Disk herniations may require treatment with medication, epidural steroid injections, therapy, or surgery, and may not respond well to Prolotherapy. However, the majority of spine pain does not originate in the disks, and thus a focus on disks as the sole source of pain reduces a physician’s “batting average” to far less than 50 percent long-term success. Because current diagnostic studies, such as MRI scans, CT scans, x-rays, bone scans, and myelograms do not reveal abnormalities of the numerous small ligaments, the typical and often unsuccessful focus is on the larger and more noticeable disk structures.
In summary, the disk is one of many potential sources of pain in the spine; however, successful treatment of spine pain requires a practitioner to recognize the numerous other pain generators as well.
Structures frequently treated in the spine and pelvis include the supraspinous ligament, the interspinous ligament, intertransverse process ligaments, facet joint capsules, sacroiliac ligament, sacrotuberous ligament, sacrospinous ligament, sacrococcygeal ligament, among many others.
Prolotherapy strengthens the connections along the spine, providing stability to reduce strain on the other structures. Over 3 to 6 months of treatment, muscle spasm and tenderness resolve, as well as the localized and referred pain. Strengthening the neck segments frequently reduces spasm and pain in the shoulder blade regions. Success often requires injections along the upper and inner aspects of the shoulder blades as well, where the trapezius, levator scapulae, rhomboid, and subscapularis muscles attach.
Headaches
Most headaches originate at weaknesses of the attachments of the suboccipital muscle tendons and fascia at the base of the back of the skull. This form of headache is referred to as tension, suboccipital, or cervicogenic and often refers to the eye, forehead, ear, or temple. The Greater and Lesser Occipital nerves run through this fibrous tissue and appear to contribute to the sensation of headache. Trauma, such as a motor vehicle accident, often causes a “whiplash” injury, creating small tears in this fibrous tissue. Although migraine headaches are thought to have a vascular (blood supply) origin, they are often triggered by the same tissue weaknesses as for tension headaches. Prolotherapy strengthens these tissue attachment weaknesses and usually greatly reduces the intensity and frequency of headaches.
Temporo Mandibular Joint Dysfunction (TMJ)
Popping, clicking, locking, and pain commonly occur in the joints of the lower jaw known as the TMJ. This can occur on one or both sides. The TMJ has been successfully treated for over 75 years with Prolotherapy; it remains the most successful and safest treatment available. Unfortunately, many patients have undergone various unproven surgeries over the last 25 years without attempting, or even being informed, about Prolotherapy first. Most of those surgical procedures are no longer practiced because of widespread failure. Prolotherapy for the TMJ usually involves 3 to 4 intra-articular (inside the joint) injections.
Shoulder, Elbow, Wrist and Hand
The shoulder, elbow, wrist, and hand have numerous ligament and tendon structures. Cartilage within these joints also may become damaged or torn. Repetitive motion of the upper extremity often results in laxity of the supporting joint capsules and ligaments, as well as a weakening of the tendon attachments. Intense athletic activities, such as pitching, golf, or tennis often result in shoulder and elbow pain. Many physicians will often be confused regarding the source of pain, often attributing numbness, tingling, swelling, and burning or achy pain to a nerve injury, which in fact, is fairly uncommon. There are painful conditions involving nerve compression that require surgery, but this is much less common than many believe. The vast majority of such injuries do not require surgery and are treated with very specific Prolotherapy injections into each localized connective tissue attachment and also inside each involved joint.
Instability of the shoulder joint is relatively easy to resolve with Prolotherapy and very difficult and inconsistent to cure with any other technique. Other causes of shoulder pain include: weakened attachments of the trapezius muscles all along the upper border of the shoulder blade and clavicle (collarbone); the attachments of the deltoid muscle tendon at the outer border of the shoulder and also the distal attachment along the outer upper arm; laxity of the acromioclavicular joint; and tears of the rotator cuff tendons. “Tennis elbow” and other elbow pain is usually caused by injury to the annular ligament, the elbow joint, and to the tendon and fascia attachments at the epicondyles, all of which respond well to strengthening with Prolotherapy injections. Wrist pain is frequently the result of ligament tears, cartilage tears, and joint capsular weakness and often is successfully resolved with Prolotherapy. The diagnosis of “Carpal Tunnel Syndrome” is commonly made for generalized wrist pain, when in fact classically this diagnosis should be reserved for true nerve entrapment of the Median nerve. Often, nerve studies, MRI, CT, and X-Rays reveal no clear abnormality, and surgery is contemplated because “there’s nothing else to do.” Although true “Carpal Tunnel Syndrome” may require surgery to decompress the nerve, surgery infrequently improves pain at the wrist, especially if studies do not reveal a significant abnormality of the nerve. All of the above respond very well to Prolotherapy injections to stimulate repair of the injured structures.
Hip, Knee, Ankle, and Foot
Hip and knee pain often are the result of joint capsule or ligamentous laxity, which ultimately may lead to degenerative arthritis if not corrected. Numerous ligaments surround the hip, knee, ankle, and foot, any of which may produce debilitating pain. Another source of pain is the tendon insertions, especially along the head of the femur (thighbone) and at the inner aspect of the knee (“Pes Anserinus”), where the hamstring muscles attach. Young men often develop “Osgood-Schlatter Disease” where the tendon from the patella (kneecap) weakens at the attachment to the tibia bone. Cartilage injury, muscle misalignment, and quadriceps weakness cause pain in the knee and under the kneecap, known as Patellofemoral Syndrome, or Chondromalacia Patellae. Recurrent ankle sprains result in weakness and lengthening of the supporting ligaments of the ankle, and may also cause cartilage injury inside the complex ankle joint. Pain also may occur with chronic tears in the Achilles tendon and in the anterior tibialis attachment on the tibia (“shin splints”). Heel pain commonly occurs along the sole of the foot, originating where the Plantar Fascia connects to the undersurface of the heel, resulting in Plantar Fasciitis. Pain in the forefoot occurs at the toe joints, the metatarsal bones, at bunions, and between the toes with tears of the transmetatarsal ligaments (commonly called “Morton’s Neuroma” or Metatarsalgia).
All of the above structures respond extremely well, permanently, to Prolotherapy, with injections given either inside the involved joints, or into the tendon and ligament attachments outside the joints. Traditional medical practice (medication, steroid injections, surgery, joint replacement) has a fair chance of resolving these problems, but at much greater risk and expense. Surgery may be justified if other less invasive techniques fail to resolve the painful structure. Usually, 4 to 6 treatments with Prolotherapy are required for each of these problems.
Chest Wall and Rib Pain
Obviously, chest pain can be serious. Assuming a more severe problem, such as cancer, heart disease, or lung disease has been ruled out, the primary causes of chest wall pain can be successfully treated with Prolotherapy. The pain is frequently associated with tears or weakness at the rib-breastbone (sternum) attachments, the muscle tendon attachments all along the rim of the ribs, the rib-vertebrae attachments, or the junction of the clavicle (collarbone) at the sternum. Prolotherapy will often reduce or resolve pain from these sites.
Groin, Vaginal, Testicular, or Rectal Pain
Numerous pelvic structures produce pain in these regions. A careful, thorough, and respectful examination of these structures will usually lead to a correct diagnosis and successful treatment. Structures may include the suprapubic joint, inguinal ligament attachments on the anterior pelvis, anterior hip capsule ligaments, sacrococcygeal ligament, iliolumbar ligament, and many others. Cramping during menstruation and back pain during pregnancy are often caused by ligamentous laxity in the pelvic region and can be greatly reduced with Prolotherapy. Prolotherapy often provides permanent relief of the pain over 4 to 6 visits.
Adopting the Orphaned Medical Intervention
To even consider Prolotherapy as an option, your physician has to question whether inflammation is always at the root of pain, or could the problem sometimes be inadequate inflammation? Health is always an act of balance. When our body is in a state of good health, the body is inflaming in a controlled way to fight off intruders and to repair damage from trauma, disease, or the wear and tear of facing gravity over a lifetime. Currently, we are taught that when we sprain our ankle, we must take anti-inflammatory medication as soon as possible. From the perspective of natural healing, this is essentially treating our body’s response to a trauma as if that response were a disease.
As doctors, if we only anti-inflame in response to pain, we are like the captain of a ship who believes the only way to steer a ship across the ocean is to always turn the wheel in one direction. If we appear off course, we just need to turn the wheel farther. But, of course, this will only lead us in circles and we will never reach our patient’s goal of health. Our present way of thinking is very much like the way we used to “care” for forests. For decades, or even centuries, we believed that we must fight all forest fires. As the bigger picture became clearer, we realized that suppressing every fire caused an overgrowth of unhealthy trees and underbrush that actually increased the chance of a devastating forest fire. By trying to help, we were creating imbalance in the ecosystem. Realizing that fires are a healthy event in the life of a forest, the forest service now thinks before acting. Sometimes it is best to suppress a certain fire, sometimes to allow a wildfire to burn itself out, and sometimes it is best to actually start a “prescribed fire.” After a prescribed fire, the unhealthy overgrowth is gone; vibrant, healthy growth begins anew. Then, the entire forest can return to balanced health.
As our health care system has moved toward integrative, complementary medicine, patients are seeking and demanding interventions that help our body do what it is naturally doing for itself. Prolotherapy is just such an intervention; it’s time for adoption has finally arrived.
Brad Fullerton, MD
The Patient-Physician Partnership
2714 Bee Cave Rd, Suite 106
Austin, TX 78746
(512)347-7246
(512)347-7245 FAX
Dr. Brad Fullerton received his medical degree from the University of Texas, Southwestern Medical School in Dallas. He completed his internship and one year of psychiatric training at the University of Connecticut, then residency training in Physical Medicine and Rehabilitation at the Graduate Hospital of the University of Pennsylvania in Philadelphia. He currently serves as medical director for the Spasticity Clinic at Children’s Hospital of Austin, while maintaining his private practice specializing in the treatment of chronic pain and sports injuries. His research interests include diagnostic musculoskeletal ultrasound imaging in Orthopedic Medicine and its use with Prolotherapy. Dr. Fullerton enjoys hiking along Austin’s beautiful spring-fed creeks and swimming holes with his wife and two daught ers.
David K. Harris, MD
The Lakewood Clinic
7307 Creekbluff Drive
Austin, Texas 78750
512-454-1234
Fax 512-476-0850
http://www.lakewoodclinic.com/
Dr. David Harris specializes in Physical Medicine and Rehabilitation in Austin, Texas. He primarily manages patients with sports and spine injuries at the Lakewood Clinic and at SpineAustin. He has used Dr. Teitelbaum’s approach with his chronic fatigue and fibromyalgia patients with great success, and this has led to the use of many of these techniques with his less “metabolically involved” patients. He has a BS in Electrical Engineering from The University of Texas, is on faculty at the University of Texas, and teaches regularly for the Texas Medical Association. He and his Physical Therapist wife, Michele, have two boys, A.J. and Kyle. He enjoys the outdoors and playing guitar with his local Austin band, Natural Causes.
To find qualified physicians who have been trained in Prolotherapy, please refer to http://www.aaomed.org (American Association of Orthopedic Medicine) and http://www.getprolo.com.
Important Points
Prolotherapy is a series of injections of a natural solution (something as simple as a sugar or salt solution, cod liver oil, known as sodium morrhuate, or herbal extract) into the area where the ligaments have either been weakened or damaged through injury or strain. This stimulates proliferation of normal tissue, which helps the body to repair painful areas.
Its effectiveness is wide-ranging and includes pain associated with the back, the neck, all joints throughout the body, arthritis, migraine headaches, fibromyalgia, sciatica, herniated discs, and Temporo Mandibular Joint Dysfunction (TMJ).
Chronic musculoskeletal pain is often due to weakness of ligaments and tendons. The injection is given at the point where the ligament or tendon connects to the bone. Many points may require injection. The injection causes the body to heal itself through the processes of controlled inflammation and production of growth factors.
Chapter 23: Prolotherapy
Banks, A.R. “A Rationale for Prolotherapy.” Journal of Orthopaedic Medicine 1991; Vol 13, No 3.
Hackett, G.S., Hemwall, G.A. Montgomery GA. Ligament and Tendon Relaxation Treated by Prolotherapy. 1993, 5th Edition, 2nd Printing, Oak Park Illinois.
Klein, R.G. “Proliferant Injectionas for Low Back Pain: Histologic Changes of Injected Ligaments and Objective Measures of Lumbar Spine Mobility before and After Treatment.” Journal of Neurology, Orthopedic Medicine and Surgery 1989; 10: 141 – 144.
Klein, R.G., Eek, B.C., DeLong, W.B., Mooney. V. “A Randomized Double-Blind Trial of Dextrose-Glycerine-Phenol Injections for Chronic Low Back Pain.” Journal of Spinal Disorders, 1993;Vol 6, No 1: 23-33.
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Maynard J, et al. “Morphological and Biochemical Effects of Sodium Morrhuate on Tendons.” Journal of Orthopaedic Research 1985;3: 234-248.
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Ongley, M.J., Dorman, T.A., Klein, R.G., Eek, B.C., Hubert, L.J. “A New Approach to the Treatment of Chronic Low Back Pain.” The Lancet, July 18, 1987: 143 – 146.
Ongley, M.J., Dorman, T.A., Eek, B.C., Lundgren, D., Klein, R.G. “Ligament instability of knees: a new approach to treatment.” Manual Medicine, 1988; 3: 152 – 154.
Reeves, K.D. “Treatment of Consecutive Severe Fibromyalgia Patients with Prolotherapy.” Journal of Orthopaedic Medicine, 1994;Vol 16, No 3.
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