Prolotherapy (Sclerosant Therapy)

Prolotherapy

The use of an agent to proliferate tissue.  Also known as sclerotherapy – formation of scar tissue with a view to strengthening the tissue.

Prolotherapy is used to repair damaged, lax, or weakened ligaments.  It has been used for over fifty years to help strengthen damaged ligaments in the back.  It has also been used in patients with varicose veins, as an alternative to surgery, to turn a tube of blood into a tube of scar tissue, to remove the varicosity.  This clinic does not treat varicose veins.

Prolotherapy has been successfully combined with manipulative techniques to improve the results of both therapies in treating chronic back injuries of a soft tissue type.  It is not useful for bony injuries, nerve injuries, infections, cancer, inflammatory diseases or spinal stenosis.  It is usually avoided in pregnant patients (due to limitation of benefit), but safe in breast-feeding patients.

Many agents are used for prolotherapy.  The common ones include glucose, phenol, alcohol, and a patient’s own blood, however these are weak sclerosants and not very effective at strengthening ligamentous tissue.  Tetradecyl Sulphate acts as an excellent sclerosant, and is eliminated from the body in 24-48 hours.  Its effect is to stimulate the growth of new scar tissue, while having minimal side-effects.  Tetradecyl Sulphate has also been used for tightening the uvula (at the back of the throat) to prevent snoring.  Tetradecyl is generally avoided in people with sulphur allergy as there is often cross-over sensitivity.  Polidocanol is also a newer sclerosing agent that is a mixture of soaps and is stronger than Ethanolamine alone (which we used to use) in its strengthening effect.  At this clinic we use 0.1% Tetradecyl Sulphate or 0.25% Polidocanol solutions for strengthening damaged ligaments. 

The injections cause a local bruise discomfort for an average of 3-5 days following injection, and can sometimes cause an actual bruise.  This bruise feeling is a desired effect as the body lays down fibrous tissue in response to the irritation caused by the sclerosing agent.  This treatment has virtually no other side-effects apart from the known sulphur allergy risk in those who are allergic to sulphur drugs, and a much rarer risk of allergy to local anaesthetic that is mixed with the agent, or to Polidocanol.  There is a rare risk of infection any time a needle goes through the skin which is listed as approximately 1:10,000.  About the same risk as dying from a car accident on New Zealand roads every year (New Zealand statistics)

After treatment:

Prolotherapy works by creating an artificial local inflammation of sufficient degree to trigger the body’s healing mechanism to lay down new white fibrous tissue (scar tissue).  This strengthens the damaged ligament that the doctor is endeavouring to repair.  The treatment site may be tender for up to a week after the injection.  When the initial tenderness subsides, it is important to remember the repair is very weak in the first six weeks, and gains strength slowly, so that by 3 months it has 3/4 of its strength and it has full strength by 6 months.  Correct lifting technique during this time is essential to avoid breakdown of the repair.

It is important not to take any anti-inflammatory drugs for the first 5 days after a sclerosant injection. (It doesn’t matter for corticosteroid injections, as corticosteroids are your body’s own natural anti-inflammatory.  Sclerosant has exactly the opposite action to steroids.)  This applies to all anti-inflammatories such as diclofenac (Voltaren), naproxen (Naprosyn, Synflex), ibuprofen (Nurofen, Brufen), and celecoxib (Celebrex).  Simple pain relief such as paracetamol (Panadol), and paracetamol plus codeine (Panadeine, Codalgin) are useful to diminish the discomfort.  The degree of discomfort varies from person to person and according to how inflamed the injury was at the time of injection.  Non-pharmaceutical pain relief can be provided with a hot water bottle or heat pack applied directly to the sore area. 

Persistence of pain after a week needs to be reported and re-assessed.  This persistence of pain is most commonly due to either a recurrent dysfunction at the repair site, from doing a wrong movement (such as an inadvertent forward bend), or from an adjacent dysfunction, which may have been present, but masked by the more severe (treated) tenderness.