Prolotherapy

Prolotherapy, also called proliferation therapy, is an injection-based treatment used in chronic musculoskeletal conditions.^[1] It has been characterised as an alternative medicine practice.^[2]

Medical uses

A 2015 review found no evidence that prolotherapy is safe or effective for

A 2009 systematic review of the efficacy in the treatment of lateral epicondylitis concluded that these therapies may benefit people with lateral epicondylitis, but the evidence was limited.^[9] A 2010 review concluded moderate evidence exists to support the use of prolotherapy injections in the management of pain in lateral epicondylitis, and that prolotherapy was no more effective than eccentric exercise in the treatment of Achilles tendinopathy.^[10] A 2016 review found a trend towards benefit in 2016 for lateral epicondylitis.^[11] A 2017 review found tentative evidence in Achilles tendinopathy.^[12]

In 2012, a systematic review studying various injection therapies found that prolotherapy and

Tentative evidence of prolotherapy benefit was reported in a 2011 review.[5]^[7] One 2017 review found evidence of benefit from low-quality studies.^[14] A 2017 review described the evidence as moderate for knee osteoarthritis.^[15] A 2016 review found benefit but there was a moderate degree of variability between trials and risk of bias.^[16] In 2019, the American College of Rheumatology recommended against prolotherapy for knee osteoarthritis.^[17]

Contraindications

• Local abscess
• Bleeding disorders^[19]
• Patient on anticoagulant medication^[19]
• Known allergy to prolotherapy agent^[19]
• Acute infections such as cellulitis^[7]
• Septic arthritis^[7]

Relative contraindications include:^{[citation needed]}

• Acute
  gouty arthritis
• Acute fracture

Side effects

Patients receiving prolotherapy injections have reported generally mild side effects, including mild pain and irritation at the injection site

Prolotherapy treatment sessions are generally given every two to six weeks for several months in a series ranging from three to six or more treatments.[18]^[20] Many patients receive treatment at less frequent intervals until treatments are rarely required, if at all.^[25]

Terminology and mechanism

The term originated with George S. Hackett, MD, in 1956 in a publication titled "The rehabilitation of an incompetent structure by the generation of new cellular tissue". He applied the term prolotherapy from the words "proli’" (Latin), meaning offspring, and "proliferate", meaning to produce new cells in rapid succession.^[26] Although the erroneous term "sclerotherapy" was utilized by some in the past to describe this treatment, it is now clear that prolotherapy does not cause scarring.^[27] The mechanism of prolotherapy requires further clarification.^{[19][20][22][27][28][29]} It is expected to involve a number of mechanisms.^[1][8][30]

Criticism

Some major

In 1840, French surgeon Alfred-Armand-Louis-Marie Velpeau published a paper detailing how he had injected an iodine solution into a hernia in order to create beneficial inflammation.^[35] American surgeon Joseph Pancoast later wrote that he had been performing this procedure (using either iodine or cantharides) since 1836.^[35] Another early American practitioner of this method was George Heaton.^[35]

After World War 1, sclerotherapy came to be a common treatment for malformations of blood vessels and the lymphatic system. This involved injecting a therapeutic liquid to shrink them.^[36]

By the late 1920s, this method was used to treat

In 1955, Gustav Anders Hemwall became acquainted with George Hackett at an American Medical Association meeting and started practicing the technique.^[38]

Hackett coined the term "prolotherapy" for the practice, a very early appearance being in his 1956 book Ligament and Tendon Relaxation (Skeletal Disability) Treated by Prolotherapy (Fibro-Osseus Proliferation).^[39]

References