Regenerative Medicine for Joint Pain and Injuries

Individuals with chronic inflammatory, joint, and musculoskeletal pain may be candidates for prolotherapy, including stem cell therapy

Millions of people live with chronic joint pain or a sports injury that has never healed. In the new and updated edition of Free Yourself from Chronic Pain and Sports Injuries, Practical Pain Management Editorial Advisory Board Member Donna D. Alderman, DO, offers practical information and a path toward becoming pain-free through prolotherapy regenerative medicine. This type of minimally invasive therapy works based on a simple principle: that the body has the capacity to heal itself.

Published by Family Doctor Press, the book is now available for pre-order, releasing in May 2018. The following is an advance excerpt* focusing on the basics of regenerative medicine and who may be a candidate for this novel therapy:

The Exciting Possibilities of Regenerative Medicine

Years ago, a friend told me a story about his coworker, a woman named Sally. Sally had a 2-year-old son whom she brought with her to the office from time to time. My friend described this child as a “monster,” always in a terrible, mean mood, smashing things, and continually screaming and crying. This went on for some time, with Sally regularly apologizing for her child’s poor behavior, until one day when her child arrived at the office happy, well behaved, and affectionate. Surprised by this dramatic change, my friend asked Sally, “What happened?” As it turned out, her son had been suffering from a very severe, but hidden, ear infection that had been going on for months. The doctor said it was the worst ear infection he had ever seen, almost resulting in hearing loss.

Although Sally and her son had seen several other doctors over the previous months, delays in diagnosis or ineffective treatments had continued until this infection was finally found and successfully treated. Once the infection was resolved, and the continual pain this poor child had been experiencing was gone, his true personality was restored—a personality not even his mother knew at that point—and both he and his mother got their lives back. This is what can happen to an individual in chronic pain.

Indeed, chronic musculoskeletal pain can be nagging, continual, and exhausting to the individual and his/her family. It was summed up best by a patient who told me, “Being in chronic pain is worse than being in prison; at least in prison you have a parole date.” For the person with musculoskeletal pain, often many doctors have been consulted, but ineffective or only temporary solutions given, or no diagnosis is found, and the problem continues. Fortunately, prolotherapy, and the exciting field of regenerative medicine, can often help.

What Exactly is “Regenerative Medicine?”

This term applies to a branch of medicine that focuses on ways to, repair, replace, or regenerate damaged human tissue. Prolotherapy is a regenerative medicine technique used to stimulate the repair of painful ligaments, tendons, and joints, including osteoarthritis and sports injuries. This technique has been around for many years, since before the term “regenerative medicine” even existed, and has a very interesting history. Prolotherapy has advanced over the years and now includes the use of one’s own blood platelets (high in growth factors) and/or stem cell–rich tissue as treatment formulas, further enhancing its remarkable ability to stimulate repair, reducing or eliminating pain.

I believe this is just the beginning and that someday injuries or painful joint conditions will be routinely treated with regenerative techniques as a first treatment. Imagine the possibilities this offers. Almost everyone has heard of, or knows, a person complaining about a “football injury” sustained years ago in high school or college. What if these types of injuries were treated immediately with regenerative techniques, and encouraged to fully heal from the get-go?

Of course, years later, these injuries can often still be helped to heal “retroactively” with prolotherapy; however, early intervention would avoid years of pain and suffering, and prevent structural changes or additional injury to other compensating joints. The use of one’s blood or stem cell–rich tissue is an exciting possibility, which not only stimulates healing, but when used early in an injury encourages it to heal potentially without scar tissue! Times are changing; the age of regenerative medicine is here. While we are not there yet, treatment pathways are changing towards regenerative approaches. Just as antibiotics revolutionized the way infections could be treated, regenerative medicine is destined to change the long-term outcomes of painful injuries, improving the quality and length of our active lives.

Prolotherapy Basics

Prolotherapy is based on a very simple principle: the body has the capacity to heal itself. Let’s say you get a paper cut. You first notice there is a rip in your skin and a little blood. Then the wound stops bleeding; it gets a little red and sore, but within a few days, it has healed. This example illustrates a stimulus-response system: you injure yourself (stimulus), which sets in motion a cascade of actions that result in healing (response). A healthy body routinely and automatically responds in this way—like a computer with “healing programs” installed.

With musculoskeletal and joint injuries, a similar “stimulus-response” process occurs. However, the healing time is much longer than with a simple paper cut, lasting weeks to months rather than days. Another difference is that, even for a healthy person, the body tends not to heal 100 percent from ligament, tendon, and joint injuries. In fact, it has been estimated that the usual best result of a ligament or tendon (connective tissue) repair cycle may be as little as 50 to 60 percent of preinjury strength.

How Prolotherapy Regenerative Medicine Works

The term prolotherapy is short for “proliferation therapy,” so named because it stimulates the proliferation (growth) and regeneration of injured ligaments, tendons, and joints. The body, like a very sophisticated computer, has the programming in place to heal; it just needs to be stimulated in that direction. Remember, after the typical four to six week healing cycle that connective tissue goes through when injured, the stimulus to heal is very small or gone. Prolotherapy is designed to be a stimulus that starts the healing response up again. In fact, you could say that Prolotherapy “tricks” the body into beginning a new, strong, and directed healing cycle for injuries that have not healed on their own.

Here’s how it works. A trained medical practitioner injects a natural solution (either dextrose, platelet-rich plasma, or stem cell–rich sources taken from your own body) precisely at the site of an injury. Even though these substances are natural, their introduction into connective tissue or joints is irritating and triggers a strong healing response. The body reacts as it would if it were organically injured, but in a much more controlled, directed, and powerful fashion. There is also irritation caused by the needle itself. That, in combination with the prolotherapy formula, stimulates increased blood flow to the area, resulting in a “sterile” (because it is done in a clean, sterile manner) “good inflammation.” This response is designed to raise growth-factor levels and effectiveness to resume or initiate a connective tissue healing cycle that is incomplete, ineffective, or was never started.

Prolotherapy produces a controlled, concentrated “stimulus-response” healing cycle at areas that otherwise would not be stimulated to heal on their own, and it does this with low risk and few side effects. It has a high success rate in helping repair and strengthen injured and weak ligaments, tendons, and joints, reducing or eliminating pain.

Who is a Candidate for Prolotherapy Treatment?

The guidelines for determining who is a candidate for prolotherapy were published in 1956 in the first physician textbook on the subject. The authors in that text write,

Criteria for Injection Therapy in New Patients:

  1. Appropriate medical problem
  2. Desire for recovery
  3. No underlying medical conditions that would significantly interfere with healing.
  4. Ability and willingness to follow instructions
  5. Willingness to report progress
  6. Willingness to receive painful injections in an effort to recover from injury

These criteria still hold true today. Age is not a factor as long as the individual is healthy, and fits the other criteria. It also does not matter how long the person has been in pain, or how long ago he/she was injured, as long as the person is in good general health. My youngest patient was 6, a very mature tennis player who just wanted to get better and was not afraid of injections. My oldest patient, Mary Faye LaBelle, was a healthy 100 years old at the time of her last treatment and did very well.

*Excerpt printed with permission from the author.

Updated on: 04/13/18