The following article appeared in the NY Times on August 7, 2007.
This is an edited version.

Injections to Kick-Start Tissue Repair

By Jane E. Brody Health Editor - NY Times


The human body is held together by a network of connective tissues that are
highly vulnerable to injury through exercise, accidents and even the
normal lifting, pulling and pushing of daily life.
Few of us, for example, get through life without spraining an ankle. And as
many sadly know, once an ankle is badly sprained, it may be sprained again
and again. That often happens as well with other body parts: shoulders,
wrists, neck, back, jaw, feet, even fingers and toes, all of which are
subject to arthritic changes after an injury.
The risk of re-injury rises when the ligaments that hold bone to bone, or
the tendons that connect bone to muscle, fail to heal completely. And such
failure is apparently very common. Over time, and with multiple injuries,
this incomplete healing can result in lax connective tissues that cannot
fully support a joint.

Dr. K. Dean Reeves, clinical associate professor of physical medicine and
rehabilitation at the University of Kansas Medical Center, likens the damage
to a partly shredded rope that lacks the strength of an intact one, and to
stretched putty that will not return to its former length. Dr. Reeves is one
of several hundred physician........ who specialize in a therapeutic
technique called prolotherapy, an alternative medicine method to promote
connective tissue repair even years after the damage occurred.

The technique received an endorsement of sorts from the Mayo Clinic. In its
April 2005 health letter, the clinic stated that when chronic ligament or
tendon pain fails to respond to more conservative treatments like physical
therapy and prescribed exercises, prolotherapy may be helpful. And when
surgery is the only remaining option to relieve chronic pain, prolotherapy
is a much less invasive and expensive technique that may be worth a try if
you can find an experienced and skilled practitioner.

What Is Prolotherapy?
Prolotherapy involves a series of injections designed to produce
inflammation in the injured tissue. To appreciate the value of such a
seemingly counterproductive measure, you need to know something about
connective tissue and how the body normally repairs it.
When tissues are injured, inflammation is a common natural response. It
stimulates substances carried in blood that produce growth factors in the
injured area to promote healing. Ligaments, tendons and cartilage have very
poor blood supplies, which can result in incomplete healing.

The healing process can also be impeded when injuries are treated with
anti-inflammatory medications like ibuprofen or Naprosyn, or prescribed
nonsteroidal anti-inflammatory drugs (Nsaids) to relieve pain and swelling.
Unlike injections of corticosteroids, which also suppress inflammation and
provide only temporary relief for a chronic condition, prolotherapy
injections given over the course of several months are meant to provide a
permanent benefit. In effect, prolotherapy tricks the body into initiating a
healing response.

The technique reactivates the healing process by injecting a mildly
irritating substance commonly a somewhat concentrated sugar solution along
with the painkiller lidocaine into the injured area to stimulate a
temporary low-grade inflammation. In some cases, growth factors themselves
may be injected.
With growth factors in place at the site of inflammation, new tissue is
said to be produced that strengthens lax or unstable ligaments and tendons.
The technique may even support damaged or degenerated cartilage, which
normally does not repair itself, by strengthening the fibrous connective
tissues that stabilize the area.
Practitioners cite experiments in laboratory animals that demonstrated
tissue growth in ligaments and tendons stimulated by prolotherapy
injections. Two animal studies also showed healing of cartilage defects.

........ it may reduce or even eliminate the discomfort associated with
arthritis by tightening the connective tissues that support an arthritic
joint.

....... it has been endorsed by former Surgeon General C. Everett Koop, and
that it is increasingly being used to treat injuries in professional
athletes.

Prolotherapy is also now the subject of a controlled clinical trial
sponsored by the National Center for Complementary and Alternative Medicine,
part of the National Institutes of Health.

Since prolotherapy is a nonsurgical technique, patients who are now facing
surgery because all else has failed might consider trying it before having
an operation. Unlike many drugs and surgery, prolotherapy has minimal side
effects when performed by an experienced practitioner who uses sterile
techniques. Patients may experience bruising and a temporary increase in
pain in the injected area because of the induced inflammation. Rare risks
include infection, headache, nerve irritation or allergic reaction.

Does It Help?
There have been dozens of studies purporting to show benefits of
prolotherapy for people with chronic pain as well as those with sports
injuries. Among scientifically designed controlled studies, most showed a
significant improvement in the patients level of pain and ability to move
the painful joint.

........in a study of people with chronic low back pain resulting from
injured ligaments in the sacroiliac joint, biopsies done three months after
treatment showed a 60 percent increase in the diameter of connective tissue.
The patients reported a decrease in pain and an increased range of motion.
In studies of knee injuries, patients with ligament laxity and instability
experienced a tightening of those ligaments, including the often disabling
anterior cruciate ligament in the center of the knee, Dr. Reeves showed in a
double-blind study. Other studies showed a significant improvement in the
symptoms of arthritis in the knee one to three years after prolotherapy
injections.

Beware of practitioners who make rash promises, fail to take a full medical
history and to tell you about the technique and its side effects, or who
.... do not do the injections themselves