Regenerative injection therapy for axial pain
Section snippets
Terminology
Before the 1930s, all injections were under one umbrella of “Injection Treatment” with the addition of a pathological descriptor, for examples: “Injection Treatment of Hernia”16 or “Injection Treatment of Varicose Veins.” The term “sclerotherapy” was coined by Biegeleisen in 1936.17
In 1956, Hackett concluded that sclerotherapy implied scar formation, and introduced the term “prolotherapy” as “the rehabilitation of an incompetent structure by generation of new cellular tissue.”12 Current
Local anesthetics in diagnosis of musculoskeletal pain
It was understood in the 1930s that posterior primary rami provide motor and sensory supply to muscles, tendons, thoracolumbar fascia, ligaments, aponeuroses, their origins and insertions, and NO definite diagnosis could be made based on clinical presentation alone. To facilitate the differential diagnosis of musculoskeletal pain infiltration of procaine at the nociceptive tissue beds, specifically at the fibro-osseous junctions, was introduced by Leriche, Haldeman and Soto-Hall, Steindler and
Complications
Complications do occur with RIT but statistically, they are rare. The most recent statistical data are from a survey of 450 physicians performing prolotherapy. A hundred twenty respondents revealed that 495,000 patients received injections. Twenty-nine instances of pneumothorax have been reported, 2 of them requiring chest tube placement. Twenty-four nonlife threatening allergic reactions were also reported. Stipulating that each patient had at least 3 visits and during each visit receives at
Solutions for injections
The most common solutions are dextrose-based. To achieve a 12.5% concentration, dilution is made with local anesthetic in 1:3 proportions, ie, 1 mL of 50% dextrose mixed with 3 mL of 1% lidocaine. A 1:2 proportion, ie,1 mL of 50% dextrose with 2 mL of 1% lidocaine, will equal 16.5% dextrose. Further, a 1:1 dilution makes a 25% dextrose solution.
For intraarticular injections, a 25% dextrose solution is commonly utilized though a recent double-blind study suggests that 10% dextrose solution may
Conclusion
Chronic spinal pain is common and an expensive problem in the United States. Prolotherapy is one of the interventional techniques utilized in managing spinal pain. Present evidence with inclusion of systematic reviews, randomized and nonrandomized evidence indicates effectiveness of RIT in painful spinal conditions with enthesopathies.
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