Regenerative injection therapy for axial pain

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Chronic pain is considered epidemic coupled with claims of inadequate treatment. While the understanding of pain, including diagnosis and treatment, is in its infancy, significant progress has been made with diagnostic and therapeutic interventional techniques during the past two decades. Though the structural basis of spinal pain is well established, some patients continue to present a diagnostic and therapeutic challenge. In addition to target-specific fluoroscopically guided techniques, Regenerative Injection Therapy (RIT), also known as prolotherapy, is a viable treatment in managing chronic spinal pain. Proponents suggest effectiveness of RIT in treating musculoskeletal pain, while opponents suggest otherwise. Multiple published studies show (RIT) is effective despite continued controversy. This review will describe various aspects of regenerative injection therapy, technical aspects and clinical effectiveness.

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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