What Are In Prolotherapy Injections?

Osmotic Proliferants (Solutions)
Irritants
Particulates
Chemotactics
Growth Factors

Most of this information is derived from the writings of Allen R. Banks, Ph.D. Proliferants used in Prolotherapy are basically substances that lead to new collagen formation. Collagen is the naturally occurring protein in the body that makes up ligaments and tendons. Prolotherapy solutions help strengthen these structures by initiating the first step in the wound-healing cascade, which is local inflammation. Once the inflammation has begun, fibroblasts are stimulated. These are the cells that make the collagen. New collagen is produced, making the ligaments and tendons stronger and tighter. The solutions vary in the mechanism by which they cause localized inflammation but, in general, they all act by causing localized tissue damage or irritation, which initiates the influx of inflammatory cells. The exception to this rule is sodium morrhuate, which probably acts more as a chemotactic (attraction) factor.
 

Osmotic Proliferants (Solutions)
Osmotic proliferant solutions are the most commonly used proliferants and include dextrose and glycerin. These are injected and cause a higher osmotic (concentrated) gradient outside of the cells than inside of the cells. This causes cells to lose water and break. These broken cell particles stimulate an influx of inflammatory cells and initiate the wound-healing cascade to the specific area. Osmotic proliferants are water-soluble and thus, very safe. Being water-soluble means that whatever the body does not need is excreted out in the urine and is not stored in the fatty tissue of the body. Other proliferants in this class include the minerals zinc, calcium, and manganese. The minerals are also cofactors for various enzymes. For instance, manganese is needed for the enzyme superoxide dismutase, which helps the antioxidant status of the body. Since some people believe arthritis is from oxidative damage, some Prolotherapy doctors, including those at Caring Medical and Rehabilitation Services, use manganese in the solution for arthritic patients.
 

Irritants
These are substances that are known to directly alter the proteins on the surfaces of the cells. They act by attaching themselves or their byproducts to the surfaces of the cells at the injection sites and they either damage the cells directly or render them reactive to the immune system. In either case, the immune cells are attracted to the area and start the immune response. The irritants that are used most commonly in Prolotherapy include dextrose, phenol, guaiacol, tannic acid, and plasma QU (quinine, urea). The Prolotherapy solution used in the two double-blinded studies was P2G, which included phenol, glycerin, and glucose.

Sarapin
We use an alkaline extract of the pitcher plant called Sarapin. The exact mechanism of how Sarapin relieves pain is unknown but is felt to be due to the ammonium sulfate concentrate in the extract of the plant. It is plausible that this ammonium sulfate compound, or some yet unidentifiable biological agent in the pitcher plant, causes a gentle irritation which adds to the proliferant effect of the solution when Sarapin is added.
 

Particulates
The most common particulate proliferant used is pumice flour. These small particles on the order of one micron, are notable for their ability to attract macrophages, which immediately phagocytize (eat up) the particles. Once the macrophages are at the injection site and ingesting pumice granules, they are actively secreting polypeptide growth factors, which ultimately result in collagen tissue growth.
 

Chemotactics
Chemotactics are proliferants that directly attract the immune cells to the injured area. Sodium morrhuate is thought to work in this way. Sodium morrhuate is the sodium salt of the fatty acid component derived from cod liver oil. Cold water fish oils are rich in polyunsaturated fatty acids, such as arachidonic acid. These compounds serve as the direct precursors to inflammation mediators. In this way, Sodium Morrhuate may directly attract the immune system to the area. Sodium morrhuate most resembles Sylnasol, one of the first proliferants ever used in Prolotherapy.
 

Growth Factors
Growth factors represent the future of Prolotherapy. As modern medicine makes advances in the regenerative mechanisms of the human body, many new growth factors are being discovered. Their effects are being tested as they directly stimulate the repair of various cells, organs, and diseases. Polypeptide growth factors act directly upon fibroblasts (which make collagen). Epidermal growth factor, Insulin-like growth factor-1 (IGF-1), fibroblast growth factors, and platelet-derived growth factors are now available for research and testing purposes. Physicians are already using Growth Hormone injections directly into joints to help regenerate cartilage. Many of these growth factors are available in homeopathic form to be taken orally during the Prolotherapy treatment course. As medical research continues, it is most assuredly certain that these growth factors will be incorporated into the technique of Prolotherapy.
 

Summary
The basic mechanism of Prolotherapy is simple. A substance is injected, which leads to local inflammation. The localized inflammation triggers a wound-healing cascade, resulting in the deposition of new collagen. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. Prolotherapy has the potential of being 100 percent effective at eliminating sports injuries and chronic pain, but depends upon the technique of the individual Prolotherapy doctor. The most important aspect is injecting enough of the solution into the injured and weakened area. If this is done, the likelihood of success is excellent.

Anti-Inflammatory In The Prolotherapy Solution?
Q. Can I ask my doctor to add an anti-inflammatory to my Prolotherapy injection to help with the pain?

A. I have been doing Prolotherapy for 15 years. I have never added cortisone, triamcinolone or other anti-inflammatories into the Prolotherapy solution.

If you are in a lot of pain, the doctor can add some extra novacaine or other 'caine' to decrease the pain. Prolotherapy helps heal tissue by stimulating the normal healing inflammatory reaction.

I believe long-term strength is being compromised by adding an anti-inflammatory to the solution. You may get over your pain with it in there but the amount of healing with each session will be compromised.