PROLOTHERAPY FOR FIBROMYALGIA
Robert Filice, M.D.

Fibromyalgia is a disorder that continues to mystify physicians, and disable patients. Widespread muscle pain and localized tender trigger points, along with insomnia, and fatigue are very common symptoms. Any number of factors have been correlated with fibromyalgia in the literature, including anaerobic cellular metabolism, Growth Hormone deficiency and other hormone imbalance, candida overgrowth, nutritional imbalances, heavy metal toxicity, sleep disorder, ligament laxity, and allergy and food or chemical sensitivities. The multitude of theories suggests we don’t have an answer yet, and that fibromyalgia may be a multifactorial phenomenon.

At Caring Medical we always search for underlying causes whenever possible in order to avoid simply “suppressing” symptoms, and usually we will test for hormones, heavy metals, and allergy and sensitivities. Environmental chemicals such as various fumes, colognes, tobacco smoke, and artificial sweeteners often show up as possible causative factors on comprehensive ALCAT blood testing. Sometimes patients may be sensitive to the effect of a chemical without it showing up on ALCAT testing. One example is aspartame sensitivity which is a not uncommon cause of fibromyalgia syndrome and other joint symptomatology. In fact, Dr H.J. Roberts studied this connection in 551 patients and reported it in the Townsend Letter for Doctors in 1991. About 10% of the total aspartame sensitive group had joint symptoms that resolved when aspartame was discontinued, and recurred when it was reintroduced. Females outnumbered males 3 to 1. Whether formal testing is done or not, we believe that any patient with rheumatic complaints deserves a trial elimination diet that removes commonly eaten foods, including artificial sweeteners. When the other factors I listed have been considered and ruled out or concurrently treated, we believe that further treatment of musculoskeletal sore spots (ligaments and tendons) with Prolotherapy will bring very significant additional relief of symptoms. Muscle trigger points often result from strain secondary to weak underlying ligaments around the nearby joints. Prolotherapy addresses this underlying weakness. In a 1994 study published by K. Dean Reeves,¹ greater than 75% of even severe fibromyalgia patients saw reduced pain and increased functional capability after Prolotherapy. Since it is a relatively little known treatment, I will present the case for Prolotherapy as concisely as I can.

The Case for Prolotherapy:
Chronic pain is one of the most common reasons for the utilization of medical services, absenteeism from work, disability, and interference with the enjoyment of an active and fulfilling life style. The traditional medical approaches to chronic pain are surgery, anti-inflammatory and pain medications, local steroid injections, electrical pain interference devices, and physical therapy. Alternative medicine commonly offers these patients acupuncture and acupressure, chiropractic or osteopathic manipulation, nutritional supplements, applied kinesiology, massage, and other body work techniques. It can safely be said that all of these techniques can help some of these patients some of the time, usually temporarily, but none of them are uniformly effective, and some of them can actually be harmful. Other physicians on the front line of caring for pain patients if speaking frankly might put it another way: existing widely employed methods of controlling chronic pain are inadequate and minimally and irregularly effective. Furthermore, they may present hazards to health or create further impediments to the stated goal of pain relief. This article is written for the purpose of presenting the case for the increased use of a little-known treatment for chronic pain known as PROLOTHERAPY.  Prolotherapy relieves pain and disability because it alone of all available treatments addresses pain at its structural source-the ligaments and tendons.
 

What is Prolotherapy?
Prolotherapy is the injection of special non-steroidal solutions to areas of pain and injury with the intent of stimulating blood flow and cellular infiltration to the area (usually at the bone-ligament junction), resulting in thickening, tightening, and strengthening of the involved structures, significant and permanent reduction in pain, stabilization of the joint, arrest of further degenerative changes, and improvement in functional capacity and range of motion. Put in other terms, Prolotherapy is the rehabilitation of an incompetent structure by the induced proliferation of new cells and supporting matrix.²

Why should I be treated by Prolotherapy rather than traditional approaches?
There are really only two answers to this question: first, traditional approaches are frequently ineffective and can be harmful, and second, Prolotherapy is very consistently effective and is extremely safe. Here are the details:
 

Traditional approaches to chronic pain and injuries are frequently ineffective and can be harmful: 

1. Traditional diagnostic tests such as X rays, and CT and MRI scans commonly reveal findings which are only occasionally the true cause of the patient’s pain, and thus serve as an inaccurate basis for the recommendation of surgery. In CT scans of the lower back in the general population, 35% irrespective of age had abnormal findings even though they had no pain. This figure is 50% of pain free individuals over 40. With MRI testing, nearly 100% of those over 60 tested positive for some type of abnormality, with 36% showing herniated disks, and all but one had degeneration or bulging of at least one lumbar disk.^3,4,5,6  This is the problem of false positives, and has been clearly published in the 1994 New England Journal of Medicine article by Maureen Jensen, MD, ⁷
 

2. Traditional diagnostic tests cannot identify laxity or damage to ligaments, the most common source of chronic pain. Therefore this type of testing will never result in the recommendation of the most appropriate treatment…Prolotherapy. This is the problem of false negative findings.⁸
 

3. Surgically removing anatomical structures such as intervertebral disks, bone, cartilage, or menisci causes near-by structures to undergo chronic abnormal mechanical stress. This often initiates or accelerates the degenerative arthritic processes. This includes arthroscopic surgery, and spinal fusion operations. Oftentimes patients continue to experience the same pain post surgically. Peer review of pain cases treated with surgery (Finneson) suggested as many as 80% of them should never have been operated upon.
 

4. Undergoing any procedure which does not address the true underlying cause of the pain or disability is bound to produce unsatisfactory results. Laxity or overstretching of ligaments is the number one true cause, and is the one factor that is never addressed in the orthodox approaches.⁸
 

5. Although providing temporary symptom relief, the use of oral anti-inflammatory drugs is counter-productive because such drugs stop the inflammatory processs, without which the body is unable to heal the injury or irritation. It has been adequately documented that chronic use of such medications accelerates the arthritis process in the affected joint.^{10,11,12,13,14,15,16,17,18, 19,20}
 

6. Injection of cortisone into damaged or painful areas is also counterproductive. Although sometimes providing very modest short term relief of pain, cortisone always blocks the healing response and weakens local bone, tendon, and ligament tissue. For example, complete rupture of the Achilles tendon is a well known complication associated with cortisone injection of that tendon when injected locally for the treatment of partial tears or tendonitis.
 

7. Traditional approaches to the physical examination of the chronic pain patient usually fail to identify the true source of the pain. In most cases no effort is made to manually identify specific painful structures such as ligaments, reproduce the patient’s pain, or to correlate patient localization of pain with known ligament referral patterns. This frequently results in ineffective treatments because they are directed at the wrong diagnosis.⁸

Prolotherapy is an effective and safe method of eradicating chronic pain:
 

1.   Examination by a Prolotherapist emphasizes precise diagnosis. This involves a careful history, awareness of ligament referral patterns, physical examination, efforts at manually reproducing the patient’s pain, and often the injection of a local anesthetic at the site of the painful structure so that immediate relief in pain confirms it as the source of the problem. Any diagnostic studies such as scans or X rays are considered supplementary and secondary to diagnosis by physical examination. Precise and accurate diagnosis which is capable of localizing the source of pain to ligaments and tendons results in a greater chance of successful treatment.⁸
 

2. As a non-surgical treatment modality, Prolotherapy is relatively inexpensive and requires minimal to no downtime from usual activities of daily living. It also shares none of the usual list of general potential complications associated with surgery.
 

3. Prolotherapy does not disturb, remove or weaken existing non-pathologically-involved structures in the painful region, nor does it ever accelerate the degenerative arthritic process.
 

4. Prolotherapy is an effective treatment for chronic pain because it is able to specifically and permanently strengthen tissue and reverse ligament laxity and tendon strain, the number one causes of chronic joint and other musculoskeletal disturbances.⁹  Beyond relieving pain, the ligament tightening effect of Prolotherapy stabilizes the commonly seen hyper-mobility in affected joints, thus literally slowing down or arresting the actual cause of the degenerative arthritis process. It is this abnormal motion and friction, relieved by Prolotherapy, that causes the wearing down of joint cartilage and reactive bone spur formation that brings on the pain and progression of the common form of osteoarthritis.^{21,22,23,24,25}
 

5.   Prolotherapy consistently produces very favorable clinical results. Patient outcomes reported by numerous clinicians (see references) after the application of Prolotherapy to the treatment of various conditions and joints suggests an approximate 80 to 90% significant improvement rate.^8,9 
 

6.   Prolotherapy is safe when properly applied by a trained prolotherapist. Dr Hemwall treated over 10,000 patients with more than four million injections without a single episode of paralysis, death, permanent nerve injury, or infection.⁸
 

7.   Considering the number of treatments usually required (3 to 8), Prolotherapy treatments cost only a small fraction of surgery.
 

Summary:
Current diagnostic and treatment methods have proven themselves inadequate to the task of permanently relieving chronic pain. Other than complete joint replacements and complete tendon tears, surgery often provides disappointing results and can make the area even weaker than before. Non-surgical management with anti-inflammatory drugs and cortisone shots provides strictly palliative care and is biochemically and structurally counterproductive in the long term. Prolotherapy, on the other hand, is a conservative treatment that effectively rehabilitates weak joints by strengthening their component ligaments and tendons, and permanently controls chronic pain in the process.

Myofascial pain syndrome and fibromyalgia syndrome have no definite assigned “cause” at this time in modern medicine. However, as we look at our clinical experience and open our eyes to the threats that may come from environmental toxins, allergies, and consider the impact of hormonal and nutritional balance, as well as the reality that ligament laxity is probably the most common cause of chronic musculoskeletal pain, we reach one inescapable conclusion. Fibromyalgia patients can be greatly helped!

References 

¹Reeves, K.  “Treatment of consecutive severe fibromyalgia patients with Prolotherapy.”  The Journal of Orthopaedic Medicine.  1994; 16:84-89.

²Babcock, P. et al. Webster’s Third New International Dictionary.  Springfield, MA: G.&C. Merriam Co., 1971, p. 1815.

³Boden, S. “abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects.”  The Journal of Bone and Joint Surgery.  1990; 72A:403-408.

⁴Jensen, M. “Magnetic resonance imaging of the lumbar spine in people without back pain.”  The New England Journal of Medicine.  1994; 331:69-73.

⁵Boden, S.  “Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects.”  The Journal of Bone and Joint Surgery, 1990; 72A”403-408.

⁶Jensen, M.  “Magnetic resonance imaging of the lumbar spine in people without back pain.”  The New England Journal of Medicine.  1994; 331:69-73.

⁷Wiesel, S.  “A study of computer-related assisted tomography 1.  The incidence of positive CAT scans in an asymptomatic group of patients.”  Spine.  1984; 9:549-551.

⁸Hackett, G.  Ligament and tendon Relaxation Treated by Prolotherapy.  Third Edition.  Springfield, IL:  Charles C. Thomas Publisher, 1958, p. 5.

⁹Klein, R.  “Proliferant injections for low back pain: histologic changes of injected ligaments and objective measures of lumbar spine mobility before and after treatment.”  Journal of Neurology, Orthopedic Medicine and Surgery.  1989; 10:141-144.

¹⁰Mishra, D.  “Anti-inflammatory medication after muscle injury: A treatment resulting in short-term improvement but subsequent loss of muscle function.”  Journal of Bone & Joint Surgery.  1995; 77A:1510-1519.

¹¹Brandt, K.  “Should osteoarthritis be treated with nonsteroidal anti-inflammatory drugs?”  Rheumatic Disease Clinics of North America.  1993; 19:697-712.

¹²Brandt, K.  “The effects of salicylates and other nonsteroidal anti-inflammatory drugs on articular cartilage.”  American Journal of Medicine.  1984; 77:65-69.

¹³Obeid, G.  “Effect of ibuprofen on the healing and remodeling of bone and articular cartilage in the rabbit temporomandibular joint.”  Journal of Oral and Maxillofacial Surgeons.  1992; pp. 843-850.

¹⁴Dupont, M.  “The efficacy of anti-inflammatory medication in the treatment of the acutely sprained ankle.”  The American Journal of Sports Medicine.  1987; 15:41-45.

¹⁵Newman, N.  “Acetabular bone destruction related to nonsteroidal anti-inflammatory drugs.”  The Lancet.  1985; July 6:11-13.

¹⁶Serup, J. and Oveson, J.  “Salicylate arthropathy:  accelerated coxarthrosis during long-term treatment with acetyl salicylic acid.”  Praxis.  1981; 70:359.

¹⁷Ronningen, H. and Langeland, N.  “Indomethacin treatment in osteoarthritis of the hip joint.”  Acta Orthopedica Scandanavia.  1979; 50:169-174.

¹⁸Newman, N.  “Acetabular bone destruction related to nonsteroidal anti-inflammatory drugs.”  The Lancet.  1985; July 6:11-13.

¹⁹Serup, J. and Ovesen, J.  “Salicylate arthropathy: accelerated coxarthrosis during long-term treatment with acetyl salicylic acid.”  Praxis.  1981; 70:359.

²⁰Ronningen, H. and Langeland, N.  “Indomethacin treatment in osteoarthritis of the hip joint.”  Acta Orthopedica Scandanavia.  1979; 50:169-174.

²¹Dorman, T.  “Treatment for spinal pain arising in ligaments using Prolotherapy:  A retrospective study.”  Journal of Orthopaedic Medicine.  1991; 13(1):13-19.

²²Ongley, M. and Dorman, T., et al.  “Ligament instability of knees: A new approach to treatment.”  Manual Medicine.  1988; 3:152-154.

²³Klein, R. “A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain.”  Journal of Spinal Disorders.  1993; 6:23-33.

²⁴Ongley, M. “A new approach to the treatment of chronic low back pain.”  Lancet.  1987; 2:143-146.

²⁵Schwartz, R.  “Prolotherapy: A literature review and retrospective study.”  Journal of Neurology, Orthopedic Medicine, and Surgery.  1991; 12:220-223.