MINISTÉRIO PÚBLICO FEDERAL PROCURADORIA DA REPÚBLICA EM PERNAMBUCO Ref. Procedimento Administrativo nº 1.26.000.000214/2013-47 eclinação de Atribuição nº 134/ Trata-se de procedimento administrativo instaurado a partir de representação formulada pela Ordem dos Advogados do Brasil - Seccional de Pernambuco, que relata possíveis (e graves) irregularidades no âmbito do HEM
Drs David and Jannice Bowler
What is Prolotherapy?
Prolotherapy is the shortened version of “proliferative therapy”. It is the injection of healing
substances into areas of tendons and ligaments near their attachments to bone. The most
common solution used to trigger the healing process is dextrose, which is sugar water.
What conditions will it help?
Typically, prolotherapy is used to promote the healing of ligaments, tendons, joints and deep soft
tissues which have been injured (for example a bad muscle sprain may pull on the ligament or
tendon and injure it along with the muscle). Sometimes there is no injury, but “wear and tear” of
daily life or just getting a bit older causes these structures to become lax and not do their job of
supporting the joints properly. If this is the case, sometimes the joint in question feels a little
unstable but usually it is just painful. There are MANY conditions which may be helped by
prolotherapy: arthritis, pain in any almost any joint in the body, migraines from neck pain, sprains
from sports or other injuries, rotator cuff shoulder pain, tennis elbow, low back pain etc etc.
How does prolotherapy work?
Injecting a concentrated dextrose solution (or other proliferative agents) into the tendon/ligament
attachment results in a short increase in inflammation in that area. This in turn results in a
proliferation of inflammatory cells and triggers a “healing cascade” of substances the body makes
in response to this stimulus. Over time these inflammatory cells stimulate the production of fibrin,
collagen and other substances so that there is healthy new tissue produced. This in turn
“tightens” up the ligament or tendon so that it can do its job of supporting the joint properly,
resulting in increasingly better function and less or no pain. It is almost like having a “face-lift” to
the joint structures.
How quickly does it work?
Sometimes there is a slight increase in pain and stiffness over the next 48 hours. After that, (the
initial inflammation stage), the pain begins to decrease and can be noticed from the 3rd day
onwards. However, healing continues long after the injection, which is why the appointments are
spread out about a month apart.
How often will I need to come?
This one is hard to answer: everyone is different and comes with a different condition and a
different degree of pain. Some people occasionally will only need one appointment. Others might
need on-going treatment as they gradually progress. The average might be 3 – 6 treatments.
How many injections will I get at any one time?
Again, this is hard to answer as it will vary from person to person and will depend on the extent of
the pain. But typically there are several injections at one visit, as all the painful areas of the
affected joint(s) are treated.
Will it hurt?
There is a slight prick as the needle enters the skin. However, most people cope well with this.
Then there might be a deeper aching sensation once the affected area is injected. There is some
local anaesthetic included in the dextrose solution (as in “freezing” at the dentist), which quickly
reduces local pain. Sometimes a pain medication will be needed over the next 48 hours. There is
also a cream you will be given to use which continues the healing process. We will do everything
we can to make the injections as comfortable as possible.
Are there any other solutions used in the injections?
There are several commonly used solutions, although dextrose (along with a very small amount
of local anaesthetic and saline) is very effective and is the cheapest. Platelet-rich plasma (taken
from your own blood and concentrated), autologous blood (ie. your own blood, not concentrated),
and some other chemicals can be used. At this time we are using dextrose because of its efficacy
Are there any risks associated with prolotherapy?
There are very few side effects or complications. However, you may notice some of these:
Light-headedness (not serious) or nausea (rare). Bruising (not serious). “Treatment stiffness” from the process of having an injection – seldom lasts more than 48 Infection (very rare). Let the doctor know if any of the sites become increasing red or Pneumothorax (extremely rare but serious). If you develop sudden shortness of breath or significant chest pain or trouble breathing you should immediately go to the nearest emergency room. Bleeding (will stop with localized pressure). This is more likely to occur if you are taking Temporary tingling or numbness from the medication is common, but it is very rare for Cost
Prolotherapy is not an insured service with BC’s Medical Services Plan. The cost depends on the
time required for the examination and injections, so please ask us about this. Currently the cost is
between $75 - $150.
Bring a hair tie if you have long hair. Wear stretchy, easy to remove or loose-fitting clothes/sports clothes. A tank top and Wear dark clothes – they might get a little blood-stained. Bring a driver or arrange a ride home afterwards especially if this is your first time. We do not recommend you drive after having these injections.
VERY IMPORTANT INFORMATION!
Prolotherapy (as mentioned in “how does prolotherapy work” above), causes a temporary
inflammation in the tissues which is crucial in triggering the healing process. It is therefore very
important not to take anti-inflammatory medication for a week prior and after the injections
(and preferably longer). Anti-inflammatory medication prevents the prolotherapy from working.
These medications include the commonly available medications Motrin, Advil, Ibuprofen, Aleve,
Naprosyn, Celebrex, and other similar pills. Also included would be full-strength Aspirin and
Robaxisol, although baby Aspirin taken for the prevention of heart disease can be taken. If you
have taken any of these medications prior to your visit, please inform us as we will need to
reschedule the appointment as we don’t want to inject you unnecessarily!
Other treatment forms you may wish to consider
We also offer trigger point treatment (useful for tight painful areas in muscles), perineural
injections (excellent for “nerve” pain) and medical acupuncture. All of these involve the use of
needles but there is a manipulation technique we can use for releasing trigger points should you
not wish to be injected. We offer advice for stretching; exercising and can recommend good
reading material for dealing with pain.
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