West Vancouver Wellness Centre uses prolotherapy and platelet-rich plasma injections to help relieve pains associated with acute major traumatic injuries and chronic musculoskeletal conditions that lead to the connective tissue degeneration. These techniques greatly reduce pain and promote healing.
These regenerative pain medicines are accomplished by injecting natural compounds — including dextrose and collagen, alongside the patient’s own blood platelets and stem cells — directly into the site of the musculoskeletal injury. This procedure helps regenerate healthy connective tissue.
Damaged and degenerated tendons, muscles, ligaments and joints cause pain and dysfunction. Also, the damage and degeneration of connective tissues cause reduced blood flow, entrapped nerve endings, as well as the accumulation of metabolic waste. Our goal is to restore health to the compromised tissue area, decrease or eliminate pain and normalize proper function.
Regenerative pain medicine helps to treat:
Biological Mechanisms of Healing
Injury to previously healthy musculoskeletal structures triggers critically important inflammatory pathways followed by a healing cascade. The majority of healing occurs in the first eight weeks after an acute trauma or injury. During this time, the body produces various growth factors and molecular signals in order to stimulate growth of new tissue. After this time, if healing is not complete, there is a localized decrease blood flow, entrapment of nerve endings and accumulation of metabolic waste. Anti-inflammatory drugs (NSAIDs and steroids such as ibuprofen or methylprednisolone) hinder this healing cascade. In essence, these tissues turn from normal connective tissue into scar tissue. As a direct result, nerve ending receptors in these tissues chronically fire pain signals. Sub-optimal healing leads to structures that do not have sufficient tensile strength (lax ligaments or joint capsules) and stretched ligaments are no longer able to stabilize their corresponding joints. This leads to muscle spasm in an attempt to stabilize joints and degenerative arthritis. In addition, nerve entrapment in scar tissue can lead to chronic pain.
Arthritis, similarly, is degeneration of joint surface tissue secondary to macrotrauma or microtrauma.
Most chronic musculoskeletal pain conditions are due to degenerative processes, not inflammatory processes. This is evident in the way that joint disease is described in the medical field; terms such as tendinitis and arthritis are being replaced by tendinosis and arthrosis which demonstrate a distinction between inflammation and degeneration. Most back and neck pain is actually due to damaged, degenerated tissues, not herniated discs even if herniated discs are present.
For the most part, conventional management of painful musculoskeletal conditions involves palliative drug therapies until the condition becomes bad enough to warrant surgery. Arthroscopic surgery for arthritis has been definitively proven to not be effective for long-term pain reduction or mobility. Statistics for disc surgery for back/neck pain are dismal.
Alternative modalities — such as physiotherapy, massage and acupuncture — may provide relief for mild to moderate conditions, but often only give a day or two of pain relief for advanced cases.
Regenerative pain medicine’s principle interventions are RIT / prolotherapy and PRP / platelet-rich plasma injections. Because regenerative pain medicine seeks to harness the body’s own healing abilities to cure the cause of pain, it is adherent to the philosophy of naturopathic medicine.
RIT / Prolotherapy
Regenerative injection therapy, or “prolotherapy,” involves the injection of natural compounds directly into damaged musculoskeletal tissues in order to stimulate growth factor release from connective tissue cells. This launches an immune system cascade that stimulates the body’s innate healing mechanisms to lay down new, healthy collagen fibres. The previously damaged tissue goes through the same healing cascade as when first injured and is given a second chance to heal. Ultrasound studies have been performed showing microscopic views of tendons before and after RIT and shows that RIT does, in fact, restore healthy connective tissue. RIT is extremely safe, relatively inexpensive (compared to drugs and surgery) and, compared to chronic pain, is relatively painless. The solutions utilized in RIT are typically a mixture of natural collagen, dextrose (a type of sugar) and sometimes B vitamins. Treatments are given at two- to four-week intervals, depending on the severity of the condition. Most patients have excellent results after just a few treatments.
PRP / Platelet-Rich Plasma
Platelet-rich plasma, or “PRP,” has been used for many years in surgical centres around North America and abroad to improve the success of bone grafting, and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. In the last 10 years, much research has been focused on injecting PRP for the regeneration of musculoskeletal tissues. Tennis elbow, plantar fasciitis, Achilles tendinitis/tendinosis, rotator cuff tears, meniscal tears, osteoarthritis and chronic low back and neck pain are all being treated with PRP injections. The procedure first involves an intravenous blood draw into special tubes for harvesting PRP. These tubes of the patient’s own blood are then centrifuged, and the platelets, stem cells and a small amount of plasma are separated out into a syringe. This 400%-600% concentration of platelets is called PRP or “platelet-rich plasma.” The area to be treated is then injected first with a small amount of mild local anaesthetic and then the PRP. Treatments are given every three to six weeks. And, depending on the severity of the condition, usually two to six treatments are required to achieve the desired result.
Prolotherapy is an approved method of treatment by the American Osteopathic Association and is endorsed by the former Surgeon General of the United States, C. Everett Koop, MD.