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What Are In Prolotherapy
Injections?
Ross Hauser, M.D.
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
Prolotherapists, 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. 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 factors, 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 Prolotherapist. 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.
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