Abstract
Significant progress has been made in interventional pain management. Despite this progress, patients continue to present a diagnostic and therapeutic challenge. Steroidal and nonsteroidal anti-inflammatory medications have limited use in degenerative painful conditions of connective tissue. Regenerative injection therapy, also known as prolotherapy, is a viable, type-specific treatment for such pathology. Several placebo-controlled studies, together with uncontrolled studies, indicate the effectiveness of regenerative injection therapy in treating painful ligament and tendon pathology. As stated in July 2003 by Mooney, this treatment has advanced “from the fringe to the frontier of medical care.”
Similar content being viewed by others
References and Recommended Reading
Kellgren J: On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Somatic Pain 1939, 4:35–46.
Feinstein B, Langton J, Jameson R, et al.: Experiments on pain referred from deep somatic tissues. J Bone Joint Surg 1954, 36A:981–996.
Hackett G, Hemwall G, Montgomery G: Ligament and Tendon Relaxation: Treated by Prolotherapy, edn 5. Springfield, IL: Charles C. Thomas; 1991.
Simons DG, Travell JG, Simons LS: Myofacial Pain and Dysfunction: The Trigger Point Manual, vol 1. Baltimore: Williams & Wilkins; 1991.
Bonica J, Loeser J, Chapman C, et al.: The Management of Pain, vol 1. edn 2. Malvern, PA: Lea & Febiger; 1990; 7:136–139.
Aprill C, Dwyer A, Bogduk N: Cervical zygapophyseal joint pain patterns: a clinical evaluation. Spine 1990, 15:458–461.
Dreyfuss P, Michaelsen M, Fletcher D: Atlanto-occipital and lateral atlanto-axial joint pain patterns. Spine 1994, 19:1125–1131.
Dreyfuss P, Tibiletti C, Dreyer S: Thoracic zygapophyseal joint pain patterns: a study in normal volunteers. Spine 1994, 19:807–811.
Dussault R, Kaplan P:Facet joint injection: diagnosis and therapy. Appl Radiol 1994, 35–39.
O’Neill C, Kurgansky M, Derby R, et al.: Disc stimulation and patterns of referred pain. Spine 2002, 27:2776–2781.
Linetsky F, Willard F: Use of regenerative injection therapy for low back pain. Pain Clin 1999, 1:27–31.
Linetsky F: History of sclerotherapy in urology. Surg Physician Assist 1999, 5:30–32.
Biegeleisen H: Varicose Veins, Related Diseases, and Sclerotherapy: A Guide for Practitioners. Fountain Valley, CA: Eden Press; 1994.
Linetsky F, Mikulinsky A, Gorfine L: Regenerative injection therapy: history of application in pain management: part I 1930s-1950s. Pain Clin 2000, 2:8–13.
Linetsky F, Botwin K, Gorfine L, et al.: Position paper of the Florida Academy of Pain Medicine on regenerative injection therapy: effectiveness and appropriate usage: Pain Clin 2002, 4:38–45.
Linetsky F, Saberski L, Miguel R, et al.: A history of the applications of regenerative injection therapy in pain management: part II 1960s-1980s. Pain Clin 2001, 3:32–36.
Linetsky F, Miguel R, Saberski L: Pain management with regenerative injection therapy (RIT). In Pain Management: A Practical Guide for Clinicians. Edited by Weiner R. Boca Raton, London, NY, Washington DC: CRC Press; 2002:381–402. A comprehensive review of the literature on the subject, mechanism of action, and technique.
Steindler A, Luck J: Differential diagnosis of pain low in the back: allocation of the source of pain by the procaine hydrochloride method. JAMA 1938, 110:106–113.
Haldeman K, Soto-Hall R: The diagnosis and treatment of sacroiliac conditions by the injection of procaine (Novocain). J Bone Joint Surg 1938, 3:675–685.
Bogduk N: Post-traumatic cervical and lumbar spine zygapophyseal joint pain. In Neurology and Trauma. Edited by Evans RW. Philadelphia: WB Saunders; 1996:363–375.
Williams P: Gray’s Anatomy, edn 38. London: Churchill Livingston; 1995.
Best T: Basic science of soft tissue. In Orthopedic Sports Medicine Principles and Practice, vol 1. Edited by Delee J, Drez D Jr. Philadelphia: WB Saunders; 1994.
Reeves D: Prolotherapy: present and future applications in soft-tissue pain and disability. Phys Med Rehabil Clin N Am 1995, 6:917–926.
Yahia H, Newman N: A light and electron microscopic study of spinal ligament innervation. Z Mikrosk Anat Forsch 1989, 102:664–674.
Leadbetter W: Cell-matrix response in tendon injury. Clin Sports Med 1992, 11:533–578.
Leadbetter W: Anti-inflammatory therapy and sport injury: the role of non-steroidal drugs and corticosteroid injections. Clin Sports Med 1995, 14:353–410.
Jozsa L: Human Tendons, Anatomy, Physiology, and Pathology. Champaign, IL: Human Kinetics; 1997.
Cotran R, Vinay K, Collins T, et al.: Robbins Pathologic Basis of Disease. Philadelphia: WB Saunders; 1999.
Freemont A: Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997, 350:178–181.
Ashton I, Ashton B, Gibson S, et al.: Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in the ligamentum flavum. J Orthop Res 1992, 10:72–78.
Tuzlukov P, Skuba N, Gorbatovskaya N: The morphological characteristics of fibromyalgia syndrome. Arkh-Patol 1993, 4:47–50.
Liu Y, Tipton C, Matthes R, et al.: An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res 1983, 11:95–102.
Maynard J, Pedrini V, Pedrini-Mille A, et al.: Morphological and biochemical effects of sodium morrhuate on tendons. J Orthop Res 1985, 3:234–248.
Klein R, Dorman T, Johnson C: Proliferant injections for low back pain: histologic changes of injected ligaments and objective measurements of lumbar spine mobility before and after treatment. J Neuro Ortho Med Surg 1989, 10:2.
Willard F: Gross anatomy of the cervical and thoracic regions: understanding connective tissue stockings and their contents. Presented at the 20th AAOM Annual Conference and Scientific Seminar. Orlando, FL: April 30–May 3, 2003.
Linetsky F, Eek B, Parris W: Regenerative injection therapy. In Low Back Pain. Edited by Manchikanti L. Paducah KY: ASIPP Publishing; 2002:519–420. Comprehensive review of the literature, mechanism of action, and technique.
Lord S: Chronic cervical zygapophyseal joint pain after whiplash: a placebo-controlled prevalence study. Spine 1996, 21:1737–1745.
Barnsley L, Lord S, Walis B, et al.: Lack of effect of intraarticular corticosteroids for chronic pain in the cervical zygapophyseal joints. N Engl J Med 1994, 330:1047–1050.
O’Neill C: Intra-articular dextrose/glucosamine injections for cervical facet syndrome, atlanto-occipital and atlanto-axial joint pain, combined ISIS AAOM approach. Presented at the 20th AAOM Annual Conference and Scientific Seminar. Orlando, FL: April 30–May 3, 2003.
Stanton-Hicks M. Cervicocranial syndrome: treatment of atlanto-occipital and atlanto-axial joint pain with phenol/glycerine injections. Presented at the 20th AAOM Annual Conference and Scientific Seminar. Orlando, FL: April 30–May 3, 2003.
Klein R: Prolotherapy: an alternative approach to managing low back pain. J Musculoskel Med 1997, 14:45–59.
Reeves D: Prolotherapy: basic science clinical studies and technique. In Pain Procedures in Clinical Practice. Edited by Lennard TA. Philadelphia: Hanley & Belfus Inc; 2000:57–70. Comprehensive review of technique and mechanism of action.
Wilkinson H: The Failed Back Syndrome Etiology and Therapy, edn 2. New York: Springer-Verlag; 1992.
Kayfetz D, Blumenthal L, Hackett G, et al.: Whiplash injury and other ligamentous headache: its management with prolotherapy. Headache 1963, 3:1.
Resnick D: Diagnosis of Bone and Joint Disorders, vol 1–6, edn 3. Philadelphia: WB Saunders; 1995.
Stark DD, Bradley WG, Bradley WG: Magnetic Resonance Imaging, vol 1 and 2, edn 3. St. Louis: Mosby; 1999.
Broadhurst N, Wilk V: Vertebral mid-line pain: pain arising from the interspinous spaces. J Orthop Med 1996, 18:2–4.
Reeves K, Hassanein K: Randomized, prospective, doubleblind, placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000, 6:68–74, 77–80.
Klein R, Eek B, DeLong W, et al.: A randomized, double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 1993, 6:23–33.
Mooney V: Prolotherapy at the fringe of medical care, or is it the frontier? Spine J 2003, 3:253–254.
Mathews R, Miller M, Bree S: Treatment of mechanical and chemical lumbar discopathy by dextrose 25%. J Minimal Invasive Spinal Tech 2001, 1:58–61. Initial trial published on intradiscal injections.
Klein R, Eek B, O’Neill C, et al.: Biochemical injection treatment for discogenic low back pain: a pilot study. Spine J 2003, 3:220–226. A more comprehensive study on intradiscal injections using a complex injectate with a 2-year follow-up.
Kang H, Jung K, Eung S: Ideal concentration of growth factors in rabbit’s flexor tendon culture. Yonsei Med J 1999, 40:26–29.
Berven S: Tissue engineering, strategies in regeneration of the intervertebral disc. Presented at Soft Tissue Injuries of the Spine: New Concepts in Diagnosis and Treatment. San Francisco: July 18–19, 2003.
Herthel D: Injection of stem cells from bone marrow aspirate into damaged ligaments and tendons. Presented at Soft Tissue Injuries of the Spine: New Concepts in Diagnosis and Treatment. San Francisco: July 18–19, 2003.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Linetsky, F.S., Miguel, R. & Torres, F. Treatment of cervicothoracic pain and cervicogenic headaches with regenerative injection therapy. Current Science Inc 8, 41–48 (2004). https://doi.org/10.1007/s11916-004-0039-3
Issue Date:
DOI: https://doi.org/10.1007/s11916-004-0039-3