The following is from Dr. David Cundiff's soon to be published book "Money
Driven Medicine"


The Prolotherapy Alternative
Practitioners of one area of alternative medicine purposefully create
inflammation in and around joints in order to strengthen tendons and ligaments
and
reduce pain. This technique has several names—reconstructive joint therapy,
sclerotherapy, prolotherapy, and prolo.
I learned about prolotherapy first hand, by being a patient. For about four
years, I had been seeing surgeons and physical medicine specialists about
chronic pain in my hip and low back. Nothing worked and I took a medical leave
of absence from work because of the problem. On the advise of a friend, I had
a series of injections of inflammatory chemicals into the area of my low
back. Quickly, the pain decreased, and I stopped using crutches in five days.
Within a month I returned to work.
Later, I still had to undergo a back fusion operation because the
degenerative arthritis and instability in my spine caused the lateral nerves at
one
level to be severely pinched. This was no longer a soft tissue problem
involving
lax and weak ligaments and tendons. The surgery relieved the pressure from
bone compressing two nerves in my lower back, but I still had further
prolotherapy after the operation to strengthen the soft tissues in the low back
area.
Now eight years after the surgery and prolotherapy, I continue lots of
walking, running, biking, swimming, and hatha yoga. Except for some morning
stiffness, my back is nearly as good as new.
One of my running partners complained of chronic low back pain at night so
severe that he had to go to the living room and sleep in a chair every night
for over a year. About six months ago, I took him to a prolotherapist for
injections of hypertonic dextrose (concentrated sugar water). After that one
treatment taking about 15 minutes, he has never had back pain again.
But these stories of symptomatic benefit with prolotherapy are anecdotes. Is
there scientific evidence that prolotherapy works? Randomized trials of
prolotherapy (injecting an inflammation-causing substance in the painful area)
versus placebo for back, knee, and finger arthritis pain showed that it
works!14-16
After my experience as a prolotherapy patient, I learned of a prolotherapy
course for physicians in La Cieba and Tela, Honduras sponsored by the Hackett
Foundation. I signed up and studied with seven other physician trainees and
six prolotherapy practitioners, learning to treat patients with chronic
musculoskeletal pain. The Hackett foundation had been conducting the
prolotherapy
training workshops for over 20 years in Honduras, so the local people knew of
the treatment by word of mouth or personal experience. Radio advertisements
recruited more patients for the free treatment. In the two-week course under
the supervision of experienced prolotherapists, I treated about 60 patients
with high concentration dextrose for chronic pain in the low back, neck,
shoulders, hips, knees, fingers, elbows, and jaws. They were extremely
grateful.
Government insurance or private insurers pay for arthroscopy but do not
reimburse prolotherapy because it is “alternative.” Prolotherapy and
arthroscopy
should be compared in randomized clinical trials for meniscus tears or soft
tissue instability involving knees and other joints. For common back pain,
prolotherapy plus exercises, joint manipulation, and massage should also be
compared with exercises, joint manipulation, and massage alone.
Cost Considerations
Ironically, arthroscopy costs about $5000,17 whereas prolotherapy costs vary
between $75 - $400 per treatment. Of the 650,000 annual knee arthroscopies,
orthopedic surgeons perform 225,000 – 300,000 for degenerative
(wear-and-tear) arthritis, at a cost of $1 billion - $1.5 billion to Medicare,
the Veterans
Administration, and private insurers in 2005.17, 18 Since arthroscopy has
not been shown to be better prolotherapy for joint pain not due to arthritis,
the remaining $2.2 billion – $5.2 billion worth of arthroscopies are
unproven to be more effective than cheaper and less risky treatment.17, 19
The medical diagnosis and treatment of back pain in the US will cost about
$48 billion in 2005.6, 19 These expenses include $20.5 billion for office
visits; $8.3 billion for hospitalization; $7.3 billion for prescription drugs;
$8.7 billion for outpatient services; and $2.0 billion for emergency room
care.19, 20 Most outpatient costs are for physicians’ services and MRIs.21
Most
hospitalization costs are for surgery. Since prolotherapy is proven in a
randomized trial to be effective for back pain and standard medical treatment
other
than exercises are not proven to be better than “tincture of time,” at
least $40 billion in tests and treatments for back pain are wasted.
Conclusion
Arthroscopy has been proven not to work in arthritis and not proven to work
better than prolotherapy in chronic pain other than arthritis of the knees
and other joints. Prolotherapy for common low back pain has been shown safe and
effective in a randomized trial. Other back pain treatments other than
exercises, including surgery, chiropractic, physical therapy, are not proven
more
effective that therapeutic exercises alone, however, patients are often more
satisfied by combining exercise with a bodywork treatment.

Chapter 15
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conservative treatments for subacute low back pain: a randomized clinical
trial.
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16. Reeves KD, Hassanein K. Randomized, prospective,
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