Prolotherapy, A Safe and Effective Treatment for Musculoskeletal Pain

"I have been a patient who has benefited from Prolotherapy....My intractable pain was not intractable and I was remarkably improved."

--Former U.S. Surgeon General C. Everett Koop

"Prolotherapy was the right choice for me. My knee joint was painful, hot to the touch, and the knee cap snapped and popped. X-rays showed the joint had deteriorated significantly. After three treatments the ligaments and tendons had regained normal function and flexibility and I was pain free. Prolotherapy is a proven technique that has been around since the 1930s and I had read about it in golf magazines. Unlike cortisone, an injection which masks the pain, Prolotherapy restores joint integrity. Prolotherapy costs significantly less than orthopedic surgery and with no downtime. I had not realized that over time I had given up horseback riding, golfing, hiking, snowshoeing, and cross country skiing because it hurt. I no longer use the excuse 'I can't, I have bad knees.' I'm enjoying an active life again thanks to Dr. Neustadt and Prolotherapy."

--Joan, age 54, Bozeman, MT

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Musculoskeletal pain can be debilitating. Whether it's pain in the knees, low back, neck wrists or ankles, everyone experiences this discomfort at some time in their lives. It's been estimated that over their lifetime, 80% of Americans suffer from low back pain. There are many potential reasons for musculoskeletal pain. It can be from tight muscles, from direct injury from sports or a car accident, and even from food allergies or infections. But the most commonly overlooked cause of musculoskeletal pain is ligament or tendon instability.

Ligaments are bands of connective tissue that connect two or more bones. Tendons are bands of connective tissue that connect muscles to bone. Both of these structures--ligaments and tendons--are frequently damaged just by normal wear and tear. There are a lot of nerves at the spots where the ligaments and tendons attach to bones. When the ligaments and tendons are weakened, additional stress can be placed on these attachments and cause pain. George Hackett, MD, one of the founders of the modern techniques and education in prolotherapy in the U.S. concluded that up to 90% of people have degenerative changes in their weight bearing joints (low back, hips, knees, etc.) by the age of 40.

There are many causes for pain, and an integrative pain specialist will conduct a thorough interview with the patient and a detailed physical exam. Many pain treatments just suppress the symptoms with anti-inflammatories (eg, Aleve, Ibuprofen, Tylenol) and steroids. However, if the underlying cause is ligament or tendon instability, then in most cases it can be corrected with prolotherapy. The pain is relieved and function is restored.

Prolotherapy is a simple, natural technique. It has been used and studied for more than 70 years. Usually all that's injected is a simple solution contain dextrose, glucosamine, some vitamin B12 and a local anesthetic.

The underlying cause of musculoskeletal pain is often a weakened ligament. Prolotherapy can restore joint integrity and relieve pain from:

• arthritis
  
• whiplash
  
• sciatica
  
• disk problems
  
• low back pain
  
• rotator cuff (shoulder) pain
  
• tennis elbow
  
• old sports injuries that are now acting up
  
• knee pain (osteoarthritis, ACL or PCL injuries)
  
• TMJ (temporomandibular joint) dysfunction.
  

Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body's healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which "turns on" the healing process. The growth of new ligament and tendon tissue is then stimulated. The ligaments and tendons produced after Prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. The ligament and tendon tissue which forms as a result of Prolotherapy is thicker and stronger than normal tissue, up to 40% stronger in some cases!

The concept of strengthening ligaments goes back to the time of Hippocrates. Reports of shoulder joint instability and its many repair methods date back to Hippocrates' treatise, "On Joints." Hippocrates described the practice of using cautery to cause the capsule to scar and thus tighten around the joint. While his technique is no longer used, the underlying concept is similar to Prolotherapy—strengthen the ligaments.

In the 1930s many case reports emerged in France and the United States of musculoskeletal disorders, such asTMJ, knee pain, and sacroiliac joint (SI joint, which holds yourpelvis to your lower back), being successfully treated with Prolotherapy. In 1956, George Hackett, MD, a surgeon, published thefirst edition of the textbook Ligament and Tendon Relaxation Treated by Prolotherapy. Dr. Hackett reported a 12-year success rate of 82% in the treatment of 1,800 patients with back pain using Prolotherapy.

Then, in 1983, microscopic examination of rabbit tendons after Prolotherapy treatment confirmed the that Prolotherapy stimulates connective tissue repair. This study was published in the journal, Connective Tissue Research (Liu YK, Tipton CM, Matthes RD, Bedford TG, Maynard JA, Walmer HC. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. 1983;11[2-3]:95-102). Another landmark study was published in 1987 in the prestigious journal Lancet by Dr. Thomas Dorman. The study demonstrated the effectiveness of using Prolotherapy to treat back pain (Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LF. A new approach to treatment of chronic low back pain. 1987;2:143-146). Interestingly, Dr. Dorman was Dr. Neustadt's mentor. Dr. Neustadt spent more than 300 hours studying directly with Dr. Dorman at Dr. Dorman's private clinic, the Paracelsus Clinic in Kent, WA (www.paracelsusclinic.com).

More recently, in 2005, the Mayo Clinic featured Prolotherapy in its Health Letter publication, which stated that Prolotherapy stimulates tissue growth and is used for tendon and ligament pain (Alternative Treatments. Dealing with Chronic Pain. Mayo Clinic Health Letter. 2005 Apr;23(4):1-3). Numerous clinical trials have proven Prolotherapy to be helpful in the treatment of musculoskeletal pain.

You may also learn more by reading Dr. Neustadt's FAQ on prolotherapy and a summary of Prolotherapy Research.

Guide to Dietary Supplements

Dr. Steve and I have been traveling and speaking with retailers, physicians and the general public about nutrition, medicine and dietary supplements. One thing has become glaringly clear to us. Nearly everyone out there has no idea how to evaluate the quality of a dietary supplement. We therefore created our NBI Interpretive Guide to Dietary Supplements, which you can download by clicking here. The Guide is written in an easy-to-understand, Frequently Asked Questions, format. Questions that you get answers to include,

1. Should I take dietary supplement?
2. How do I know if a dietary supplement is good?
3. Are there any potentially toxic nutrients?
   

We are actively working to educate retailers on how to best evaluate dietary supplements so that they can provide the best advice to you, the consumer. NBI Health nutraceuticals are now being carried by Rosauer's Huckleberry market, Medicine Shoppe, Montana Harvest, Gesundheit! Nutrition Centers, other retailers and physicians across the country.

Ask that your local health food store starts carrying NBI Health formulas so that you, your family, neighbors and friends will have easier access to these high-quality nutrients.

Oprah's Thyroid

My wife Romi, a big Oprah fan, showed me the October 2007 issue of O Magazine, in which she discussed her recent struggle with hypothyroidism (low thyroid function). Oprah's public discussion of her health issues has brought widespread attention to this condition. Thyroid hormone is sometimes called the "master hormone" since it affects every system in the body. That's why I wanted to spend some time educating my readers about this essential element to good health.

The thyroid gland is a butterfly-shaped gland at the base of the neck. It produces the thyroid hormones levothyroxin (T4) and triiodo-thyronine (T3). About 80% of thyroid hormone is T4 and about 20% is T3. T4 is inactive and is converted into active T3 in different tissues in the body.

This is why low thyroid function can cause such wide-ranging symptoms. According to the Merck Manual, the American Association of Clinical Endocrinologists, and the Thyroid Foundation of America symptoms of hypothyroidism in adults include feeling cold; depression; fatigue; weight gain; inability to lose weight; coarse, dry hair that is brittle and falling out; constipation; dry, coarse skin; puffiness or swelling around the eyes; joint aches; restlessness; forgetfulness; decreased sex drive; and more frequent infections. And this is just a partial list. Low thyroid function can also occur in neonates and children, which requires immediate medical attention as it can cause stunted growth and developmental delays.

Within adults there are two general categories of hypothyroidism--autoimmune and non-autoimmune. An autoimmune condition is one where the immune system attacks the person's own tissues. Autoimmune thyroid dysfunction is called Hashimotos Thyroiditis after the doctor who discovered it in 1912. There appears to be a genetic link, as Hashimoto Thyroiditis tends to run in families. Therefore, if a relative of yours has been diagnosed with an autoimmune thyroid condition and you are experiencing any of the symptoms above, you may want to get your thyroid tested. More on thyroid testing in a moment.

If the reason for low thyroid function is not an autoimmune condition, there are several explanations. First, some medications and diseases may decrease thyroid function. Second, it may be that the conversion of T4 (inactive thyroid hormone) to T3 (active thyroid hormone) is not happening well enough. This conversion requires the minerals selenium and zinc. If a person is deficient in either of these nutrients, they could have difficulty creating T3. This condition is called "functional hypothyroidism" because your thyroid gland is producing enough of the thyroid hormones, but they're not being transformed into the active form. Additionally, high levels of cortisol, a stress hormone secreted when people are under stress, inhibits the creation of T3.

Finally, thyroid hormones come from the phenylalanine, an essential amino acid, meaning that your body cannot produce it, but that it must be ingested from food or dietary supplements. Phenylalanine is transformed in the body to tyrosine, which requires iron, and then down its pathway to form thyroid hormones.

While there can be many different explanations for the myriad symptoms associated with hypothyroidism, a comprehensive thyroid evaluation includes a physical exam and blood tests for TSH (thyroid stimulating hormone), Free T4, Total T3, red blood cell intracellular selenium and zinc, serum ferritin (the most sensitive laboratory indicator of iron deficiency) and plasma amino acids. If an autoimmune hypothyroid condition needs to be ruled out, then your doctor will order an antithyroglobulin antibody and antithyroid microsomal antibody blood tests.

Unfortunately, conventional medical screening for thyroid function does not test for the actual thyroid hormones themselves or for any of the nutritional factors required to produce and activate thyroid hormones. Instead, the standard screening test for low thyroid function is a measurement of TSH, which is actually produced in a region of the brain called the anterior pituitary gland. Its role is to stimulate the production T4 and T3 in the thyroid gland. In "functional hypothyroidism" the TSH and T4 are normal, but the T3 is low. This may simply be due to low selenium or zinc.

People who only receive the conventional medical workup can experience depression, fatigue, difficulty losing weight, and frequent coldness when the underlying cause may be low thyroid function because of nutritional deficiencies and/or chronic stress. I have had many cases of people with normal TSH, normal T4 and low T3, which have been corrected by identifying nutritional deficiencies and prescribing those nutrients to the patients.

This leads me to the interpretation of the TSH test. Many labs are still relying on the old reference range, which has an upper limit of normal of 5.0. An elevated TSH is the laboratory criteria for diagnosing hypothyroidism. However, what is considered "normal" has been changing. In 2002 the American Association of Clinical Endocrinologists (AACE) recommended that upper limit of normal be lowered to 3.0, and also in 2002 the National Academy of Clinical Biochemistry (NACB) suggested the correct upper range of normal will someday be lowered to 2.5.

Many clinicians use a combination of laboratory values and symptoms to determine when to treat, and most, including myself, will consider prescribing thyroid replacement hormone when the TSH is 2.5-5.0 when the patient is symptomatic and other causes are ruled out. If your TSH is greater than 2.5 and you are symptomatic, you may want to discuss with your doctor if it's appropriate to try low-dose thyroid replacement hormone.

The thyroid gland is incredibly important. If you have not been getting regular thyroid tests at your annual physicals, I recommend you do so. At the very least, get your TSH checked regularly.

(Note: Dr. Neustadt was voted as one of the leading thyroid doctors in the Thyroid Top Doctors Directory.)

Osteoporosis--Don't Forget Vitamin K2

Osteoporosis is a major health concern in the United States and leads to an inability to do normal, daily tasks and even early death. More than 10 million people in the U.S. have been diagnosed with osteoporosis, and the National Osteoporosis Foundation indicates that 44 million people are at risk for the disease by virtue of having low bone mineral densities. Each year 1.5 million fractures occur in people with osteoporosis. The cost of treating fractures of the spine alone is more than $745 million. Hip fractures are more expensive still.

People with osteoporosis are at an increased risk for fractures, particularly of weight-bearing bones such as the hip and spine. Debilitating acute and chronic pain in the elderly is often attributed to fractures from osteoporosis and can lead to further disability. Fractures of the hip and spine have a 15% greater chance of dying within five years than people without these fractures. After a hip fracture, only 50% of people regain the same level of independence they had before the injury, and 12 to 40% of patients who suffer hip fractures die within 6 months.

While calcium and vitamin D are important, they aren't the whole story. In fact, clinical trials mostly conclude that these two nutrients decrease the rate of bone loss, but don't necessarily decrease the risk of fracture. Decreasing fracture risk is the most important thing for preventing complications from osteoporosis. In fact, the only risk from osteoporosis is fractures, so what people really should be looking as is the ability for a drug or nutrient to decrease fracture risk.

Well, the best nutrient for your bones turns out not to be vitamin D or calcium, although they are important. The most important is Vitamin K2. There have been many clinical trials using vitamin K2. So many, in fact, that the esteemed Archives of Internal Medicine published a review of all the clinical trials for osteoporosis that used vitamin K2. The researchers concluded that 45 mg of vitamin K2 decreases the risk of vertebral fractures by 60%, hip fractures by 71% and all nonvertebral fractures by 81%. This is better than Fosamax without any of the Fosamax side effects.

The only bone formula currently on the market that contains this amount of vitamin K2, plus calcium and vitamin D is Osteo-K, which was formulated by Dr. Neustadt to help his patients. It's now available to anyone in stores and online at www.nbihealth.com. Don't wait until it's too late. Take Osteo-K.

Some people ask if vitamin K2 increases clotting risk because they've heard that people taking blood thinners such as warfarin (eg, coumadin) shouldn't take extra vitamin K. Clinical trials that used vitamin K2 evaluated this question and showed no increase in the tendency to clot. However, people taking coumadin should absolutely not take extra vitamin K as a dietary supplement unless they speak with their healthcare provider first.

To your health,

Dr. Neustadt