25 July 2012
The secret cure for back pain
Nigel Summerley | Daily Mail Online
Could a 'secert' injection cure your backache?
A 'secret' therapy, in which fluid is injected into the ligaments around the spine, could be the answer to chronic back pain for thousands of sufferers.
The treatment - prolotherapy - triggers a proliferation of healthy new connective tissue in areas that were damaged. Ligaments ensure stability in joints by firmly linking bone to bone. But when they are damaged, stretched or weakened, joints - or a spinal disc - can be put under stress. This can be caused by a car crash, a fall, lifting heavy objects, or wear and tear, and often creates disabling pain.
In prolotherapy, 0.5 cubic centimetresof a fluid mixture is injected into each of the two ends of the damaged ligament, near where it joins the bone. The liquid is made up of water (38per cent), dextrose and glycerol (30 per cent each), and phenol (2per cent). Usually, three lots of injections are given at intervals of one or two weeks. Each injection causes ' microtraumas' - or miniature wounds - and sets off the body's selfrepair mechanism.
Phenol is an irritant, while dextrose and glycerol are ' hyperosmolar' agents: they make tissue cells swell to the point where they burst. Cell break-up attracts cells called granulocytes, which begin building new tissue. Meanwhile, scavenger cells, known as macrophages, clean up the area, and fibroblasts construct replacement collagen fibres. Inflammation may last for up to three days, but within ten days, new improved connective tissue begins to form.
Dr John Tanner, a musculoskeletal physician and sports injury specialist based in Chichester, West Sussex, is one of a handful of practitioners who uses prolotherapy in the UK. He describes it as 'secret' because so few doctors - or patients - know about it. Yet the treatment was first used in the U.S. in the late 1950s and early 1960s. But two patients died after injections went wrong. After that, the method of injection and the mixture used for the liquid were made safer. Prolotherapy's image remained tarnished. 'But as far as invasive treatments go, it's one of the safest,' says Dr Tanner. 'There has not been a serious problem with it for 40 years.' The treatment had a reputation for being painful, but this, too, has changed. As well as having local an aesthetic as part of the injection, patients have the option of Entonox (gas and air), or intravenous sedation.
For sports enthusiast Andy Huggett, 45, prolotherapy was a last-ditch attempt at regaining full mobility. 'I felt just about suicidal,' he said. 'I was unhappy, to the point of crying at night, after being told by a chiropractor that I shouldn't play squash ever again.' From the age of 30, Andy had suffered with lower-back pain. One of the discs in his spine had become thinner through playing lots of sport, including squash, golf and tennis - and 'driving a sports car with bad seats'. Because the damage pinched nerves, he also suffered pain down his legs. Andy, a lawyer from Clapham, South London, tried physiotherapy and then chiropractic manipulation. 'But it got to the point where almost before I got home, the pain was returning.'
He also tried a pain-killing epidural injection. 'That worked for seven days, then it stopped.'Then Andy consulted Dr Tanner. 'First he tried manipulation under an aesthetic,' says Andy, 'but that didn't work. He injected some dye around my spine and got me to move while he looked at a scan.
After prolotherapy, Andy was back playing his favourite sports within three months. Six years on, he is still playing, still free of pain and 'just as fast and fit'. Dr Robin Chakraverty has been using prolotherapy in his NHS practice at the Royal Orthopaedic Hospital, Birmingham, for three or four years. He believes he's getting good-toexcellent results in 57 per cent of cases and hopes to start clinical trials early next year. But Bupa regards prolotherapy as 'unproven'. It will fund it only as part of a clinical trial.The Department of Health says: 'It is a clinical matter and it would be up to doctors to decide on an individual basis whether it would be of benefit.' The treatment is not an overnight cure but it seems to work for people of all ages and with many different conditions. These include: chronic lowerback pain where the ligaments have become lax, degeneration of the spinal discs causing ligaments to loosen, chronic sacroiliac dysfunction, where the pelvic ligaments have been strained, whiplash injuries and sports injuries.