Dextrose Prolotherapy and Knee Osteoarthritis

A colleague and someone that I learned directly from, Jeff Patterson DO, co-authored a recent blinded trial of dextrose prolotherapy vs. placebo injection or exercise therapy. The results suggested that prolotherapy is an effective solution for knee osteoarthritis with reductions in pain and stiffness and an increase in range of motion and function. Prolotherapy can be extremely beneficial for numerous types of joint pain and musculoskeletal complaints. Dr Glen Jarosz is a skilled practitioner of prolotherapy as well as numerous other regenerative injection therapies. Please contact him for a free consultation to see if you may benefit from these types of therapies.

June 04, 2013

Dextrose Prolotherapy Can Improve Knee Osteoarthritis

(HealthDay News) – For adults with knee osteoarthritis, dextrose prolotherapy is associated with greater improvements in pain, function, and stiffness compared with saline injections or at-home exercise, according to a study published in the May/June issue of the Annals of Family Medicine.

David Rabago, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a three-arm blinded, randomized controlled trial involving 90 adults with ≥3 months of painful knee osteoarthritis. Participants were randomized to receive blinded injection (dextrose prolotherapy or saline) or at-home exercise. Injections were provided at weeks one, five, and nine, with additional treatments at weeks 13 and 17, as needed. An exercise manual and in-person instruction were provided to exercise participants.

The researchers found that all groups reported an improvement in composite Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores from baseline to 52 weeks. The improvement in WOMAC scores at 52 weeks was significantly more for the dextrose prolotherapy group compared with the saline or exercise groups, after adjustment for age, sex, and body mass index. In the prolotherapy group, the individual knee pain scores also improved more. High satisfaction was noted with prolotherapy and there were no adverse events reported.

“Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises,” the authors write.

 

The Abstract From the Recent Study:

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

  1. David Rabago, MD1, Jeffrey J. Patterson, DO1, Marlon Mundt, PhD1,Richard Kijowski, MD2, Jessica Grettie, BS1, Neil A. Segal, MD, MS3 andAleksandra Zgierska, MD, PhD1

Author Affiliations

  1. 1Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
  2. 2Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
  3. 3Departments of Orthopaedics & Rehabilitation, Epidemiology, and Radiology, The University of Iowa, Iowa City, Iowa
  1. CORRESPONDING AUTHOR: David Rabago, MD, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715,david.rabago@fammed.wisc.edu

Abstract

PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.

METHODS Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.

RESULTS No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.

CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.

For full text of this research study: http://www.annfammed.org/content/11/3/229.full

Psoriasis – It’s More Than Skin Deep

Psoriasis – It’s More Than Skin Deep

Screen shot 2013-08-07 at 4.20.59 PM

This August is Psoriasis Awareness Month, and a good time to become more familiar with this diagnosis which affects millions of Americans. Despite being a relatively common condition, many of us hold onto the false assumption that it is only skin deep. Psoriasis, in all of its forms, actually goes much deeper, to the level of the immune system. Interested in knowing more? Read on for an introduction to this autoimmune disorder, related health concerns, and how it can be treated.

 

Psoriasis – An Immune System in Distress
Like other Autoimmune (AI) diseases, Psoriasis is a chronic inflammatory condition caused by a dysfunctional immune system. Though psoriatic presentations may differ, they are caused by the same underlying imbalances that exist within all AI diseases.

Our immune systems are designed to create antibodies which tag harmful foreigners such as viruses & bacteria so that our white blood cells know where to attack. In AI disease, the body loses the ability to differentiate between a true foreigner, and our own tissues. As a result, antibodies toward our own cells are produced, directing our immune system to target tissues and organs. Inflammation develops, followed by tissue destruction and dysfunction within the body.

While there is no single cause for AI disease, there are suspected triggers that may lead to development of auto(self)-antibodies. Additionally, there can be a genetic predisposition to developing an AI disease. Common triggers that may increase the risk for autoimmune disease include:
     Chronic Infections (viral, bacterial, fungal & parasitic)
     Continuous Allergen Exposure (including food sensitivities)
     Chronic Heavy Metal Toxicity
It is especially important to limit these potential triggers in your daily life if you have a known family history of autoimmune diseases.

Psoriasis In Its Many Forms
Plaque Psoriasis
The most common form – Plaque psoriasis occurs when overactive inflammatory immune cells create cytokines (proteins that act as immune cell signals) which target keratinocytes in the skin. The result is an inflammatory, raised plaque which appears red and exhibits a silvery build up of dead cells. When removed, pinpoint bleeding known as Auspitz’s Sign is seen. Plaques tend to arise on the outer aspects of joints (knees, elbows) but can occur anywhere on the body. They may also arise in areas of recent skin trauma.

Psoriatic Arthritis
Approximately 30% of patients with Psoriasis will develop a type of Psoriatic Arthritis. This painful and debilitating condition is categorized as a spondyloarthropathy, meaning it is similar in symptoms and presentation to arthritis disorders such as Ankylosing Spondylitis, & Reactive Arthritis. The joints may become very swollen, red & extremely tender to palpate. The arthritis may develop on one or both sides of the body, and may affect the spine. Types of psoriatic arthritis include Symmetric, Asymmetric, Distal Interphalangeal predominant (joints closest to the fingertips), Spodylitis (affecting the spine) and Arthritis Mutilans (rare, but severely debilitating).

Additional Forms
Though plaque psoriasis is more commonly seen, individuals may also be diagnosed with:
Guttate Psoriasis (thinner, smaller lesions that are greater in number)
Inverse Psoriasis (red, smooth lesions that arise in body folds)
Pustular Psoriasis (red, non-infectious pustules develop on the skin)
Erythrodermic Psoriais (widespread, poorly defined red lesions with pain & peeling)

How is Psoriasis Diagnosed?
Diagnosis of psoriatic skin lesions can be based on appearance, and may include biopsy for confirmation. Additional testing for other psoriatic presentations may include X-rays or synovial fluid testing for joint symptoms, and blood tests to assess for inflammation (ESR, CRP) or a genetic component (HLA-B27). Further testing may be recommended to effectively rule out other potential causes.

Treatment – Conventional & Alternative Approaches
Conventional treatments for psoriasis are primarily suppressive, meaning they cover symptoms by blocking the activity of the inflammatory cells without addressing the underlying causes for immune dysfunction. For skin changes, these treatments usually consist of topical creams, whereas systemic immunosuppressive drugs are more commonly prescribed for arthritic symptoms. These medications can be of great value for symptom relief and interruption of tissue destruction, but it is equally important to treat the underlying imbalance.

An in-depth investigation of potential triggers is often indicated, followed by avoidance of those which are found to be significant. Even the basic removal of dietary and environmental allergens can help to decrease symptoms and decrease the number and duration of treatments needed. In addition to the chronic infections, allergens and heavy metals noted above, you should also speak with your healthcare provider about mental & emotional stressors, gastrointestinal dysbiosis, medications, and nutrient deficiencies. Each of these may contribute to auto-immune activity and aggravation of your psoriatic symptoms.

Potential treatments worth investigating for longer-lasting relief and healing include:
Heavy metal testing & Chelation therapy (when indicated)
Food allergy elimination diets (based on diagnostic test findings)
Anti-inflammatory protocols
Essential macro & micro nutrient supplementation (to reverse deficiencies)
Diagnosis & treatment for chronic infections
Gastrointestinal support (including diagnostic testing for SIBO, leaky gut syndrome, & more)
Ozonotherapy IV’s & topicals (to modulate inflammation & decrease immune dysfunction)
Low Dose Naltrexone (to modulate inflammation & decrease autoimmune activity)

 

Questions about treatments for Psoriasis and other autoimmune disorders? Contact Dr. Kaley at Restorative Health Clinic (503) 747-2021.

 

Dr. Kaley Bourgeois

 

References:

National psoriasis foundation. (n.d.). Retrieved from https://www.psoriasis.org/

Blauvelt, MD, A. (July). Pathophysiology of psoriasis. Retrieved from http://www.uptodate.com/contents/pathophysiology-of-psoriasis

Knee Osteoarthritis and Improvement with Prolotherapy

More and more research is being published about the benefits of prolotherapy for numerous musculoskeletal complaints, this particular one on knee osetoarthritis. Prolotherapy is a form of regenerative injection technique that is very effective at treating injuries to tendons and ligaments. It has also been  shown to be beneficial for arthritis and discopathy. If you have pain or instability at or around a joint that impairs your daily activities, contact Dr Jarosz for more information.

Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study. 

Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C, Allard J, Bélanger M. Pain Med. 2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print]

Source 

Dr. Georges-L.-Dumont Regional Hospital, Vitalité Health Network, Moncton, New Brunswick Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick Dieppe Family Medicine Unit, Dieppe, New Brunswick Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec Department of Mathematics and Statistics, Université de Moncton, Moncton, New Brunswick Research Centre, Vitalité Health Network, Moncton, New Brunswick, Canada.

Abstract 

Objective. We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Design. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Patients. Thirty-six patients with chronic knee osteoarthritis. Interventions. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. Outcome Measures. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Results. Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1 ± 13.9, P = 0.11). There was a significant decrease in this groups’ WOMAC scores during the last 16 weeks when the participants received RIT (-9.3 ± 11.4, P = 0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. Conclusions. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks. 

Gentle nerve stimulation effective for migraines

Gentle nerve stimulation effective for migraines

Non-toxic, non-drowsy, non-chemical, non-addictive headache medicine that WORKS…………….. no side effects!

This kind of medicine is more along the lines of what is needed to make a lasting difference in chronic pain.

As you can see in the quoted MedPage study below, the highlighted words indicate the merit of micro-current as an electro medical modality:

  1. Non invasive – good, decreases side effects.
  2. Non chemical – good, less chance of messing something else up and needing more treatment for that in sensitive or multiple chemical sensitivity patients
  3. Affects trigeminal nerve – great, this is a very important pain generator in migraine headache

Results of electrical stimulation of branches of the trigeminal nerve:

  • Fewer monthly migraine attacks (19% versus 4% decline)
  • Fewer days per month with any headache (33% versus 4% reduction)
  • Lower monthly intake of acute anti-migraine drugs (-37% versus +1%)

Other options:

Neuraltherapy injections to the stellate and spehnopalatine ganglia are also very effective in clearing up migraine and sinus headaches.

Cleaning up your diet by avoiding the usual culprit foods like wheat, gluten, egg etc and

supporting your liver and gallbladder also are very helpful in cutting down the pain or sometimes better.

Trigger points in the base of the skull, muscles of the neck and shoulders are also very strongly involved in migraine headache causation.

Werner Vosloo ND, MHom

Nerve Stimulation Cuts Down on Migraines

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: February 11, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

 

A noninvasive device that electrically stimulates the trigeminal nerve prevented migraines for patients whose episodes were not well controlled by medication alone, a trial showed.

The number of days with a migraine dropped significantly by about two per month in the supraorbital transcutaneous stimulation group, without a change in the sham control group, Jean Schoenen, MD, PhD, of Belgium’s Liège University, and colleagues found.

While the difference between the two didn’t reach statistical significance, the coprimary endpoint showed three times more responders with at least a 50% drop in migraine days with neurostimulation (38% versus 12%, P=0.023), the group reported in the Feb. 19 issue of Neurology.

“The therapeutic gain (26%) is within the range of those reported for other preventive drug and nondrug anti-migraine treatments,” they wrote.

An accompanying editorial called for further study due to some issues with the trial, particularly whether blinding was good enough.

The 16 mA electrical pulses delivered by the device at 60 Hz intervals would be easy to feel if patients touched the electrodes whereas the 1 mA-, 1 Hz-sham stimuli “would be barely noticeable,” noted Eishi Asano, MD, PhD, of Wayne State University in Detroit, and Peter J. Goadsby, MD, PhD, of the University of California San Francisco.

“Taken together, this study has provided Class III evidence that neurostimulation with this device is effective and safe as a preventive therapy for migraine,” they concluded.

The PREMICE trial (Prevention of Migraine using the STS Cefaly) randomized 67 adults with at least two migraine attacks per month, regardless of aura, at five Belgian tertiary headache clinics to wear the sham or real device for 20 minutes daily for 3 months.

The Cefaly device consists of an eye glasses-style band with a self-adhesive electrode above the bridge of the nose covering the supratrochlear and supraorbital branches of the trigeminal nerve.

In an attempt to minimize unblinding, patients weren’t asked what the stimulation with their device felt like, weren’t enrolled if they were acquainted with another participant, and were kept from contact with each other during office visits so they wouldn’t have a chance to compare.

The sham group had a 20% drop in migraine days in the first month of treatment, similar to the active treatment group, but that effect disappeared thereafter.

By month 3, the mean number of migraine days in the neurostimulation group had fallen 30% to an average of 4.88 versus 6.94 per month during the run-in phase (P=0.023).

The average showed no change in the control group (6.54 versus 6.22 days per month, P=0.608).

“That the reduction in migraine days after effective supraorbital transcutaneous stimulation treatment just failed to reach the level of significance compared to sham stimulation may be due to the fact that the study was powered for responder rates, not for reduction in migraine days,” the researchers suggested.

Results didn’t differ by migraine aura status.

Among the secondary endpoints, significant advantages of neurostimulation versus sham were:

  • Fewer monthly migraine attacks (19% versus 4% decline)
  • Fewer days per month with any headache (33% versus 4% reduction)
  • Lower monthly intake of acute anti-migraine drugs (-37% versus +1%)

 

By comparison, the migraine prevention drug topiramate (Topamax) reduced monthly migraine days by 44% and monthly migraine attacks by 48%, with a 50% responder rate of 45% across its clinical trials.

Responder rates for other anticonvulsants, propranolol (Inderal), and behavioral therapy are in the same range as for the neurostimulation device.

“Since supraorbital transcutaneous stimulation therapy seems to be effective and well tolerated, it can be combined with drug treatments without risking cumulative adverse effects,” Schoenen’s group pointed out.

No adverse events or side effects occurred in either group.

The researchers acknowledged partial unblinding as a potential limitation of the study, as well as the younger age and shorter duration of migraine in the treatment group.