If you are in pain, this is an alternative treatment you need to know about! It is a more natural and a safer alternative than the cortisone injections which are routinely used in those so called “Pain Clinics”. It is a well known fact that repeated cortisone injections, in the long run damages cartilage and ligaments in the joints and spine, and also that they rearely last more than a few weeks. Prolotherapy is becoming very popular for painful joints, backs, rotator cuff tears, plantar fasciatis torn ligaments, etc. Unfortunately however it does not work for everyone.
2. Who is Dr. Dieguez? Business Bio
Education and Background.
E. Dieguez Jr. MD is an Anesthesiologist and Interventionist specializing in Orthobiologic Medicine who primeraly uses orthobiologics.He has practiced in St. Augustine since 1988. He is a graduate of the prestigious European University of Santiago de Comostela School of Medicine, a university founded over five hundred years ago in 1495. Coincidentally, this was the same medical school that his maternal grandfather Dr. Benito Batallan graduated from in 1906.
After graduation Dr. Dieguezserved as an unpaid intern in the Department of Surgery at the university, under the tutelage of Professor Jose Luis Puente Dominguez MD, a member of the Royal Academy of Medicine and Surgery of Spain. Upon returning to the US, he served as a surgical resident in Baltimore Maryland at Johns Hopkins affiliated surgical programs. Later he went on to the prestigious University of Miami, Florida where he completed his Anesthesiology residency.
3. Our Facility location.
We are located at 811 State Road 206 East Ste.1 in Saint Augustine Florida 32086. We are next to Rugery construction offices and also next to Bistro 206. Our phone number is (904) 824-0955 and our fax number is (904) 824-2226.
4. Prolotherapy. What is the rationale behind it?
It is a technique that consist on injecting tissue irritating substances, such as hypertonic glucose (sugar water), among others, into the tissues. The theory behind it is that the injections of the tissue irritating substances used, called proliferates, stimulate healing, tissue regeneration, proliferation and repair when injected into precise points called the enthesis.
In life, when injuries occur, the area may not heal completely due to lack of proper treatment or poor blood supply. Due to this lack of blood supply or proper treatment, ligaments, joints and tendons heal very poorly. If left like that, the damaged ligaments become loose, allowing bones in the joint to shift with excessive movements, causing pain, muscle spasms, and eventually arthritis. Aging can have the same effect. Arthritis occurs in the joints and spine as a result of instability in the structures supporting them.Prolotherapy can intervene by stabilizing the structures and decreasing the progression of pain, degeneration and aging.
When stretched, small nerve fibers in the damaged ligaments transmit pain impulses to the brain. Through a subconscious reflex, the surrounding muscles go into painful spasms in an attempt to stabilize the joint. This causes the region to feel tight, stiff, achy, burning, tingling, numb, fatigued and painful. The individual often notice painful knots in the surrounding muscles. These muscles become tight and painful as they try to compensate for the weak and damaged underlying structures. Spasms in the muscles decrease blood flow and nutrient delivery to the tissue, further contributing to the breakdown. Also the chronic tension from the muscle in spasm leads to deterioration of the tendon attachments, leading to tendinosis (degeneration without inflammation). Not only is pain felt locally, but also it is referred to other areas.
Injecting an irritating solution to the sites of the tissue breakdown, causes inflamation and stimulates the body’s own healing mechanism to repair and rebuild.
5.The stages of healing after an injury are as follows:
a. INFLAMATORY STAGE: Occurs during the first week. There is increased blood flow, swelling, and discomfort as the healing process begins. Immune cells remove damaged and unhealthy tissue from the treated area.
b. FIBROBLASTIC STAGE: Starts about day three and continues for six weeks. Swelling and pain begin to subside. New blood vessels form with an improved blood and nutrient supply. Tissue repair cells (fibroblast) form new collagen, repairing the injured and unstable tissue.
c. MATURATION STAGE: Continues from six weeks to 18 month. New blood vessels mature. The tissues now become stronger with more organized and healthy fibers. Pain subsides. Collagen density and tissue strength increases.
When the injured areas are injected with a Prolotherapy solution, a reaction begins, re-starting the three stage healing process described above. Studies have shown that the strength of the injected ligament can increase up to 40% above normal. Pain and muscles spasms decrease as stability increases.
If during the three stages of the healing process after the initial injury, anti-inflammatory drugs (NSAID), ice and or immobilization are used to reduce pain and inflammation, then complete and normal healing will be inhibited. Most people are taught that inflammation is bad and don’t realize that, without inflammation, no healing will occur. Unfortunately, most physicians, when they see a patient with an injury immediately want to decrease the inflammation with elevation, ice and anti-inflammatory medication such as Advil, Aleve, etc. The end result is poor healing with weak loose joints and ligaments.
Prolotherapy strengthens the joints, ligaments, and tendons, and decreases the pain by stimulating the body’s own repair and healing process. There is no covering up the pain as tissues heal naturally and become stronger, without forming scar tissue. Several treatments spaced apart by about two to six weeks are usually required to get the full benefits. Each treatment builds on the previous until the desired outcome is obtained.
Prolotherapy is a safe procedure when performed by a trainedphysician who has in-depth knowledge of the anatomy and experience using this injection technique. Prolotherapy does not “cure” every painful condition, nor always eliminate 100% of one’s pain. The vast majority of the patients who receive prolotherapy (usually two to ten sessions) will receive at least 50% relief of their pain. Many even report complete resolution of their pain after a series of treatments. It is also important to know that Prolotherapy treatment only strengthen tissues. No structure is weakened like when using cortisone and no scars are formed. But remember Chronic problems do not occur overnight and they do not heal that way either.
6. Dr. C. Everett Koop’s story. Former US Surgeon General comments and reprinted excerpts from the preface he wrote on the book “Prolo Your Pain Away”.
The reason why I consented to write the preface to this book is because I have been a patient who has benefited from Prolotherapy. Having been so remarkably relieved of my chronic disabling pain, I began to use it on some of my patients – but more on that later.
When I was 40 years old, I was diagnosed in two separate neurological clinics as having intractable (incurable) pain. My comment at the time was that I was too young to have intractable pain.
Around that time it was by chance that I learned of Gustav A. Hemwall, M.D., a practitioner in the suburbs of Chicago, who was an expert in Prolotherapy. When I asked him if he could cure my pain, he asked me to describe it. When I had done the best that I could, he replied., “There is no such pain. Do you mean a pain …….?” And then he continued to describe my pain much better than I could. When I said, “That’s it exactly", he said, “I can fix you.” To make a long story short, my intractable pain was not intractable and I was remarkably improved to the point where my pain ceased to be a problem. Much milder recurrences of that pain over the next 20 years were retreated the same way with equally beneficial results.
I was so impressed with what Dr. Hemwall had done for me that on several occasions, just to satisfy my curiosity, I watched him work in his clinic and witnessed the unbelievable variety of musculoskeletal problems he was able to treat successfully. Many of his patients were people who had been treated for years by all sorts of methods, including major surgery, some of which had left them worse off than they were before. Many of his patients had the lack of confidence in further treatment and the low expectations that folks inflicted with chronic pain frequently exhibit. Yet I saw so many of them cured that I could not help but become a “believer” in Prolotherapy.
I was a pediatric surgeon, and there are not many times when Prolotherapy is needed in children because they just don’t suffer from the same relaxation of musculoskeletal connections that are so amenable to treatment by Prolotherapy. But I noticed frequently that the parents of my patients were having difficulty getting into their coats, or they walked with a limp, or they favored an arm. I would ask what the problem was and then, if it seemed suitable, offered my services in Prolotherapy at no expense, feeling that I was a pediatric surgeon and this was really not my line of work.
The results I saw in those many patients were just as remarkable as was the relief I had received in the hands of Dr. Hemwall. I was so impressed with what Prolotherapy could do for musculoskeletal disease that I, at one time, thought that might be the way I would spend my years after formal retirement from the University of Pennsylvania. But the call of President Reagan to be Surgeon General of the United States interrupted any such plans.
The reader may wonder why, in spite of what I have said and what this book contains, there are still so many skeptics about Prolotherapy. I think it has to be admitted that those in the medical profession, once they have departed from their formal training and have established themselves in practice, are not the most open to innovative and new ideas.
It is important to remember that Prolotherapy is not a cure-all for all pain. Therefore, the diagnosis must be made accurately and the therapy must be done by someone who knows what he or she is doing. But all in all the nice thing about prolotherapy, if properly done, is that it cannot do any harm. How could placing a little sugar-water at the junction of a ligament with a bone be harmful to a patient?
7. Differences Between Prolotherapy and Cortisone shots.
PROLOTHERAPY VS. CORTISONE
Strengthens tendon-bone attachmentsYes No
Strengthens muscles YesNo
Strengthens and rebuilds ligament tissueYesNo
Leads to progressive and harmful arthritic changesNo Yes
Suppresses the immune systemNo Yes
Inhibits growth hormone No Yes
Inactivates Vitamin DNoYes
Inhibits calcium absorption in the digestive tractNo Yes
Cortisone shots can permanently damage bones, ligaments, muscles, cartilage, and tendons, resulting in a weakening of the joint and resultant degenerative joint disease (DJD), or osteoarthritis, osteoporosis, fractures, and muscle weakness. This structurally weakens the joint, increasing the production of more pain, which leads to more cortisone shots and eventually surgery like total knee replacement or worse yet spinal fusion surgery.
8. Facts about Prolotherapy for the treatment of Chronic Musculoskeletal Pain, as published in the Journal of American Family Physician.
a. Prolotherapy is an injection-based complementary therapy for common chronic musculoskeletal conditions including tendinopathy, knee osteoarthritis, and low back pain.
b. Patients with severe refractory lateral epicondylosis (Tennis elbow) treated with prolotherapy, reported approximately a 90 percent reduction in resting elbow pain on a 10-point visual analog scale compared with a 22 percent reduction in the control group.
c. Other overuse injuries including Achillis tendinopathy, Abductor tendinopathy and Plantar fasciitis have responded well to prolotherapy.
d. Prolotherapy has also been used in multidisciplinary care plans. Participants in an Achilles tendinopathy study responded earlier and with less money spent on treatment when physical therapy and prolotherapy were combined compared with either treatment alone.
e. The largest and most methodologically rigorous study compared prolotherapy in 110 participants with an average of 14 years of nonsurgical low back pain. Participants reported substantial and sustained reductions in pain (26 to 44 percent) and disability (30 to 44 percent) at 12 months.
f. Positive outcomes have been reported in prospective studies assessing prolotherapy for the following conditions: refractory coccygodynia,sacroiliac joint dysfunction, and leg pain caused by moderate to severe degenerative disk disease.
g. Prolotherapy performed by an experienced injector appears safe; no clinical trials report significant adverse events. Current data suggest that prolotherapy has a positive effect compared with baseline status, and in some cases compared with control therapy, in carefully selected patients for several indications including: Achillis tendinopathy, Coccygodynea (tailbone pain), knee osteoarthritis, lateral epicondilitis, degenerative disk disease, nonspecific low back pain, plantar fasciitis, and sacroiliac joint dysfunction.
9. Answers to some of your questions regarding Prolotherapy
a. I HAVE NOT HEARD OF PROLOTHERPAY BEFORE. WHY?
Answer: Prolotherapy is not taught in most medical schools. Unless a doctor has taken the extra training required to be an effective prolotherapy doctor they may not be aware of the beneficial effects of prolotherapy. At times, one prolotherapy procedure may take up to an hour and many clinics cannot afford to take this amount of time for one patient. They base their practice in volume and have to run as many patients as possible in and out of the office in any single day. At times you are treated by a physician extender and don’t even see the doctor at all. Also, many doctors and patients want a “quick fix” as provided with medications. Lastly, most insurance companies consider it “investigational” and “alternative”, and it is not covered by your policy.
b. WHAT SIDE EFFECTS CAN I EXPECT?
Answer: Side effects of prolotherapy injections are usually minimal and may include temporary soreness, stiffness and occasional bruising in the injection site. To relief the discomfort non-anti- inflammatory over the counter pain medication such as Tylenol may be taken or prescription non- anti-inflammatory medication can be provided, as needed. Do not take Advil, Aleve, BC powder, Mobic, Celebrex and the like since these interfere with Prolotherapy.
c. DOES PROLOTHERAPY HURT?
Answer: The amount of discomfort varies. It depend upon each patient and their individual condition, Normally females are more tolerant to prolotherapy injections than men.
d. CAN PROLOTHERAPY CURE ALL PAIN?
Answer: Of course not. No single treatment modality is capable of treating all pain conditions and prololtherpy is no exception. Additionally it is not an overnight cure.
e. IS PROLOTHERAPY THE SAME AS CORTISONE INJECTIONS?
Answer: No it is not. Cortisone is a steroid and stops the inflammatory process and prevents tissue healing. Cortisone is not part of the prolotherapy injection.
f. WHAT SOLUTIONS ARE USED?
Answer: A typical prolotherapy solution consists of Lidocaine (an anesthetic), 50% dextrose (a sugar solution), and methycobalamine (B12). Sodium morrhuate may be added to increase the prolotherapy effects but this last ingredient increases the risks.
g. IS PROLOTHERPAY SAFE?
Answer: Yes, prolotherapy is very, very safe when performed by an MD or DO trained in prolotherapy. Procedures are always carried out using sterile techniques and each patient’s condition is unique and individualized.
h. HOW MANY TREATMENTS ARE NEEDED?
Answer: The number of treatments varies and will depend upon the severity of the problem and their unique condition. The average person usually receives 4-6 treatments, with some needing more and some needing less. Treatments are normally given every 3 to 4 weeks apart on a decreasing basis. Maintenance treatments may be needed from time to time.
10. References about Prolotherapy.
There will be those out there that will tell you that there are no references about prolotherapy or that it is experimental or that it does not work. Those statements are due to the fact that they have no clue or experience with prolotherapy because they have no training in Prolotherapy. Just pure ignorance. Here are some just a few of the references available.
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