Proloterapi: Aile Hekimliği’nde Kronik Ağrı Yönetiminde Yeni Bir Yöntem

Year 2016, Volume: 16 Issue: 2, 0 - 0, 20.05.2016

Hakan Yaman , Ramazan Vural

https://doi.org/10.17098/amj.77156

Cited By: 2

Abstract

 

Proloterapi ,proliferatif ve irritan (dekstroz ,gliserin ,fenol v.b) solüsyonların sorunlu bağ ve kiriş dokularına enjekte edilmesi ile oluşan enflamasyona karşı vücudun iyileştirici bir savunma mekanizması geliştirme esasına dayanan bir tamamlayıcı tıp yöntemidir. Kas iskelet sisteminin değişik bölgelerinde  kronik ağrıya neden olan Tendinopati,gonatroz ,bel ağrısı,epikondilit vb sorunlarda değişik irritan sıvıların kişinin gereksinimi ve yaşına göre değişen miktarlarda sorunlu bölgeye enjekte edilmesi yolu ile uygulanan ve yaklaşık yarım asırdan fazla süredir kullanılan bir yöntemdir.Konu ile ilgili yapılmış çalışmaların farklı sonuçlar göstediği gibi tedavi yöntemleri ve süreleride farklılıklar göstermektedir.Sternoklaviküler instabilitesinde ağrıda azalma ve tam aktiviteye dönüş sağlanmış olup mikropeforasyon yöntemi önerilmektedir.Lateral epikondilitte cerrahi olmayan tedavilerin tercih edilen yöntemler arasında net üstünlük yoktur. Kronik bel ağrılarında proloterapi başka modaliteler ile birlikte kullanıldıkları taktirde yakınmaları ve engelliliği azaltabileceğini bildirmektedir .Osteitis pubis ile ilgili bir vaka serisinde yapılan çalışmalar son derece başarılı bulunmuş, çoğu sporcu ağrılarında kurtulmuş ve tamamı spora dönebilmiştir. Gonartroza ilişkin bir çalışmada proloterapi uygulama öncesi duruma göre ağrı ve işlevselliğe dair ölçülerde iyileşme sağlarken, kontrol grubuna göre anlamlı fark elde edememiştir. Aşil tendinitte proloterapi ağrıyı azaltıp, hasta memnuniyetini artırdığı gösterilmiştir. Ülkemizde ise bu uygulama Proloterapi Derneği ve Entegratif Tıp Derneği gibi dernekler öncülüğünde uygulanmaktadır. Sağlık Bakanlığı bünyesinde önümüzdeki süreçte hekimlere eğitimler verilecektir. Proloterapiyi destekleyen kanıt düzeyi yüksek çalışmalara  gereksinim sürmektedir . Iyi yetiştirilmiş ellerde proloterapi uygun hastalarda iyi neticeler vermesi beklenilen bir tamamlayıcı tıp yaklaşımıdır. Kas iskelet sorunlarının yaygın olduğu gündelik aile hekimliği pratiğinde medikal tedavilerin yararlı olmadığı ya da yan etkilerinden çekinildiği durumlarda maliyet etkin destekleyici bir uygulama olarak son derece yararlı bir tedavi yöntemidir.

Keywords

Proloterapi, Aile Hekimliği, Kronik Ağrı

Prolotherapy : A New Method for Chronic Pain Management in Family Medicine

Abstract

Prolotherapy is a complementary medicine method which is based on the principle of    healing  body defens , against inflammation caused by injecting proliferative and irritant (dextrose, glycerin, phenol, etc.) solution into the problematic tissue ,ligaments and tendons.Problems like tendinopathy ,gonatroz, lumbago, epicondylitis etc.  which causes chronic pain in different regions of the musculoskeletal system various irritant liquids applied by way of injection into the problematic area varying to the requirements and the age of a person and is more than half a century is a employed method. İn Sternoclavicular instability micropeforastion method is recommended,pain reduction and return to full activity is achieved. There is no clear superiority among the preferred methods of non-surgical treatment of lateral epicondylitis .Prolotherapy can reduce symptoms of chronic low back pain and disability if they are used in conjunction with other modalities. It has been  successfully case series studies reported  relating to Osteitis pubis  , in many athletes  pain liberated and all have able to return to full fitness.

In a study of osteoarthritis taken Prolotherapy application improvement in pain and function were provided .It has been unable to obtain significant difference compared to the control group. Achilles tendonitis taken Prolotherapy reduced the pain has been shown to improve patient satisfaction. In our country this application is practiced under the leadership of Prolotherapy and Integrative Medicine associations . The Ministry of Health will be given training to physicians in the future. Proloterapy is  complementary medicine approach and  In trained hands it is expected to give good results in appropriate patients.

musculoskeletal problems are common in family practice  if medical treatment is not useful or in cases where it is feared from side effects proloteraphy is an effective supportive therapy practice. 

Keywords

Prolotherapy, Family Medicine, Chronic Pain

References

• Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature The Spine Journal 2005;5:310–28.
• Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care 2010;37(1):65-80.
• Jensen KT, Rabago DP, Best TM, Patterson JJ, Vanderby R Jr. Response of knee ligaments to prolotherapy in a rat injury model. Am J Sports Med 2008;36(7):1347-57.
• Rabago D, Yelland M, Patterson J, Zgierska A. Prolotherapy for Chronic Musculoskeletal Pain. Am Fam Phys 2011;84(11):1209-10.
• Rabago D, Patterson JJ. Letter: Prolotherapy: An Effective Adjunctive Therapy for Knee Osteoarthritis. J Am Osteop Assoc 2013;113(2):122-3.
• Klein RG, Dorman TA, Johnson CE. Proliferant injections for low back pain: histologic changes of injected ligaments and objective measurements of lumbar spinal mobility before and after treatment. J Neurol Orthop Med Surg 1989;10:141–4.
• Stein A, McAleer S, Hinz M. Microperforation prolotherapy: a novel method for successful nonsurgical treatment of atraumatic spontaneous anterior sternoclavicular subluxation, with an illustrative case. Open Access Journal of Sports Medicine 2011;2:47–52.
• Sims SEG, Miller K, Elfar JC, Hammert WC. Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials. HAND 2014;9:419–46.
• Krogh TP, Bartels EM, Ellingsen T, et al. Comparative Effectiveness of Injection. Therapies in Lateral Epicondylitis A Systematic Review and Network Meta-analysisof Randomized Controlled Trials. The American Journal of Sports Medicine. 2013; 41(6):1435-46.
• Rabago D, Best TM, Beamsley M, et al. A systematic review of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med 2005;15:376-80.
• Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 1993;6:23-33.
• Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet 1987;2:143-6.
• Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev 2007;(2):CD004059.
• Cusi M, Saunders J, Hungerford B, et al. The use of prolotherapy in the sacro-iliac joint. Br J Sports Med 2010;44:100-4.
• Kim WM, Lee HG, Jeong CW, Kim CM, Yoon MH. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain. J Altern Complement Med 2010;16:1285-90.
• Khan SA, Kumar A, Varshney MK, et al. Dextrose prolotherapy for recalcitrant coccygodynia. J Orthop Surg 2008;16:27-9.
• Miller MR, Mathews RS, Reeves KD. Treatment of painful advanced internal lumbar disc derangement with intradiscal injection of hypertonic dextrose. Pain Physician 2006;9:115-21.
• Laura M. Distel, MD, Thomas M. Best. Prolotherapy: A Clinical Review of Its Role in Treating Chronic Musculoskeletal Pain. PM R 2011;3:78-81.
• Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil 2005;86:697–702.
• Haemi Choi, Michael McCartney, Thomas M BestTreatment of osteitis pubis and osteomyelitis of thepubic symphysis in athletes: a systematic reviewBr J Sports Med 2011;45:57–64, doi:10.1136/bjsm.2008.050989.
• Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000;6(2):68-74,77-80.
• Rabago D, Zgierska A, Fortney L, et al. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: an uncontrolled study with one-year follow-up. J Altern Complement Med (In press).
• Rabago D, Patterson JJ, Mundt M, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med 2013;11:229-37.
• Yelland MJ, Sweeting KR, Lyftogt JA, et al. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Br J Sports Med 2011;45:421-8, doi:10.1136/bjsm.2009.057968.
• Gross CE, Hsu AR, Chahal J, Holmes GB. Injectable Treatments for Noninsertional Achilles Tendinosis: A Systematic Review. Foot&Ankle Int 2013;34(5):619–28.
• Ryan MB, Wong AD, Gillies JH, Wong J, Taunton JE. Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis. Br J Sports Med 2009;43(4):303-6.
• Slattengren AH, Christensen T, Prasad S, Jones K. Prolotherapy: A nontraditional approach to knee osteoarthritis. The Journal of Family Practice 2014;63(4):206-8.