Sacroiliac joint pain treatmentOctober 15, 2014 October 15, 2014
If you suffer from unresolved sacroiliac joint pain, Prolotherapy, Platelet Rich Plasma Therapy, and Stem Cell Therapy may be the answer.
Researchers writing in the medical journal Pain Physician examined various treatment recommendations for patients suffering from sacroiliac joint pain. They noted: “It is generally accepted that approximately 10% to 25% of patients with persistent low back pain may have pain arising from the sacroiliac joints.” So determining good treatment options would be helpful to many people.
Sacroiliac joint pain treatment – the findings
- “The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is fair.
- The evidence for effectiveness of intraarticular steroid injections is poor.
- The evidence for periarticular injections of local anesthetic and steroid or botulinum toxin is poor.
- The evidence for effectiveness of conventional radiofrequency neurotomy is poor.
- The evidence for pulsed radiofrequency is poor.” (1)
Why isn’t prolotherapy, stem cell therapy, and platelet rich plasma the standard in treatment of low back pain?
There isn’t a week that goes by when a patient who has experienced relief of chronic lower back pain asks, “why did it take so long for me to find out about Stem Cell Therapy or prolotherapy?” This is often followed by, “I can’t believe prolotherapy was not the first treatment recommended for my back – it was the only treatment that works.”
Sacroiliac joint pain treatment
Most patients that seek either prolotherapy, platelet rich plasma (PRP) treatment, or stem cell therapy of their lower back pain come to us as a last chance effort. They have tried nearly every other treatment and have exhausted all possibilities – chiropractic, acupuncture, epidural steroid injections, physical therapy, massage, and a litany of medications such as anti-inflammatories, Lyrica, Neurontin, anti-depressants, muscle relaxers, and others. Some patients have also had surgeries on their back – fusions, laser spine surgery, discectomy, and decompression. Unfortunately, most patients who have chronic lower back pain sometimes give up, and are told to “deal with it”, or end up on large amounts of opiates like Oxy Contin.
So why would prolotherapy, stem cells, and PRP work so well for this large subset of patients? Why would a patient who suffered each and every day in pain for 20 or 30 years experience relief within a few months of starting prolotherapy or PRP? The answer is simple. The back is not just a disc problem. The disc is a shock absorber for vertebrae, and while this shock absorber can become defective, there are so many other parts of the lower back and support structure for the lower back that can cause pain.
“Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies are needed to confirm the safety of the procedure and to validate an appropriate injection protocol.” (2)
“Ninety-one percent (91.0%) of (Prolotherapy) patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work.” (3)
Take, for instance, the sacroiliac joint (or SI joint). Not only can this joint become arthritic, but all of the ligament and tendon structures that hold this joint together can become stressed, strained, or torn but may appear normal on MRI (which is not very accurate at diagnosing sacroliliac pain). Research published in the medial journal Spine, states “ligament laxity in the sacroiliac joint is the number one reason for sciatica, or pain radiating down the side of the leg, and is one of the most common reasons for chronic low back pain.” (4)
Additionally, most back pain patients have a functional leg length discrepancy / tilted pelvis which further exacerbates sacroiliac joint pain. While epidurals, steroids, or surgery cannot repair the damage that cause sacroiliac pain, prolotherapy and platelet rich plasma (PRP) injections can!
If you have the opportunity to examine and study the anatomy of the lower back and pelvis, look at the ligament structure. The ligaments that insert into the L4 and L5 vertebrae (which are the most common to herniate in the lower back), actually are contiguous structures with the sacroiliac joint, coccyx, and insert into the ischium (sit bones). Therefore, dysfunction in any part of this ligament structure can impact what happens with the L4 and L5 disc and vertebrae. Just a tilt in the pelvis completely disrupts the balance between the left and right sides of the back and contributes to back and pelvic pain.
Now if you are skeptical, and still think that prolotherapy and platelet rich plasma injections to the lower back are without merit, realize not only has this treatment withstood the test of time, with doctors practicing prolotherapy dating back to the 1950s, but randomized medical studies have shown significant success (greater than 85%) in patients with chronic lower back pain. In fact, in my home town of Philadelphia, PA, the head orthopaedic spine surgeon, Abraham Myers, MD realized that the back surgeries that he performed on his patients did not help, he decided instead to treat his patients with prolotherapy. He practiced prolotherapy for back pain until he was in his 80s, and had a satisfying and successful career curing patients with chronic back pain.
Yes, many insurance companies may not cover prolotherapy, and often patients are driving or flying to our office to seek our expert treatment, but in the long run think about how much time, aggravation, and wasting time on other procedures, medications, and therapies you will spend, hoping for a cure, when prolotherapy may be it. All it takes is a careful history, physical examination of the back, pelvic tilt, feet, hips, reflexes and strength in skilled and experienced hands to determine if someone has an excellent chance at being cured of their back pain with prolotherapy and/or platelet rich plasma.
1. Hansen H, Manchikanti L, Simopoulos TT, et al. A systematic evaluation of the therapeutic effectiveness of sacroiliac joint interventions. Pain Physician. 2012 May;15(3):E247-78.
2. 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 Dec;16(12):1285-90.
3. Hooper RA, Ding M.Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy.J Altern Complement Med. 2004 Aug;10(4):670-4.