Techniques in Regional Anesthesia & Pain Management
Volume 9, Issue 1 , Pages 40-49 , January 2005

Regenerative injection therapy for axial pain

  • Felix S. Linetsky, MD

      Affiliations

    • Department of Anesthesiology, University of South Florida, Tampa, Florida
    • Department of Osteopathic Principles, Nova Southeastern College of Osteopathic Medicine and the Orthopaedic Medicine and Pain Treatment Center, Palm Harbor, Florida
    • Corresponding Author InformationAddress reprint requests and correspondence: Felix S. Linetsky, MD, 34672 US 19 North, Palm Harbor, FL 36472.
  • ,
  • Laxmaiah Manchikanti, MD

      Affiliations

    • University of Louisville, Louisville, Kentucky
    • Pain Management Center of Paducah, Paducah, Kentucky.

References 

  1. Luo X , Pietrobon R , Liu GG , et al.   Estimates and patterns of direct health care expenditures among individuals with back pain in the United States . Spine . 2004;29:79–86
  2. Manchikanti L , Staats PS , Singh V , et al.   Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain . Pain Physician . 2003;6:3–80
  3. Medicare Payment Advisory Commission Report to the Congress . Paying for Interventional Pain Services in Ambulatory Settings . 2001;
  4. Kuslich SD , Ulstrom CL , Michael CJ . The tissue origin of low back pain and sciatica (a report of pain response to tissue stimulation during operation on the lumbar spine using local anesthesia) . Orthop Clin North Am . 1991;22:181–187
  5. Bogduk N . In: Low back pain, in Clinical Anatomy of the Lumbar Spine and Sacrum . (ed 3).. New York, NY: Churchill Livingstone; 1997;p. 187–214
  6. Manchikanti L , Singh V , Fellows B . Structural basis of chronic low back pain . In:  Manchikanti L ,  Slipman CW ,  Fellows B editor. Interventional Pain Management: Low Back Pain: Diagnosis and Treatment . Paducah, KY: ASIPP Publishing; 2002;p. 77–96
  7. Cavanaugh JM , Ozaktay AC , Yamashita T , et al.   Mechanisms of low back pain (a neurophysiologic and neuroanatomic study) . Clin Orthop . 1997;335:166–180
  8. Pang WW , Mok MS , Lin ML , et al.   Application of spinal pain mapping in the diagnosis of low back pain (analysis of 104 cases) . Acta Anaesthesiol Sin . 1998;36:71–74
  9. Manchikanti L , Singh V , Pampati V , et al.   Evaluation of the relative contributions of various structures in chronic low back pain . Pain Physician . 2001;4:308–316
  10. Kellgren J . On the distribution of pain arising from deep somatic structures with charts of segmental pain areas . In: Somatic Pain . 1939;p. 35–46
  11. Feinstein B , Langton JN , Jameson RM , et al.   Experiments on pain referred from deep somatic tissues . J Bone Joint Surg . 1954;36A:281–996
  12. Hackett G . Ligament and Tendon Relaxation (Skeletal Disability) Treated by Prolotherapy (Fibro-Osseous Proliferation) . (ed 3).. Springfield, IL: Charles C. Thomas; 1958;
  13. Travell JG , Simmons DG . In: Myofacial Pain and Dysfunction-Triggered Point Manual . vol 1: Baltimore, MD: Williams and Wilkins; 1991;
  14. Bonica J , Loeser J , Chapman C , et al.   In: ed 2. The Management of Pain . vol II: Philadelphia, PA: Lea and Febiger; 1990;
  15. Linetsky F , Willard F . Use of regenerative injection therapy (injecting sclerosing solutions into painful areas can relieve low back pain) . Pain Clin . 1999;1:19–23
  16. Linetsky F . Sclerotherapy (clinical applications in the treatment of hernias) . Pain Clin . 2000;2:20–24
  17. Biegeleisen H . Varicose Veins, Related Diseases and Sclerotherapy (A Guide for Practitioners) . Montreal, Canada: Eden Press; 1984;
  18. Linetsky F , Mikulinsky A , Gorfine L . Regenerative injection therapy (history of application in pain management, part I 1930s–1950s) . Pain Clin . 2000;2:8–13
  19. Linetsky F , Botwin K , Gorfine L , et al.   Position paper of the Florida Academy of Pain Medicine on Regenerative Injection Therapy (effectiveness and appropriate usage) . Pain Clin . 2002;4:38–45
  20. Linetsky F , Miguel R , Saberski L . Pain management with regenerative injection therapy (RIT) . In:  Weiner RS editors. Pain Management (A Practical Guide for Clinicians) . Washington DC: American Academy of Pain Management; 2002;p. 381–401
  21. Yelland MJ , Del Mar C , Pirozzo S , et al.   Prolotherapy injections for chronic low back pain (a systematic review) . Spine . 2004;19:2126–2133
  22. Yelland MJ , Glasziou PP , Bogduk N , et al.   Prolotherapy injections, saline injections, and exercises for chronic low-back pain (a randomized trial) . Spine . 2004;29:9–16
  23. Hackett GS , Hemwall GA , Montgomery GA . In: Ligament and Tendon Relaxation Treated by Prolotherapy . G.A. Hackett Oak Park, Illinois: Hemwall, GA; 1991;p. 94–100
  24. Liu YK , Tipton CM , Matthes RD , et al.   An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength . Connect Tissue Res . 1983;11:95–102
  25. Klein RG , Dorman TA , Johnson CE . Proliferant injections for low back pain (histologic changes of injected ligaments and objective measurements of lumbar spine mobility before and after treatment) . J Neurol Orthop Med Surg . 1989;10:123–126
  26. Ongley MJ , Dorman TA , Eek BC , et al.   Ligament instability of knees (a new approach to treatment) . Man Med . 1988;3:152–154
  27. Leadbetter W . Anti-inflammatory therapy in sports injury (the role of nonsteroidal drugs and corticosteroid injection) . Clin Sports Med . 1995;14:353–410
  28. Jozsa L , Kannus P . Human Tendons, Anatomy, Physiology and Pathology . Human Kinetics . 1997; Champaign, IL,
  29. Cotran R , Kumar V , Collins T . Robbins Pathologic Basis of Disease . Philadelphia, PA: WB Saunders; 1999;
  30. Steindler A , Luck J . Differential diagnosis of pain low in the back; Allocation of the source of pain by the procaine hydrochloride method . JAMA . 1938;110:106–113
  31. Haldeman K , Soto-Hall R . The diagnosis and treatment of sacro-iliac conditions by the injection of procaine (novocain) . In: J Bone Joint Surg . 1938;p. 20
  32. Boswell M , Singh V , Staats P , et al.   Accuracy of precision diagnostic blocks in the diagnosis of chronic spinal pain of facet or zygapophyseal joint origin (a systematic review) . Pain Physician . 2003;6:449–456
  33. Lord SM , Barnsley L , Wallis BJ , et al.   Chronic cervical zygapophyseal joint pain after whiplash (a placebo-controlled prevalence study) . Spine . 1996;21:1737–1745
  34. Barnsley L , Lord SM , Wallis BJ , et al.   Lack of effect of intra-articular corticosteroids for chronic pain in the cervical zygapophyseal joints . N Engl J Med . 1994;330:1047–1050
  35. Manchikanti L , Singh V , Pampati V , et al.   Evaluation of the prevalence of facet joint pain in chronic thoracic pain . Pain Physician . 2002;5:354–359
  36. Manchikanti L , Boswell MV , Singh V , et al.   Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions . BMC Musculoskelet Disord . 2004;5:15
  37. Manchikanti L , Hirsch JA , Pampati V . Chronic low back pain of facet (zygapophysial) joint origin (is there a difference based on involvement of single or multiple spinal regions?) . Pain Physician . 2003;6:399–405
  38. Manchikanti L , Singh V , Pampati V , et al.   Is there correlation of facet joint pain in lumbar and cervical spine? An evaluation of prevalence in combined chronic low back and neck pain . Pain Physician . 2002;5:365–371
  39. Schwarzer AC , Aprill CN , Derby R , et al.   Clinical features of patients with pain stemming from the lumbar zygapophysial joints . Is the lumbar facet syndrome a clinical entity? Spine . 1994;19:1132–1137
  40. Schwarzer AC , Aprill CN , Derby R , et al.   The relative contributions of the disc and zygapophyseal joint in chronic low back pain . Spine . 1994;19:801–806
  41. Schwarzer AC , Wang SC , Bogduk N , et al.   Prevalence and clinical features of lumbar zygapophysial joint pain (a study in an Australian population with chronic low back pain) . Am Rheum Dis . 1995;54:100–106
  42. Schwarzer AC , Aprill CN , Derby R , et al.   The prevalence and clinical features of internal disc disruption in patients with chronic low back pain . Spine . 1995;20:1878–1883
  43. Fortin JD , Dwyer AP , West S , et al.   Sacroiliac joint (pain referral maps upon applying a new injection/arthrography technique. Part I: asymptomatic volunteers) . Spine . 1994;19:1475–1482
  44. Fortin JD , Aprill CN , Ponthieux B , et al.   Sacroiliac joint pain referral patterns upon application of a new injection/arthrography technique. Part II: clinical evaluation . Spine . 1994;19:1483–1489
  45. Schwarzer AC , Aprill CN , Bogduk N . The sacroiliac joint in chronic low back pain . Spine . 1995;20:31–37
  46. Maigne JY , Aivakiklis A , Pfefer F . Results of sacroiliac joint double block and value of sacroiliac pain provocation test in 54 patients with low back pain . Spine . 1996;21:1889–1892
  47. Gray H . Gray's Anatomy . (British ed 38).. London: Churchill Livingstone; 1995;
  48. Best T . Basic science of soft tissue . In:  Delee J ,  Drez D editor. Orthopedic Sports Medicine Principles and Practice . vol 1: Philadelphia, PA: WB Saunders; 1994;p. 7–53
  49. Reeves K . Prolotherapy (present and future applications in soft-tissue pain and disability) . Phys Med Rehabil Clin N Am . 1995;6:917–926
  50. Yahia H , Newman N . A light and electron microscopic study of spinal ligament innervation . Z Mikrosk Anat Forsch . 1989;103:664–674
  51. Leadbetter W . Cell-matrix response in tendon injury . Clin Sports Med . 1992;11:533–578
  52. Freemont A . Nerve ingrowth into diseased intervertebral disc in chronic back pain . In: Lancet . 1997;p. 178–181
  53. Ashton IK , Ashton BA , Gibson SJ , et al.   Morphological basis for back pain (the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum) . J Orthop Res . 1992;10:72–78
  54. Tuzlukov P , Scuba N , Gorbatovskaya A . The morphological characteristics of fibromyalgia syndrome . Arkh-Pathol . 1993;55:47–50
  55. Fortin J , Vilensky J , Merkel G . Can the sacroiliac joint cause sciatica? . Pain Physician . 2003;6:269–271
  56. Maynard JA , Pedrini VA , Pedrini-Mille A , et al.   Morphological and biochemical effects of sodium morrhuate on tendons . J Orthop Res . 1985;3:234–248
  57. Willard F . Gross anatomy of the cervical and thoracic regions (understanding connective tissue stockings and their contents) . 2003; In 20th AAOM Annual Conference and Scientific Seminar. Orlando, FL,
  58. Linetsky F , Eek B , Derby R , et al.   Regenerative injection therapy . In: Manchikanti  , Slipman  , Fellows  editor. Low Back Pain Diagnosis and Treatment . Paducah, KY: American Society of Interventional Pain Physicians; 2002;p. 519–540
  59. Merskey H , Bogduk N . Classification of chronic pain . In:  Merskey H ,  Bogduk N editor. Descriptions of Chronic Pain Syndromes and Definition of Pain Terms . (ed 2).. Seattle, WA: IASP Press; 1994;p. 180–181
  60. Manchikanti L , Singh V , Vilims BD , et al.   Medial branch neurotomy in management of chronic spinal pain (systematic review of the evidence) . Pain Physician . 2002;5:405–418
  61. Boswell MV , Hansen HC , Trescot AM , et al.   Epidural steroids in the management of chronic spinal pain and radiculopathy . Pain Physician . 2003;6:319–334
  62. Dickey S . The spinal uncertainty principle . Pain Clin . 2001;3:42–47
  63. Linetsky F , Miguel R , Torres F . Treatment of cervicogenic pain and cervicogenic headaches with regenerative injection therapy . Curr Pain Headache Rep . 2004;8:41–48
  64. Reeves K . Prolotherapy (basic science, clinical studies, and technique) . In:  Lennard T editors. Pain Procedures in Clinical Practice . Philadelphia, PA: Hanley and Belfus Inc; 2000;p. 172–189
  65. O'Neill C . Intra-articular dextrose/glucosamine injections for cervical facet syndrome, atlanto-occipital and atlanto-axial joint pain, combined ISIS AAOM approach in 20th American Association of Orthopaedic Medicine Annual Conference and Scientific Seminar; A common sense approach to “hidden” pain generators . 2003; Orlando, FL,
  66. Klein R , Eek B . Prolotherapy (an alternative approach to managing low back pain) . In: J Musculoskel Med May . 1997;p. 45–59
  67. Wilkinson H . The Failed Back Syndrome, Etiology and Therapy . (ed 2).. Berlin: Springer-Verlag; 1992;
  68. Derby R , Eek B , Lee S , et al.   Comparison of intradiscal restorative injections and intradiscal electrothermal treatment (IDET) in the treatment of low back pain . Pain Physician . 2004;7:63–66
  69. Linetsky F . History of sclerotherapy in urology . Pain Clin . 2000;2:41–43
  70. Stanton-Hicks M . Cervicocranial syndrome (Treatment of atlanto-occipital and atlanto-axial joint pain with phenol/glycerine injections) . 2003; In 20th American Association of Orthopaedic Medicine Annual Conference and Scientific Seminar; A common sense approach to “hidden” pain generators. Orlando, FL,
  71. Nelemans PJ , deBie RA , deVet HCW , et al.   Injection therapy for subacute and chronic benign low back pain . Spine . 2001;26:501–515
  72. Klein RG , Eek BC , DeLong WB , et al.   A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain . J Spinal Disord . 1993;6:23–33
  73. Ongley MJ , Klein RG , Dorman TA , et al.   A new approach to the treatment of chronic low back pain . Lancet . 1987;2:143–146
  74. Dechow E , Davies RK , Carr AJ , et al.   A randomized, double-blind, placebo controlled trial of sclerosing injections in patients with chronic low back pain . Rheumatology . 1999;38:1255–1259
  75. Wilkinson HA: A single-blinded randomized and crossover study of phenolic prolotherapy for periosteal trigger points causing axial spinal pain. Unpublished.
  76. Yelland M , Yeo M , Schluter P . Prolotherapy injections for chronic low back pain (results of a pilot comparative study) . Australasian Musculoskeletal Med . 2000;5:20–23
  77. Klein R , Eek B , O'Neill C , et al.   Biochemical injection treatment for discogenic low back pain . Spine J . 2003;3:220–226
  78. Derby R , Eek B , Lee S , et al.   Comparison of intradiscal restorative injections and intradiscal electrothermal treatment (IDET) in the treatment of low back pain . Pain Physician . 2004;7:63–66
  79. Mathews R , Miller M , Bree S . Treatment of mechanical and chemical lumbar discopathy by dextrose 25% . J Min Invas Spinal Tech . 2001;1:58–61
  80. Reeves K , Hassanein  . Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity . 77-80 Alt Ther Health Med . 2000;6:68–74
  81. van Tulder MW , Koes BW , Bouter LM . Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions . Spine . 1997;22:2128–2156
  82. Turner JA , Loeser JD , Bell KG . Spinal cord stimulation for chronic low back pain (a systematic literature synthesis) . Neurosurgery . 1995;37:1088–1095
  83. Fritzell P , Hagg O , Wessberg P , et al.  Swedish Lumbar Spine Study Group   Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group . Spine . 2001;26:2521–2532
  84. Guzman J , Esmail R , Karjalainen K , et al.   Multidisciplinary rehabilitation for chronic low back pain (systematic review) . BMJ . 2001;322:1511–1516
  85. Linetsky F , Saberski L , Dubin J , et al.   Letter to the Editor in response to Yelland et al . Spine . 2004;29:1840–1841
  86. Kidd R . Letter to the Editor in response to Yelland et al . Spine . 2004;29:1841–1842
  87. Yelland M . Letter to the Editor in response to Yelland et al . Spine . 2004;29:1842–1843
  88. Koop CE: Prolotherapy articles. American Association of Orthopaedic Medicine. Available at: http://www.kalindra.com/prolotherapy.htm.
  89. Kayfetz DO , Blumenthal LS , Hackett GS , et al.   Whiplash injury and other ligamentous headache (its management with prolotherapy) . Headache . 1963;3:1–8
  90. Resnick D . Diagnosis of Bone and Joint Disorders . (ed 3).. Philadelphia, PA: WB Saunders; 1995;
  91. Stark D , Bradley W . In: Magnetic Resonance Imaging . vol 1 and 2: St. Louis, MO: Mosby; 1999;
  92. Bogduk N , McGuirk B . Precision Diagnosis . In:  Bogduk N ,  McGuirk B editor. Medical Management of Acute and Chronic Low Back Pain. An Evidence-Based Approach: Pain Research and Clinical Management . vol 13: Amsterdam: Elsevier Science BV; 2002;p. 169–176
  93. Bogduk N , McGuirk B . Assessment . In:  Bogduk N ,  McGuirk B editor. Medical Pain Management of Acute and Chronic Low Back Pain. An Evidence-Based Approach: Pain Research and Clinical Management . vol 13: Amsterdam: Elsevier Science BV; 2002;p. 127–138
  94. Bogduk N , McGuirk B . Causes and sources of chronic low back pain . In:  Bogduk N ,  McGuirk B editor. Medical Management of Acute and Chronic Low Back Pain. An Evidence-Based Approach: Pain Research and Clinical Management . vol 13: Amsterdam: Elsevier Science BV; 2002;p. 115–126
  95. Broadhurst N , Wilk VJ . Vertebral mid-line pain (pain arising from the interspinous spaces) . J Orthopaed Med . 1996;18:2–4
  96. Dreyfuss P , Michaelsen M , Horne M . MUJA: manipulation under joint anesthesia/analgesia: a treatment approach for recalcitrant low back pain of synovial joint origin . J Manipulative Physiol Ther . 1995;18:537–546
  97. Dorman T . Prolotherapy (a survey) . J Orthopaed Med . 1993;15:49–50
  98. Keplinger J , Bucy P . Paraplegia from treatment with sclerosing agents . JAMA . 1960;173:1333–1335
  99. Schneider R . Fatality after injection of sclerosing agent to precipitate fibro-osseous proliferations . JAMA . 1959;170:1768–1772
  100. Hunt W , Baird W . Complications following injections of sclerosing agent to precipitate fibro-osseous proliferation . J Neurosurg . 1961;18:461–465
  101. Grayson M . Sterile meningitis after lumbosacral ligament sclerosing injections . Journal Orthopaed Med . 1994;16:98–99
  102. Whitworth M . Endplate fracture associated with intradiscal dextrose injection . Pain Physician . 2002;5:379–384
  103. Reeves K , Hassanein K . Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity . 77–80 Alternative Ther Health Med . 2000;6:68–74

PII: S1084-208X(05)00005-4

doi: 10.1053/j.trap.2005.01.004

Techniques in Regional Anesthesia & Pain Management
Volume 9, Issue 1 , Pages 40-49 , January 2005