If you’ve ever tried to get Prolotherapy reimbursed, you’ve probably heard these words: “For any indication, Prolotherapy (also known as proliferant therapy or proliferation therapy) is considered experimental and investigational.” Prolotherapy has been practiced since the fifth century B.C., and while the methods have evolved, the theory underlying it has not. Prolotherapy boosts the body’s healing mechanisms and self-repair by producing inflammation in torn ligaments. Nonetheless, even for those who have had their pain completely resolved, insurance companies classify Prolotherapy as experimental across the board.
Prolotherapy should not be called a “experimental” method for several reasons, but first understand what the term “experimental” means. There is no universally accepted definition of the phrase. “In the insurance contract, “experimental” means whatever the insurance company thinks it means. These definitions usually focus on whether a procedure is widely accepted in the medical community as being successful and appropriate for the specific diagnosis being treated. Occasionally, the language will rely solely on the Plan Administrator’s discretion, leaving the patient unable to discern what will be covered on his own. A plan or jurisdiction may, on rare occasions, rely on a more specific definition of “It’s an experiment.”
Consider the Kansas Board of Healing Arts’ more specific definition, which was adopted for uses other than insurance. A procedure is not experimental if it is “taught as an acceptable method or procedure as part of the core curriculum of an approved professional school,” “taught as an acceptable method or procedure by an academic training institution in an approved post graduate program in the healing arts,” or “taught as an acceptable method or procedure by an academic training institution in an approved post graduate program in the healing arts.” “based on a sufficient number of peer-reviewed publications demonstrating safety and efficacy.”
Prolotherapy has its own specialist college within the American Osteopathic Association, is done and taught at the University of Wisconsin School of Medicine, and has even been cited as a treatment for ligament pain by the Mayo Clinic. Prolotherapy training is also widespread at Osteopathic medical schools and universities, and is a necessity in neuromuscular residency training for Osteopathic practitioners.
Many insurance companies continue to pay treatments that are not backed by data, despite the fact that Prolotherapy is not typically covered. For example, there is little evidence that cortisone is beneficial after three weeks, and some research have suggested that cortisone may hasten the arthritic process. Some methods of arthroscopy for knee osteoarthritis, for example, have been demonstrated to provide little benefit when compared to sham surgeries or placebo. Before asking another patient to undergo a costly and painful surgery and rehabilitation, we should look into the evidence to see if the procedure is effective. Patients would receive better care and health-care costs will be kept in check if a culture of evidence-based medicine is established.
Why is prolotherapy not covered by insurance?
The medical effectiveness of these therapies has not been verified by scientifically controlled studies, according to the Coverage Issues Manual (CIM) ’35-13, “Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents – Not Covered,” and thus cannot be covered by the Social Security Act.
What is the average cost of prolotherapy?
Individuals can spend a lot of money on prolotherapy. Many insurance companies do not cover prolotherapy, therefore patients must pay for it out of themselves. The surgery appears to cost anything between $250 and $600.
Is prolotherapy injections covered by insurance?
The Food and Drug Administration (FDA) has not approved prolotherapy, and most insurance companies do not cover treatment.
Depending on your treatment plan, each injection could cost you $150 or more.
The following are typical treatment courses, according to an article published in the Journal of Prolotherapy:
- Three to six injections at four- to six-week intervals for an inflammatory joint disease.
- For example, to treat facial nerve discomfort with neural prolotherapy: 5 to 10 weeks of weekly injections
What is the success rate of prolotherapy?
When administered by a prolotherapy-trained physician, success rates have been reported to vary from 80% to 90%. Many of these accounts are based on the physicians’ own anecdotal experience. Prolotherapy has yet to be linked to favorable effects for back pain and recovery in studies.
Finally, it’s vital to remember that no one really knows what happens during prolotherapy. There is no objective medical data, and no histology of what happens when an injection is given into the pained soft tissues has been reported.
What is better prolotherapy or PRP?
Both PRP and dextrose prolotherapy have been demonstrated to help the body repair naturally. 14 Both can be successful, and both should be addressed in a connective tissue repair treatment strategy. However, in cases where the tissue or joint has degenerated, there is osteoarthritis, or the problem is older and more chronic, PRP prolotherapy may be deemed more appropriate. When platelet-rich plasma is used in prolotherapy, it not only offers needed irritation (concentrated platelets are irritating), but it also supplies growth factors that help the body heal faster. Using PRP is similar to fertilizing newly planted seeds rather than simply planting them; the condition of the seeds is improved “soil” can assist in determining which formula is best. In cases of tendon sheath or muscle injury, platelet-rich plasma may be chosen to dextrose; dextrose is occasionally, but not always, used to treat these areas.
Another issue to remember is that PRP is a more aggressive formula than dextrose, so the patient may have more pain and discomfort afterward. Furthermore, because of the additional ingredients required, the cost of PRP prolotherapy is higher than that of dextrose prolotherapy. Another distinction is that PRP prolotherapy appears to induce several healing cycles, sometimes resulting in the creation of more “peaks and valleys” in pain levels in the weeks after a treatment When it comes to dextrose, however, there is usually only a brief time of discomfort, though this varies from patient to patient. Generally speaking, PRP requires fewer treatments than dextrose. The bottom line is that there are various things to consider, and the decision on which form of prolotherapy to utilize is determined on an individual basis after thorough consideration of all factors, including patient preference, by the doctor and the patient.
How painful is prolotherapy?
The inflammatory process is hypothesized to trigger the formation of fibroblasts (the body’s repair cells), which deposit new tissue fibers to repair a damage, stabilizing the area, restoring function, and reducing discomfort. The reduction in pain and increase in function that results has the potential to be long-term. Each prolotherapy session takes about 30 minutes from start to finish in the clinic.
What Can I Expect at a Prolotherapy Treatment Visit?
Before the operation can begin, the patient and clinician will have a preliminary conversation about the risks and benefits of prolotherapy. Before beginning with the therapy, the patient must have a complete grasp of the procedure and accompanying dangers.
The patient is positioned on an exam table, and the treatment region is prepped and sterilized before to the operation.
Multiple injection sites may be required depending on the source of the complaint or injury as well as the location of the injection site.
In most cases, a very fine needle will anesthetize the area with lidocaine before administering the prolotherapy injection (s). To prevent infection, the solution is injected into the treatment region and coated.
How frequently are injections needed?
A series of two to three injections are given every four weeks, depending on the injury or condition. Depending on how quickly the symptoms go away, fewer treatments may be required. Everyone’s recovery time is different, but most patients may anticipate to see improvements three to four days following their appointment. However, because this is a regenerative healing process, full results may take a few weeks.
What can I expect after I receive an injection?
For the next few days, the injection site will most likely be uncomfortable and achy, but this will usually go away 24 to 72 hours after the injection. It is very advised to freeze the injection site. For seven days after your procedure, avoid using any steroids or Non-Steroidal Anti-Inflammatories (NSAIDS) such as ibuprofen (Motrin) or naproxen (Aleve); doing so will simply hinder the intended regeneration response.
To avoid infection, wait 24 hours after the treatment before swimming or bathing the injection site in a bath or hot tub.
How does prolotherapy differ from steroid injections?
Steroid injections are a frequent treatment for acute and chronic musculoskeletal disorders to reduce inflammation and pain, but they are usually only a temporary fix.
“You can limit inflammation and pain with corticosteroids, but they come with a lot of adverse effects.” “High blood pressure, high blood sugar, weight gain, and even cosmetic side effects,” James A. Thompson, DO of TPMG Newport News Internal Medicine, explained.
Steroid injections obstruct the body’s natural healing process while masking pain, and they may impair joints and ligaments in the long run. It’s possible that it’s causing the joint to deteriorate.
What are the side-effects of prolotherapy treatment? Is it painful?
Prolotherapy treatments offer minimal adverse effects like any other injection, such as edema, aside from mild discomfort during and after the injection. Steroid injections, on the other hand, have been linked to hyperglycemia (high blood sugar), weight gain, skin pigmentation, and high blood pressure (high blood pressure). Prolotherapy injections are somewhat uncomfortable, similar to a flu shot, and can be numbed with a topical lotion if necessary. Consult your doctor about what drugs you may be able to take for any post-surgery ache.
Can prolotherapy make you worse?
It’s quite normal to have greater pain or soreness at the injection site(s) for a week or longer. Swelling around this same location is also possible. It’s not uncommon for you to feel worse before you start to feel better. Bruising of the skin around the wound is also common.
For at least 6 weeks following your injection, avoid any anti-inflammatory drugs and steroids (cortisone). Ibuprofen, Advil, Aleve, Mobic, and more drugs fall under this category. These medications will counteract the injection’s action and prevent the body from repairing itself. As needed, use Tylenol or any other prescription pain reliever.
ICE SHOULD NOT BE APPLIED TO THE AFFECTED AREA. Inflammation may usually be reduced by using ice. We strive to generate temporary inflammation with Prolotherapy in order to get the body to recover itself.
A brief rise in blood sugar levels is expected in diabetics. This should be closely checked.
Can prolotherapy cause nerve damage?
Because of the close proximity of the spinal cord, prolotherapy for the back and neck has a higher risk of problems than other locations. Although the risk of permanent nerve injury is low, it does exist. Prolotherapy’s hazards to this area are still lower than the risks connected with back or neck surgery. During your consultation, if you have any questions concerning prolotherapy, don’t hesitate to ask Dr. Neal Pollack.
Spinal headaches arise when the spine’s pressure system is disrupted by an injection. Fortunately, most headaches go gone on their own after 4 to 6 weeks. If a spinal headache lasts longer than a week, extra therapy may be necessary.
You most likely have a spine headache if the pain goes away while lying flat but returns or intensifies while standing or sitting. Consult your physician for a diagnosis and treatment plan.
How often can you get prolotherapy?
The usual patient will require three to six Prolotherapy treatments spaced out over a period of 4-6 weeks. Some people, usually younger patients or those who sought Prolotherapy shortly after an injury, only only 1-2 treatments to achieve complete healing. For more severe situations, individuals may require six or more treatments. A patient’s overall health plays a part in their recovery; eating a nutritious diet, getting enough sleep, leading an active lifestyle, decreasing stress, and quitting smoking can all assist speed up the process. While doing all of these things to help with healing, the majority of our patients also take high-quality nutritional supplements formulated to aid with tissue restoration.