Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Michael J Yelland, Kent R Sweeting, John A Lyftogt, Shu Kay Ng, Paul A Scuffham and Kerrie A Evans. Br J Sports Med. Published Online. 22 June 2009 and 22 April 2011.sin
Objective: To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis.
Design: A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points on a 100 point scale.
Setting: Five Australian private primary care centres.
Participants: 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed the treatment protocols.
Interventions: Participants were randomised to a 12 week programme of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14).
Main outcome measurements: VISA-A, pain, stiffness and limitation of activity scores and treatment costs were assessed prospectively over a period of 12 months.
Results: At 12 months, the proportions of participants achieving the MCIC for VISA-A scores were 73% for ELE, 79% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9)for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incrementalcost per additional responder (AU$1539) compared with ELE.
Conclusions: For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long term VISA-A scores are similar.
Helene Bertrand, Marylene Kyriazis, K. Dean Reeves, John Lyftogt, David Rabago: Topical Mannitol reduces capsaicin-induced pain: results of a pilot level double-blind, randomised controlled trial. PM R May 12 2015
Capsaicin specifically activates, and then gradually exhausts, the transient receptor potential vanilloid type 1 (TRPV-1) receptor, a key receptor in neuropathic pain. Activation of the TRPV-1 receptor is accompanied by burning pain. A natural substance or medication that can reduce the burning pain resulting from capsaicin application may have therapeutic potential in neuropathic pain.
J Lyftogt. Prolotherapy and Achilles tendinopathy: A prospective pilot study of an old treatment, Australasian Musculoskeletal Medicine May 2005
Background: Prolotherapy has been successfully used for over 60 years in the treatment of a large variety of musculoskeletal conditions. No studies on prolotherapy and achilles tendinopathy have been published.
Conclusions: Prolotherapy is a safe, effective and inexpensive treatment for achilles tendinopathy in this pilot study.
Recovergrams are an effective clinical tool for monitoring progress, evaluating effect and predicting duration of treatment.
J Lyftogt. Chronic Exertional Compartment Syndrome and Prolotherapy. Australasian Musculoskeletal Medicine Nov 2006
Background: Chronic exertional compartment syndrome (CECS) is not uncommon. It affects mainly young, active people itis debilitating and intensely painful. Conservative treatment is not effective however surgery through fasciotomy offers hope.
Conclusions: This pilot study suggests that it is reasonable to offer patients with CECS a trial of prolotherapy. Recovergrams are an effective tool for monitoring effects of treatment and study recovergrams demonstrate the combined results readily in graphic format.
J Lyftogt. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Australasian Musculoskeletal Medicine Nov 2007
Abstract: In 2005, 127 patients were treated with subcutaneous prolotherapy: painful knees (74), shoulders (33) and lateral elbows (20). The mean length of symptoms was 23.9 months and mean length of treatment 7 weeks. The mean initial visual analogue scale (VAS) of 6.7 reduced at mean follow up of 21.4 months to VAS 0.76. Patient satisfaction rates at follow up were 91.7%. The treatment was well tolerated and safe.
J Lyftogt. Subcutaneous prolotherapy for Achilles tendinopathy: The best solution? Australasian Musculoskeletal Medicine Nov 2007
Abstract: Subcutaneous prolotherapy is an effective treatment for achilles tendinopathy in the primary care setting. Different glucose/local anesthetic concentrations were clinically trialled over a four-year period with long-term follow up of 132 achilles tendons. All 169 achilles were prospectively monitored with an evidence based Recovergram and 132 achilles were independently followed up after a mean period of 20 months. Mean follow up VAS was 0.4 and 90% of patients were satisfied with treatment.
All solutions were effective at follow up.
J Lyftogt. Prolotherapy for Recalcitrant Lumbago. Australasian Musculoskeletal Medicine May 2008
Abstract: Recalcitrant lumbago with a mean duration of 5.5 years in 41 consecutive patients presenting over a one-year period was treated effectively with a series of subcutaneous prolotherapy treatments. 90% improved by more than 50% from an initial mean Visual Analogue Score (VAS) of 7.6, with 29%, reaching VAS 0 at a mean treatment length of 8.3 weeks. Subcutaneous prolotherapy treatment has been shown to be highly effective in the treatment of a variety of peripheral neuropathic painful conditions. This clinical practice is founded on a proposed working hypothesis that subcutaneous prolotherapy is a suitable, effective and inexpensive treatment for prolonged pathological peripheral neurogenic inflammation.
J Lyftogt. Pain Conundrums: Which Hypothesis? Central Nervous System Sensitization versus Peripheral Nervous System Autonomy. Australasian Musculoskeletal Medicine Nov 2008
Abstract: The two hypotheses, central nervous system (CNS) sensitisation and peripheral nervous system (PNS) autonomy are at first glance irreconcilable. CNS sensitisation is the reigning paradigm in mainstream pain medicine. It is shared by most members of the medical scientific community. PNS autonomy is not recognised despite convincing scientific and clinical evidence. It has yet to establish a paradigm status and would require a scientific revolution or paradigm shift for it to gain acceptance, as predicted by Thomas Kuhn.
J Lyftogt. Treating Inferior Heel Pain with Vitamin D3 Dermal Cream: A clinical report on two case histories. Australasian Musculoskeletal Medicine Nov 2008
Abstract: Inferior heel pain, also known as plantar fasciitis, is aperipheral neuropathic pain syndrome due to persistentneurogenic inflammation of the medial Calcanealbranches of the tibial nerve. Vitamin D3 is considered to bea neurosteroid with neuroprotective properties. This is the first report of two patients responding favourably to twicedaily applications of vitamin D3 transdermal cream for this difficult-to-treat condition.
WALDMAN: PAIN MANAGEMENT. Prolotherapy. K. Dean Reeves. J Lyftogt. Section V. Chapter 139. Second Edition. 2011. ELSEVIER