A h i i I fl

Arthritis, Inflammation 
i
And Joint Pain
And Joint Pain‐‐
Can Prolotherapy 
Help?
p
 P t A
Peter A. Fi
Fields
ld MD
MD,DC
DC
Board Certified Medical Physician
Board Certified Chiropractor

Director
Pacific Prolotherapy and Wellness
Center
Santa Monica, CA
 Over 100 Types of Arthritis
Over 100 Types of Arthritis
• Osteo (DJD, Degenerative)
Osteo (DJD Degenerative)
• Rheumatoid
• Ankylosing Spondylitis
• Polymyalgia Rheumatica
l l i h i
• Psoriatic
• Gout
 Osteoarthritis
• Most
Most Common type
Common type
• Any Joint
y
• Most  often in hands, spine, hips and 
knees
• Deterioration of Cartilage 
Deterioration of Cartilage – most 
most
commonly due to weak ligaments
 Risk Factors
Risk Factors
• Over 45 years of age
Over 45 years of age
• Physical labor
y
• Injuires
• Obesity
• Heriditary
• Defective cartilage
 Definition
• Arth:  joint
A th j i t
• itis: inflammation
iti i fl ti
IInflammation and Pain 
fl i dP i
are  the result of  joint 
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dysfunction
f .
 Joint dysfunction is 
y
commonly the result of 
y
weak or loose ligaments 
(and sometimes tendons)
 Li t tt h b
•Ligaments attach bone 
to bone
to bone
T d h
•Tendons attach a 
muscle to a bone
l t b
Staying active
Staying active
Keeping Fit
Keeping Fit
OR NOT FACE REALITY
OR NOT FACE REALITY
 Conventional Medicine
• Medicine ‐ Anti‐inflammatory 
y
(NSAIDS), pain and muscle relaxants
• Physical Therapy
Physical Therapy
• Rest
• Surgery
S
 Non‐Steroidal 
Anti‐Inflammatory Drugs
• Impair
Impair tendon and ligament repair and 
tendon and ligament repair and
cartilage production 
• Decrease pain but compromise the final 
Decrease pain but compromise the final
outcome of the healing process
• Raise BP
R i BP
Dangers of Anti‐Inflammatory 
Medicines Interview
d
 Physical Therapy
Physical Therapy
• Strengthen
Strengthen weak or damaged  
weak or damaged
muscles  
• Does not strengthen ligaments and 
h l d
tendons
• Body builders (eg: the Goveneator) 
ligaments are the same size as
ligaments are the same size as 
everyone else
Rest
 Surgery
• No
No need for quick decision in joint 
need for quick decision in joint
or back surgery cases. 

• 4 years after surgery, both surgical 
and non surgical groups had the
and non‐surgical groups had the 
same level of symptoms
. 
 Surgery

• 50% of back of surgeries get better; 
25% stay the same and 25% get 
worse
• Period of rehabilitation and 
recuperation 
Post Back Surgery 
Prolotherapy
 Prolotherapy‐other
Prolotherapy other names
names
• Regenerative Injection Therapy 
Regenerative Injection Therapy
(R.I.T)
• Sclerotherapy
• Nonsurgical ligament 
reconstruction
 Definition of Prolotherapy
f f l h

A technique for healing
A technique for healing ligament 
ligament
and tendon weakness or injury by 
stimulating the growth of normal
stimulating the growth of normal 
cells and tissue
 Prolotherapy
• A
A natural non
natural non‐surgical
surgical method of assisting the 
method of assisting the
body to heal injured tendons and ligaments.
• It
It’ss modern model was founded in the 1950s 
modern model was founded in the 1950s
by Drs. George Hackett and Gustav Hemwall,
• Helps your body make new cells, which 
H l b d k ll hi h
strengthen weak or torn ligaments and 
tendons.
d
 Prolotherapy
• Still have pain in an injured area or weakness 
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even after a healing period of weeks, months or 
years.
• Ligaments and tendons have very poor 
Ligaments and tendons have very poor
circulation 
• They have lots of nerves 
They have lots of nerves –causing
causing pain. 
pain.
• Relaxed and weak ligaments lead to increased 
cartilage degeneration, bone‐on‐bone friction 
and arthritis type pain. 
d hii i
• Nerves around soft tissues become stretched and 
irritated and produce pain
irritated and produce pain.
 How Does Prolotherapy Work?
• Injection of a proliferant 
• Causes an inflammatory response 
• Stimulates the healing process  
Stimulates the healing process
• Results  ‐ proliferation (growth) of 
ligament or tendon
ligament or tendon 
• Weakened area heals and the pain is 
reduced or eliminated. 
 Proliferants

• Dextrose –– the most common
Dextrose the most common
• Sodium Morrhuate
• P2G: Dextrose, phenol and glycerine
• Chondroitin and glucosamine
Chondroitin and glucosamine
 Prolotherapy First – Surgery Last
Prolotherapy First  Surgery Last
• No recovery time or rehabilitation 
No recovery time or rehabilitation
• Can stay up and active
• No side effects if it does not work
id ff if i d k
• You can always have surgery if Prolotherapy 
fails to resolve most of your symptoms.
Prolotherapy Interview
Prolotherapy Interview
 What does Prolotherapy Treat
What does Prolotherapy Treat
• chronic  conditions
chronic conditions • shoulder pain
shoulder pain
• some acute cases • knee pain
• Arthritis
hii • tendonitis 
d ii
• degenerated joints  • sports injuries 
• bursitis  • sciatica 
• back pain
back pain  • headaches
• neck pain • fibromyalgia
Face
• TMJ
 Cervical
• Instability
• Whiplash
• Disc disease
i di
• Facet joint OA
• Scalene muscles
Spine

• Scoliosis
• Kyphosis
• Compression
Compression 
fractures
• Degenerative
Degenerative 
disc disease
• Instabilityy
• Costo‐
vertebral joint 
j
 Shoulder
• Rotator cuff
Rotator cuff
• Frozen shoulder
• A‐C
A C joint instability, OA
joint instability OA
• Torn labrum
Elbow
• Medial epicondylosis
• Lateral epicondylosis
Lateral epicondylosis
• OA
 Wrist
• OA
• Carpal tunnel
• Sprain
• TFCC
Hand
• OA finger joints
• Intermetacarpal ligament strain
 Lumbosacral Spine
Lumbosacral Spine
• Degenerative
Degenerative disc 
disc
disease
• Instabilityy
• Ilio‐lumbar ligament 
strain
• Sacro‐iliac ligament
yg y
• Coccygodynia
• Facet arthopathy
• Spinal stenosis
Spinal stenosis
 Hip
• OA
• Labral tear
• Sports hernia
Sports hernia
• Adductor strain
• ITB piriformis gluteus
ITB, piriformis, gluteus 
tendonosis
Knee • OA
• ACL/ PCL
• Coronary
Coronary 
ligaments
• MCL/LCL
• Patellar/ 
Patellar/
Quadriceps 
tendon
• Posterolateral / 
Posterolateral /
Anterolateral 
instability
• Pes Anserinus 
Pes Anserinus
Tendonosis
 Ankle
• Deltoid ligament
• Sinus tarsi
• OA
• Achilles Tendonopathy
Foot
• Plantar
Plantar fasciitis
fasciitis
• Intermetatarsal 
ligament weakness
g
• Bunion
• Turf toe
Turf toe
• OA toe joints
• Inter
Inter‐tarsal
tarsal ligament 
ligament
strains
Frequently asked questions 
about Prolotherapy
 Is this the same thing as 
cortisone injections?
cortisone injections?
• Long
Long term studies ‐actually weakens 
term studies actually weakens
tissue. 
• Not more than three times 
• Lasts from one week to one year
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How many treatments will I need?
How many treatments will I need?
• ~ 6 sessions every 2 to 4 weeks 
6 sessions every 2 to 4 weeks
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• 8, 10 or 12 sessions for post surgical, 
long standing or other complicated 
cases 
cases
 When Should I Expect Results
When Should I Expect Results
• Many
Many patients feel relief of pain after the 3rd 
patients feel relief of pain after the 3rd
or 4th treatment. 
• Some reported some relief of pain after only 
Some reported some relief of pain after only
two sessions.
• Initially a decrease in the time to onset of 
I i i ll d i h i f
pain
 Will I need to continue care after 
treatment??
• Once
Once treated, the problem should be
treated the problem should be fixed
• Healing will continue to take place for at least 
one year following treatment
one year following treatment. 
• If there is an injury or insult to the area an 
additional treatment maybe needed
ddi i l b d d
 Is Prolotherapy safe?
Is Prolotherapy safe?
• Extremely
Extremely safe procedure
safe procedure
• With any procedure, there are risks and side 
effects 
effects
• Most common is pain and swelling – lasting 
1 3d
1‐3 days
• The risks are far less than taking aspirin or 
Motrin for a lifetime to temporarily alleviate 
chronic pain
 Do the Treatments Hurt?
Do the Treatments Hurt?
• Lidocaine (anesthetic) is injected prior to the 
treatment
• If needed a cold spray or a gel of Lidocaine to 
If needed a cold spray or a gel of Lidocaine to
numb the skin prior to the treatment.
• Patients say :“the pain from the injections 
Patients say :“the pain from the injections
was nothing compared to the pain that I was 
experiencing prior to Prolotherapy” or “It 
i i i t P l th ” “It
wasn't that bad."
Stress/Pain Relievers for the Therapy
Stress/Pain Relievers for the Therapy
• If
If needed, a prescription can be given for 
needed a prescription can be given for
Ultram, Tylenol with codeine or Vicodin.
• We have calming music to listen to, stress balls, 
We have calming music to listen to stress balls
and hot packs to help ease one’s mind during 
the treatment
the treatment. 
• Ninety
Ninety‐‐nine percent of our patients receive the 
treatments without pain killers and do just fine 
ih i kill d d j fi
 Products
• Natural
Natural supplements that one can take for 
supplements that one can take for
helping with information and/or pain
 Fish Oil

Benefits of Omega 3 Fish Oil:

Benefits of Omega 3 Fish Oil: 
Reduces inflammation and arthritis pain 
Lowers triglycerides and cholesterol 
Healthy skin and hair
Fights infections by enhancing immune system
Enhances overall health and wellness
Helps prevent cancer, heart disease, 
atherosclerosis, and stroke
 Super*Flex Arthritis Formula with
Glucosamine & Chondroiten
Treats:
Beneficial for the osteoarthritis (
Beneficial for the osteoarthritis (“wear
wear and tear
and tear”)) form of 
form of
arthritis; Also back pain and joint deterioration.

Glucosamine ‐ precursor in the biosynthesis of cartilage 
p y g
and stimulates the body’s ability to repair and regenerate 
cartilage tissue. 
Chondroiten inhibits enzymes that degrade cartilage 
tissue. 
Bromelain inhibits edema and swelling of the joints 
Boswellin potent anti‐inflammatory and anti‐rheumatic 
agent. 
 Wobenzyme‐ nutritional support for 
Inflammation
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Osteoarthritis * Sprains and Strains * sports

injuries * joint & muscle pain *Rheumatoid
Arthritis

Pancreatin
P ti - helps
h l reduce
d jjoint
i t di
discomfort
f t and
d swelling.
lli
Bromelain - strengthens the immune system, supports anti-
inflammatory activity and reduce joint swelling.
Trypsin - boosts immune system; accelerates repair of
injuries
Papain - strong anti-inflammatory activity
Chymotrypsin - keeps blood flowing freely to enhance
circulation.
Rutin, a powerful free radical scavenger and acts an anti-
inflammatory by inhibiting the enzymes
 Traumeel

Indications:
Inflammatory Processes
Inflammatory Processes
Arthritis 
Bursitis 
Bursitis
Arthrosis of Hip, Knee, Small Joints 
Sprains 
Sprains
Contusions
Fractures
 Heel Arthritis Formula
Heel Arthritis Formula

Treats:
Swollen Joints ‐ pain with motion, better upon 
continued motion; 
Rheumatic pains all extremities ‐ better with 
motion; 
i
Neck stiffness 
Heaviness of legs and feet
Heaviness of legs and feet
Soreness, especially when at rest 
Pain in joints of upper limbs ‐
j pp worse in cold 
wet weather
 Arthritol

SUPPORT FOR BONES AND JOINTS –
A unique combination of botanical 
i bi i fb i l
extractions from chamomile flowers 
and olive leaves The extractions are
and olive leaves. The extractions are 
bio‐enhanced with MediBotanicas 
p
patent
Who’s back would you 
rather have?
A Surgical back
A Surgical back
A Prolotherapy Back 
Prolotherapy
• “I have been a patient 
p
who has benefited from 
Prolotherapy. Having 
been so remarkably
been so remarkably 
relieved of my chronic 
disabling pain, I began 
gp g
to use it on some of my 
patients – “
C E
C. Everett Koop, M.D.
tt K MD
Former Surgeon General of the United States
 Prolotherapy
“…this fringe treatment (prolotherapy) is no 
this fringe treatment (prolotherapy) is no
longer at the periphery and seems to be at the 
frontier of a justifiable rational treatment
frontier of a justifiable, rational treatment 
with a significant potential to avoid 
destructive procedures ”
destructive procedures.
Vert Mooney, M.D.    “Prolotherapy at the fringe of medical Care,    or is it at 
the frontier?” Spine, 20033(4):p.253
the frontier? Spine, 20033(4):p.253‐4.
4.
What’ss wrong with this picture?
What wrong with this picture?
 Left knee has had no ACL, no LCL, and no medial or lateral meniscus 
for 30 years.  Treatment has been Glucosamine for >20 yrs., intra‐
articular dextrose periodically for about 10 yrs and low resistance long
articular dextrose periodically for about 10 yrs. and low resistance long 
distance bicycle riding.
 MRI Report 
DATE:  12/2/2003  PATIENT:
TYPE OF STUDY: MRI OF LUMBAR SPINE 
INDICATIONS:  EVALUATE FOR DISC HERNIATION

FINDINGS:   
spondylolisthesis of L5 relative to 
•L5‐S1, there is 1st degree spondylolisthesis 
spondylolysis 
spondylolysis of the pars interarticularis bilaterally.  
d l l i f h i i l i bil ll
•There is also significant spondylosis at L5‐S1 to include dehydration of 
this disc with a large broad‐based central and somewhat left paracentral 
g p
disc protrusion with mass effect on the ventral dura. 
•displacement of traversing nerve roots. 
significant neural foraminal stenosis bilaterally but mostly on the left 
•significant neural foraminal stenosis bilaterally but mostly on the left
and this most likely compromises the intraforaminal nerve roots 
bilaterally.  
Dr. Fields finishing his seventh 70.3 
Ironman Triathlon (1 2 mile swim
Ironman Triathlon (1.2 mile swim, 
56 mile bike, 13.1 mile run) Oct ‘07
 For Additional Information
For Additional Information

• www.DrFields.com
D Fi ld
• www.Prolotherapy‐HHF.org 
P l th HHF
• www.HealingEdge.net
H li Ed t
Machu Picchu, Peru
Machu Picchu, Peru
Th k Y
Thank You