Treatment of Chronic Painful Musculoskeletal Injuries and Diseases with Regenerative Injection Therapy (RIT): Regenerative Injection Therapy Principles and Practice

Abstract

Regenerative injection therapy (RIT), also known as prolotherapy or sclerotherapy, is a treatment for chronic musculoskeletal pain caused by connective tissue diathesis utilizing chemical or biologic substances, Steroidal and nonsteroidal anti-inflammatory medications are useful in degenerative disease processes with concomitant inflammatory changes or fibrosis which tethers adjacent structures such as nerves or tendons. In such instances, hydrodissection with injectates containing corticosteroid may also prove useful. RIT is a viable, type-specific treatment for chronic conditions that involve collagen destruction or degeneration. Multiple controlled and uncontrolled studies indicated effectiveness of RIT in treating painful degenerative musculoskeletal conditions. Advances in imaging technology such as MRI and diagnostic ultrasound made it possible to visualize soft tissue pathology in the muscles, ligaments, and tendons. Tendinosis is frequently present in the appendicular and axial tendons. The diagnosis of tendinosis requires therapeutic interventions different from corticosteroids. There is literally an army of capable doctors who need biologically active substances to repair or regenerate degenerative pathologic changes. Old and newer injectates used for RIT such as polidocanol, platelet-rich plasma, and stem cells meet these requirements and are rendering impressive results. The published pain patterns from ligaments, muscles, intervertebral discs, and synovial joints in the cervical thoracic and lumbar regions overlap significantly. Nonetheless, ligaments and tendons of these regions are rarely included in differential diagnosis. This chapter is addressing the diagnostic and therapeutic approaches to chronic musculoskeletal pain related to the pathology of fibrous collagenous connective tissue that could benefit from RIT. (PsycINFO Database Record (c) 2016 APA, all rights reserved)