Management of Musculoskeletal Pain

Abstract

Musculoskeletal pain is a distressing, unpleasant feeling and an emotional experience associated with actual or potential tissue damage. Prolotherapy is an injection therapy designed to stimulate tissue healing. Lyftogt PIT (perineural injection therapy) treats the neurogenic inflammation. Therefore it stops the pain and promotes the release of NGFs (nerve growth factors) which are important for tissue regeneration. Vitamin D3 receptors are ubiquitous in tissue distribution, which opens the possibility for unforeseen biological functions of vitamin D endocrine system. Dextrose is the most commonly used tissue proliferant in prolotherapy. It has different ways of action aiming to stimulate the tissue regeneration. Platelet Rich Plasma is also used in the IROM (interventional regenerative orthopedic medicine), and it is very powerful because it delivers "growth-factors" which stimulate the local tissue progenitor cells (adult mesenchymal stem cells) enhancing the regeneration of the tissues. Adult Mesenchymal stem cell is the hot topic nowadays in the non-surgical field of pain management. In this paper, 250 patients suffering from chronic pain and dysfunction of different body joints (knee, hip and elbow), were treated with one or two injection therapy techniques, to evaluate the patient improvement regarding the pain and function. The effect of adding an intra-articular injection of vitamin D to the above techniques was also evaluated regarding the joint pain and function improvement. Some of the patients were treated with Platelet Rich Plasma and others were treated with Bone Marrow Stem cells. The results of the 250 patients were compared with those obtained from 30 matching control patients, having same conditions and were treated with physiotherapy. Conclusions show that the therapeutic benefit from combining the two techniques, Lyftogt Perineural Injection Therapy and Prolotherapy, is better than using only one of them regarding the pain and function for the different body joints. Adding an intra-articular injection of vitamin D to the treatment of some patients gave a better result than those treated with dextrose only. However, using the Platelet Rich Plasma and the Stem cells instead of dextrose gave the best results ever regarding the pain and function of the musculoskeletal system.