What can you expect from your prolotherapy appointment? Here is an overview of the entire process...
Before Treatment During Treatment After Treatment
→ Before Treatment: The Examination Process
When you are brought back to the examination room, Dr. Reeves will enter to take notes on your medical history. First, he will start with a history of your pain. He will ask about when your difficulties first began, so be prepared to tell him the sequence of what came first. He will ask about what diagnoses have been given, what types of specialists you have seen, and what testing has been done. If there are MRI scans, X-Rays, or other special testing, he will want to read a report, so if possible, bring a copy of the report when you are seen.
Next is the examination process. This typically consists of a general examination of the related sections of your nervous system, muscles, and joints. This is brief, but covers many areas. There are general findings that will sometimes be important for the specific problem for which you are being seen. Then you will be asked to put on a gown, still wearing your underclothing, for an examination related to the specific regions of the body that hurt.
Please be aware: This process of examination needs to be complete in order to be accurate and useful for determining how to treat -- and for estimating how fast or successful treatment will be. It is important to remember that this is not like a high-traffic general practitioner's office in which you must mention only one area of concern at a time. Instead, every area of pain should be mentioned so that examination can include everything. The areas are often related to each other and should not be treated in a piecemeal fashion.
Following that, the specific source(s) of every pain will be identified. One by one, specific examination techniques will be applied to "zero in" on those sources. The two methods of examination that perhaps will be the most unusual for you will be the nerve examination and ultrasound examination. The nerve examination utilizes manual (finger) pressure which is light and with just one finger over precise areas where small sensory nerves penetrate muscle and can contribute to pain. This is actually very common. The ultrasound examination uses the same sound waves used to see babies in the womb. High-quality ultrasound shows details of ligaments, tendons, and nerves in a way that is often better or different than MRI scans are capable of. Another advantage is that ultrasound allows your joints to be examined while in motion, which can provide even more information.
After the examination, a map of findings is made. If you are treated, this map will be re-checked at your next followup appointment.
→ During Treatment: How We Treat
Here are some pointers which will help you be prepared for your prolotherapy treatment...
1. It is best to use the restroom facilities before entering the room, as the treatment is meticulous and can last a while.
2. The areas to treat will be marked with a marker. Prior to your departure, these marks will be lightened using 91% alcohol, but there may be some marks that remain a few days.
3. Based on the number of treatable areas and their depth, we decide how to make the treatment as comfortable as possible. Our goal is to make treatment no more uncomfortable than the earlier examination was. This is done by oral pain medication, the use of as small needles as possible, and the injection of fluid as the needle enters, which pushes little nerves and sensitive structures out of the way. The fluid injection is very helpful.
4. Several different areas of your body may benefit from treatment...
A. Superficial nerve penetrator locations. This is where sensory nerves are diving down through holes in membranous layers called fascia, which line our muscles. Nerves can become irritated at those locations, and will produce pain chemicals (substance P included) that cause pain, and other chemicals (CGRP and nitric oxide) that can cause degenerative change and irritation of nearby joints, ligaments, and tendons. Injections here employ a small needle, delivering a 12.5% dextrose solution just under the skin. Dextrose helps with the healing of all soft tissue, which includes ligaments, tendons, and nerves. For more information on why superficial nerve penetrators are treated, see the articles in the section of this site titled "For Medical Professionals."
B. Deeper areas of nerve penetration. These fascial areas are stretched and separated using the dextrose solution. This both frees up deeper nerves and treats them at that location. This is often done using ultrasound to view the separation process for more accuracy.
C. Ligaments, which connect bones together. Joints cannot move properly without healthy ligaments. This is important, as an example, for a shoulder to move without rubbing the rotator cuff. Backs with weak ligaments may rotate, or feel loose or weak. Also, muscles may tighten up when ligaments are weak in a reflex attempt to protect the area; this is a reason for stiffness (muscles may also tighten when the aforementioned nerve penetrators are irritated).
D. Tendons, which connect muscles to bones. These are ropelike structures, very much like ligaments, and they cannot be strengthened by exercise. As an analogy, this treatment adds strands to an existing "rope" of a tendon.
5. We utilize dextrose cream to complement the prolotherapy injection treatments. You will be given a "dextrose cream map" that will indicate areas of the body where application of the cream is recommended. An application of twice a day is ideal. There are some cases, such as advanced arthritis, in which it may be important to use it daily even when you are doing quite well. This dextrose cream is not just a simple cream, but actually treats the superficial nerve causes of pain and can reduce the amount of injection treatments needed. The dextrose cream can be made up by you very easily with a simple mixer, dextrose powder and a cream of your choice so that it will cost only pennies a day. If you are not sure it is helping, feel free to apply it only to one side for a period of time as a test of efficacy.
6. A specific frequency of further treatment will be recommended. For elite athletes with pending obligations, a one- to four-week frequency can be considered. Our goal, however, is to allow full time for natural healing, which can decrease the treatment frequency needed. We recommend a two- to three-session trial, typically at two-month intervals. Our treatments are quite comprehensive; we do not need more than 2-3 treatments to determine if your condition will respond to prolotherapy. After that period, our goal is to taper (as soon as possible) to 3-12 months intervals, or more infrequently as needed.
→ After Treatment: What to Expect
Most patients have a variety of questions about what to expect after treatment. Dr. Reeves has compiled these questions, and his answers, into this helpful handout. Additionally, Dr. Reeves has some post-treatment instructions for you.
If there are further questions about how we treat that you want to ask before treatment, feel free to call the office at (913) 362-1600, or come in ready to ask.
It is, of course, difficult to make specific comments before the examination, since so much examination is needed to decide on the specific treatment need.