Proloterapi: Kronik Ağrı Yönetiminde Etkili Bir Yöntem

Proliferatif ve irritan (dekstroz, gliserin, fenol v.b) solüsyonların sorunlu bağ ve kiriş dokularına enjekte edilmesi ile oluşan inflamasyona karşı vücut iyileştirici bir savunma mekanizması geliştirir. Proloterapi bu esasa dayanan bir tamamlayıcı tıp yöntemidir. Tendinopati, gonatroz, bel ağrısı, epikondilit gibi kas iskelet sisteminin değişik bölgelerinde kronik ağrıya neden olan sorunlarda irritan sıvıların kişinin gereksinimi ve yaşına göre değişen miktarlarda sorunlu bölgeye enjekte edilmesi ile uygulanan ve yaklaşık yarım asırdan fazla süredir kullanılan bir yöntemdir. Konu ile ilgili yapılan çalışmaların sonuçları gibi, tedavi yöntemleri ve süreleri de farklılıklar göstermektedir. Sternoklaviküler instabilitede ağrıda azalma ve tam aktiviteye dönüş sağlanmış olup mikroperforasyon yöntemi önerilmektedir. Kronik bel ağrılarında proloterapinin başka modaliteler ile birlikte kullanıldığı takdirde, yakınmaları ve engelliliği azaltabileceği bildirilmektedir. Osteitis pubis ile ilgili bir vaka serisi son derece başarılı bulunmuş, çoğu sporcu ağrılarından kurtulmuş ve tamamı spora dönebilmiştir. Gonartroza ilişkin bir çalışmada proloterapi uygulama öncesi duruma göre ağrı ve işlevselliğe dair ölçülerde iyileşme sağlarken, kontrol grubuna göre anlamlı fark elde edilememiştir. Aşil tendinitinde, proloterapinin ağrıyı azaltıp hasta memnuniyetini artırdığı gösterilmiştir. Proloterapiyi destekleyen kanıt düzeyi yüksek çalışmalara gereksinim sürmektedir. İyi yetiştirilmiş ellerde proloterapi, uygun hastalarda iyi neticeler vermesi beklenilen bir tamamlayıcı tıp yaklaşımıdır. Kas iskelet sorunlarının yaygın olduğu gündelik aile hekimliği pratiğinde medikal tedavilerin yararlı olmadığı ya da yan etkilerinden çekinildiği durumlarda maliyet etkin destekleyici bir uygulama olarak son derece yararlı bir tedavi yöntemidir

Prolotherapy: A New Method for Chronic Pain Management in Family Medicine

Prolotherapy is a complementary medicine method which is based on the principle of healing body defence against the inflammation caused by injecting a proliferative and irritant (dextrose, glycerin, phenol, etc.) solution into the problematic tissue, ligaments and tendons. In problems like tendinopathy, gonarthrosis, lumbago, epicondylitis etc. which cause chronic pain in different regions of the musculoskeletal system, various irritant liquids injected to the problematic area varying to the requirements and the age of a person. In sternoclavicular instability, microperforation method is recommended to achieve pain reduction and returning to full activity. There is no clear superiority among the preferred methods of non-surgical treatment of lateral epicondylitis. Prolotherapy can reduce symptoms of chronic low back pain and disability if it is used in conjunction with other modalities. Successful case series have been reported related to osteitis pubis, in many athletes pain liberated and all were able to return to full fitness. In a study of gonarthrosis, improvement in pain and function were provided. It has not been possible to obtain a significant difference compared to the control group. Prolotherapy has reduced the pain and has improved patient satisfaction in achilles tendinitis. The need for evidence-based studies on behalf of prolotherapy are still needed. Proloterapy is a complementary medicine approach and in trained hands, it is expected to give good results on appropriate patients. Musculoskeletal problems are common in family practice. If medical treatment is not useful or in cases where side effects are of concern, proloteraphy is a cost-effective supportive therapy method

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