Prolotherapy and Low Level Laser Therapy: A Synergistic Approach to Pain Management in Chronic Osteoarthritis

Abstract

Regenerative injection therapy and low level laser therapy are alternative remedies known for their success in the treatment and symptomatic management of chronic musculoskeletal conditions. In response to the growing demand for alternative therapies in the face of the opioid epidemic, the authors conduct a literature review to investigate the potential for prolotherapy and LLLT to be used adjunctively to manage chronic osteoarthritis (OA). OA is a degenerative chronic musculoskeletal condition on the rise in North America, and is frequently treated with opioid medications. The regenerative action of prolotherapy and pain-modulating effects of LLLT may make these two therapies well-suited to synergistically provide improved outcomes for osteoarthritis patients without the side effects associated with opioid use. A narrative descriptive review through multiple medical databases (Google Scholar, PubMed, and MedLine) is conducted, restricted by the use of medical subject headings. 71 articles were selected for reading in full, and 40 articles were selected for use in the study after reading in full. A review of the literature revealed good clinical results in the use of prolotherapy and LLLT separately to manage chronic musculoskeletal pain due to osteoarthritis and other chronic conditions. It is also recognized in the literature that prolotherapy works most effectively when used adjunctively with other treatments. Downsides to the use of prolotherapy include mild side effects of pain, stiffness and bruising and potential adverse events as a result of injection. This study is limited by the lack of clinical trials available involving both LLLT and prolotherapy injections used adjunctively, and by the low number of high impact literature concerning the treatment of (specifically) osteoarthritis by alternative methods. The authors suggest that practicing health care providers consider utilizing LLLT and prolotherapy together as a supplementary method in the management of chronic pain due to osteoarthritis, to minimize the long-term prescription of opioids and emphasize a less invasive treatment for this debilitating condition.

Keywords: Chronic Pain; Laser Therapy; Osteoarthritis; Pain Management; Prolotherapy.

Figure 1.. Flow Diagram of Review System and Selection of Sources

Figure 2.

A, Simplified schematic representation of normal anatomy of the knee joint, with some of the major anatomical structure labeled; B, Ligamentous damage stimulates macrophages from the synovium to release inflammatory cytokines. The migration of T-cells and neutrophils from the surrounding vasculature causes an increased concentration of proteases intra-articularly; C, The osteoarthritic joint demonstrates deficient articular cartilage, subchondral sclerosis, osteophyte formation as well as decreased joint space. Pain signalling molecules are persistent in the affected joint, and stimulate sensorineural fibers in the fibrous capsule (A-delta mechanoreceptors) and in the synovium (C polymodal nerve endings) , causing chronic pain.

Figure 3.

The above map offers a representation of the 3 main pillars of osteoarthritis pathophysiology; ligamentous laxity, articular cartilage degradation and the excessive presence of inflammatory mediators (IL-1, TNF, IL-8, PGE-2, VIP) and the mechanism by which prolotherapy and low level laser therapy likely contribute to the physiological benefits of osteoarthritis symptom management and joint support.