PROLOTHERAPY COST EFFECTIVENESS, An Eight Year Study
April 2009
Kent L. Pomeroy, M.D. | Prolotherapy in AZ
3610 N. 44th St. #210
Phoenix, Arizona 85018
602-912-4996
www.drpomeroy.com
The effectiveness of prolotherapy or sclerotherapy treatments for pain and musculoskeletal problems has been reported by practitioners and their patients since the 1930’s. The first lumbar laminectomy was performed in the late 1930,s and the focus of low back treatment shifted to the surgical approach. Over the past six decades, the conventional approach to musculoskeletal pain and dysfunction has included the use of drugs, cortisone injections and epidural blocks, physical therapy, pain center treatments and surgery.
Many patients have had good results with these methods of treatment, but many have not been as successful. The cost of medical care for musculoskeletal pain treatment has continued to rise with the increase in modern technology and surgical techniques. The most expensive treatment is that which does not solve the pain problem.
It has been the belief of the prolotherapy practitioner, that the use the of proliferant injections to stimulate the body’s own repair mechanism can, in most cases, produce pain alleviation and function improvement by treating the problem at its source. Prolotherapy costs are much lower than conventional methods and often produce a better and more permanent result.
A study was started in 1997 in a solo private practice office to establish the cost and effectiveness results of proliferant injections (prolotherapy/sclerotherapy) by comparing patients’ conditions at the start of treatment with their conditions at discharge, at six months and at twelve months follow-up reports and record the costs of medical care while using prolotherapy as the primary treatment.
The study included information on the patient’s age, sex, compensation or non-compensation status, complications of treatment, areas treated, primary and related ICD-9 diagnoses, duration of the condition prior to treatment, pain levels at the start, discharge, six months and twelve months follow-ups, narcotic or other medication use and changes, assistive device use, work levels or sports and activity level changes, the prevention of recommended surgery, surgery that was still needed, and the cost of single area or multiple area treatments.
The number of treatments for each case was not recorded but was reflected in the cost of treatments.
606 patients qualified for the study during the eight years of data collecting and an additional 450 patients left the study without completing their recommended number of treatments. Not all of the 606 qualifying patients completed the series, but enough data could be collected to add them to the study. The reasons that patients left the study without completing the recommended number of treatments varied. Feedback information from patients’ family, friends or from the patients themselves during the years after the study was completed, indicated that a number of them had their pain problems leave after the first or second treatment and they did not bother to cancel their appointment or call in. Some stopped because their insurance did not reimburse them for the treatment, some did not tolerate the injection pain and several moved or passed away from unrelated causes.
Of the 606 patients, 1115 areas were treated. Each area was given a separate reporting line for data collection. The area totals included the following: cervical 135, thoracic 78, lumbar 204, sacroiliac 163, shoulder 135, hip 97, knee 147, elbow 29, hand and wrist 59, ankle and foot 60, TMJ 5, other 3.
There were no complications related to any of the areas treated in the study. One complication that occurred after the study was concluded and therefore not reported in the study, is mentioned here. This was a case of a staph infection in a shoulder bursa following prolotherapy treatment. To help prevent this complication from occurring again, all joint or bursa areas treated that may hold a large amount of synovial fluid, such as the knee or shoulder, or that may be difficult to disinfect are prepped with Povidone before treatment.
The substances used for the injections normally included 50% dextrose with 1% lidocaine and/or 0.25% bupivacaine as anesthetics. Sodium morrhuate was often added to the mixture as an additional proliferation stimulant. Sodium morrhuate dosage ranged from 0.01 cc per 10 cc of the dextrose and anesthetic mixture, to 1 cc per 10 cc of the mixture.
Prolotherapy Outcome Study
· Began Jan, 1997
· Ended Sep. 2005
· 606 patients qualified for the study
· 450 patients disqualified for lack of return or follow up
1115 areas of treatment within the 606 patients
Areas treated
· Cervical– —————————–135
· Thoracic spine and ribs————–78
· Lumbar—– —————————204
· Sacroiliac and pubic symphysis—163
· Coccyx———————————–1
· TMJ————————————–5
· Shoulder——————————135
· Elbow——————————— 29
· Wrist———————————–45
· Hand———————————–14
· Hip————————————-97
· Knee———————————-147
· Ankle———————————-29
· Foot————————————31
· Achilles tendon————————2
· Age distribution:
· Average age was 57
· Teenagers————–1.5%
· 20’s———————2.8%
· 30’s———————9.3%
· 40’s———————17%
· 50’s———————18.6%
· 60’s———————17%
· 70 or older————-23.9%
· Medicare age (65 & up) 34.8%
LUMBAR SPINE 204 cases
· Spondylosis—————-113———55.39%
· Lumbar sprain—————41——–20.09%
· Lumbar disc herniation—-20———–9.8%
· Post laminectomy pain—–18———-8.82%
· Scoliosis———————–4———-1.96%
· Spondylolisthesis————-2———-0.98%
· Spondylolysis—————–1———-0.49%
· Spinal stenosis—————-1———-0.49%
· Lumbar fracture————–4———-1.96%
LUMBAR PAIN LEVELS (ZERO TO TEN), at treatment start, discharge, 6 months and 12 months follow up
START (204) DISCHARGE (204) 6 MONTHS(153) 12 MONTHS(144)
Pain level
10 25.49% 2.45% 0.65% 0.69%
9 13.72% 0% 0.65% 0.69%
8 29.9% 1.047% 0% 0.69%
7 10.78% 2.45% 2.61% 1.38%
6 8.82% 3.92% 3.92% 4.16%
5 5.88% 5.39% 4.57% 4.16%
4 2.94% 4.33% 3.26% 7.63%
3 1.96% 13.23% 13.72% 35.55%
2 0.49% 13.72% 13.07% 11.8 %
1 0 % 21.07% 18.95% 24.37%
0 0 % 27.94% 38.56% 40.97%
LUMBAR SPINE
Work or Sports capability at Start, Discharge, 6 months and 12 months:
START DISCHARGE 6 MONTHS 12 MONTHS
Impaired 100% 6.93% 3.82% 3.97%
Improved 30.19% 16.56% 13.06%
Normal 62.87% 79.61% 82.95%
SURGERY
Recommended by surgeon prior to treatment 19.70%
Other potential surgical cases 25.61%
(total 45.31%)
Surgery carried out 9.35%
AVERAGE COST OF PROLOTHERAPY TREATMENT $1,151
COST OF LUMBAR DISC SURGERY FOR FACILITY AND SURGEON CHARGES $ 20,000 (internet, mymedicalcosts.com)
SHOULDER 135 Cases
· Degenerative arthritis————-25————-18.51%
· Rotator cuff tendinosis———–68————–50.37%
· Rotator cuff sprain—————-36————–26.66%
· Acromioclavicular sprain——–4—————–2.96%
· Sternoclavicular sprain———–1—————–0.07%
· Recurrent dislocation————-1—————–0.07%
SHOULDER PAIN LEVELS (zero to ten) at treatment start, discharge, 6 months and 12 months follow-up
START(135) DISCHARGE(135) 6 MONTHS(107) 12 MONTHS(95)
Pain Level
10 15.55% 0% 0% 0%
9 9.62% 0.74% 0% 0%
8 16.29% 0.74% 0% 0%
7 15.55% 2.22% 0% 2.1%
6 12.59% 0.74% 2.8% 0%
5 14.81% 8.88% 4.67% 7.36%
4 9.62% 8.14% 7.47% 2.1%
3 2.96% 8.14% 3.76% 8.42%
2 2.96% 14.81% 14.01% 6.31%
1 0% 22.96% 19.62% 18.94%
0 0% 32.59% 47.66% 54.73%
SHOULDER
Work or Sports capability at Start, Discharge, 6 months and 12 months
START DISCHARGE 6 MONTHS 12 MONTHS
Impaired 98.51% 4.44% 1.85% 3.15%
Improved 24.44% 15.74% 11.57%
Normal 1.49% 71.11% 82.4% 85.26%
One re-injured by 6 months
SURGERY
Recommended by surgeon prior to treatment 11.85%
Other potential surgical cases 57.77%
(total 69.62%)
Surgery carried out 1.48%
AVERAGE COST OF PROLOTHERAPY TREATMENT $899
COST OF SHOULDER SURGERY FOR FACILITY AND SURGEON:
Arthroscopic surgery: $7,700
Rotator cuff repair $17,000
(internet; mymedicalcosts.com)
HIP 97 CASES
Case History:
53 y/o w/f
C/O Rt. Groin pain and hip pain. 3yrs, no trauma
Pain level 8 in 0-10 scale
Pain and tightness in lateral thigh.
Groin, hip and lateral thigh pain worse after standing or walking for 5 minutes.
Worse dressing feet. Cannot flex hip over 90 degrees.
Pain increased when lying on back or left side.
Pain better when sitting or lying affected right side.
Another Dr. gave her a diagnosis of asceptic necrosis and recommended hip replacement.
EXAM
Ht. 5’7”, Wt. 158#
Stands with flexed hip and knee, cannot straighten either with weight bearing.
Tenderness anterior Rt. Hip and trochanter tendons.
Hip ROM: R/L: abd. 30/45, flex. 85/150 (w/ pain on Rt. At 40degrees), ext. minus 5/10, int. rot. minus10/30, ext. rot. 30/70.
Dx: DJD Rt. Hip, tendonitis, possible asceptic necrosis.
Treatment: prolotherapy of anterior and superior hip capsule and tendons, 8 treatments.
Result: Pain level 1-2. Resumed normal activities.
No Surgery
Hip 97 cases
· Tendinosis and bursitis————–57———–58.76%
· Degenerative arthritis—————-38———–39.17%
· Aseptic necrosis———————–1————-0.10%
· Hip injury——————————1————-0.10%
HIP PAIN LEVELS (zero to ten), at treatment start, discharge, 6 months and 12 months
follow up
START(97) DISCHARGE(97) 6 MONTHS(65) 12 Months(58)
Pain level
10 17.52% 1.03% 0% 1.72%
9 15.46% 2.06% 0% 0%
8 20.06% 4.12% 0% 3.44%
7 13.40% 4.12% 3.07% 3.44%
6 16.49% 3.09% 3.07% 0%
5 11.34% 3.09% 3.07% 8.62%
4 3.09% 7.21% 9.23% 6.89%
3 3.09% 10.30% 13.84% 5.17%
2 0% 18.55% 12.30% 12.06%
1 0% 15.48% 10.76% 13.79%
0 0% 28.86% 44.61% 44.82%
HIP
Work or sports capability at Start, Discharge, 6 months and 12 months
START DISCHARGE 6 MONTHS 12 MONTHS
Impaired 100% 13.40% 6.25% 13.79%
Improved 0% 27.83% 23.43% 15.51%
Normal 0% 58.76% 70.31% 70.68%
SURGERY
Recommended by surgeon prior to treatment 5.15%
Other potential surgical cases 40.20%
(total 45.35%)
Surgery carried out 17.52%
AVERAGE COST OF PROLOTHERAPY TREATMENT $732
COST OF TOTAL HIP REPLACEMENT FOR FACILITY AND SURGEON RANGES FROM $24,000 TO $46,000 (internet MedPath Group, Google)
KNEE 147 cases
Case history
D.M.: 46 y/o male, 20K runner and up hill bicycle racer.
C/O right knee pain
Injury of right knee on 1/6/00.
MRI report: Extensive truncation of posterior horn of the medial meniscus consistent with complex tear/maceration.
Surgery 1/18/00: chondroplasty, drilling and partial medial meniscectomy.
Surgical response: good pain reduction, poor “fluid motion” in knee, stiffness, unsteady and occasional pain. The surgeon told him that he would never run again.
May 3, 2000: first visit for prolotherapy evaluation:
Atrophy of Rt. medial quadriceps muscle. Good M-L and A-P knee
stability.
Moderate crepitation. Tender superior and inferior patellar poles.
Normal range of motion. X-ray: narrow medial meniscus, spurs on inferior and superior patellar poles.
Prolotherapy started that day. He had 15 prolotherapy treatments between 5/3/00 and 2/12/01.
He was able to run 4-5 miles each day, but decided that he could not compete in running races because the knee felt a little unsteady and he was scuffing his shoe a little.
He put all of his competitive effort into bicycle racing and did a 45 mile race after the fifth treatment. After 12 treatments, he won a bicycle hill climb championship.
The other knee was painful in March, 2001 and treatment was started on the left knee. He had five treatments on the left knee. The right knee has not needed treatment since 2/12/10.
On October 1, 2001, while continuing to run and to win bicycle championships, he had no tenderness in either knee, no crepitation in the left knee and only minimal crepitation in the right knee.
KNEE 147 cases
· Degenerative joint disease———-85———–57.82%
· Meniscus tear————————-33———–22.43%
· Sprain———————————-14————9.52%
· Collateral ligament tear————–6————-4.08%
· Chondromalacia patella————-3————–2.04%
· Cruciate ligament tear—————2————–1.36%
· Rheumatoid arthritis—————–1————–0.68%
· Post fracture—————————1————-0.68%
· Pes anserine tendinitis—————1————–0.68%
KNEE PAIN LEVELS (zero to ten), at treatment start, discharge, 6 months and 12 months follow-up
START (147) DISCHARGE (144) 6 MONTHS (121) 12 MONTHS (104)
Pain level
10 9.52% 1.38% 0% 0%
9 10.20% 0.69% 0% 1.92%
8 25.85% 1.38% 0.82% 0.96%
7 13.60% 2.08% 0% 0%
6 17.00% 1.38% 0% 0.96%
5 11.56% 6.94% 4.95% 2.88%
4 9.52% 9.02% 14.04% 6.73%
3 1.36% 9.02% 9.09% 5.76%
2 1.36% 15.97% 18.18% 16.34%
1 0% 18.05% 16.52% 11.53%
0 0% 34.02% 36.36% 52.88%
KNEE
Work or Sports capability at Start, Discharge. 6 months and 12 months
START DISCHARGE 6 MONTHS 12 MONTHS
Impaired 100% 5.44% 2.47% 2.41%
Improved 25.17% 8.96% 27.41%
Normal 69.38% 81.81% 70.16%
SURGERY
Recommended and potential surgical candidates 58.50%
Surgery carried out 9.52%
AVERAGE COST OF PROLOTHERAPY TREATMENT $833
COST OF SURGERY:
Knee replacement $35,000
A Medicare patient may have $4,257 out of pocket expenses
(Internet: costhelper.com )
Knee arthroscopic surgery $2,500 (surgeon) plus $5,200 (facility)
(Internet: mymedicalcosts.com)
SUMMARY:
Prolotherapy, using the standard solutions and method of treatment, provides a statistically significant benefit in pain relief and long-lasting improvement. It is an effective method of treating pain and weakness or instability of joints and related tendons and ligaments by treating the problem at its source. The cost of treatment is very small by comparison to other conventional and experimental treatments that are being used today. The risk of serious or permanent injury resulting from prolotherapy treatment is very small and is minimized by good training and compliance to the guidelines of safe treatment. If Medicare and the various health plans and insurance companies were truly interested in reducing the cost of medical claims, they would do well to learn the realities of prolotherapy and add it to the benefits of their policy holders.
{ 2 comments… read them below or add one }
Does any Kaiser Hosp.in Southern California do Prolotherapy? I have Senior Advantage Medicare with Kaiser——-I am 69 years old and have bone on bone and moderate Arthritis. I had Prolotherapy 5 yrs. ago at Dr. Darrow in WLA and I did receive some relief. I started having knee problems again 2 yrs. ago.I can no longer play tennis. I was told I need Total Knee replacement at Kaiser. Thank you for your reply. Kathleen OLeary
Hi Kathleen,
O’Leary…O’Neill…we know where we came from. Seriously, (not too) I came across the question you asked regarding Prolotherapy at Kaiser Southern California. Did you ever get an answer?. I do know that Dr. Braitman in Physical Medicine at the Cadillac Drive facility says he does Prolotherapy although when I went to him about head, neck, knee pain he sent me to physical therapy. I did attend a three hour lecture last night by Dr. Darrow and he demonstrated the procedure on three men who seemed to handle it very well…no outcries. I’m considering now going to him but first will explore whether or not Kaiser has any other MD’s who do “a lot” of physical therapy. My friend went to Braitman and vowed never to go to him again $5 co-pay or not…she’d rather pay for Darrow. You can telephone me at 310-809-7315.
Hope to hear from you,
Alice O’Neill
San Pedro, CA