Conway McLean, DPM, Journal columnist

As America ages, the aches and pains of life become more frequent, a veritable chorus of complaints, sung daily in clinics across the land. Even the slightest injury, whether recent or decades old, has the potential to haunt us, making every step painful. Regardless of the body part, they are all susceptible to the ravages of time. And healing of damaged tissues rarely results in a structure as strong as prior to the injury.

Pain is the impetus for most visits to a healthcare provider. Understandably, pain relief is important, but masking the pain with analgesics tends to be a temporary solution. Healing is different and implies actual resolution. True healing means lasting relief. For musculoskeletal maladies, repair of the injured tissues is what’s needed, and that in turn provides lasting relief.

The lay public and healthcare providers alike are quick to label musculoskeletal pain simply as ‘arthritis.’ This term, tremendously overused, is often startlingly imprecise. Osteoarthritis is a more specific term, an actual, definitive diagnosis. On the other hand, “arthritis” simply means a joint is inflamed and nothing else. Many people suffer minor injuries, or some subtle soft tissue trauma, from which they do not fully heal. These come back to haunt us in our later years, eventually driving many older Americans to their healthcare provider.

The outcome of this accumulated trauma is the development of chronic pain. Also, our connective tissues weaken subtly, gradually, over time. The minor variations in skeletal architecture most humans are endowed with cause subtle stressors to many components of our body parts, specifically those allowing bi-pedal weight bearing (the amazing feat of full time upright posture, standing, while perched on two legs).

When any of the joints, tendons, ligaments, or sundry such structures involved in stance and gait, wear out or become symptomatic, the response of many practitioners is to relieve pain, a desirable goal, but too often, little else is done. The number of people surviving on anti-inflammatory medications taken daily, consistently, on a yearly basis, is frightening. Especially in light of the latest research revealing their prolonged use may change an injury, lending it to becoming chronically inflamed, changing the nature of the injured tissues.

Pain relief is not the same as healing. Healing consists of tissue repair, which usually includes relief. Pain can be relieved in any number of ways, from counterirritants like the topical menthol products, to your generic, over-the-counter acetaminophen, the ever-popular Tylenol. But these are only temporary measures, benefits counted in hours. Opioids were heavily promoted decades ago, effective as they are for relieving pain, but we now know better the dangers of long term use.

If pain continues, steroids are often administered in some fashion. These ubiquitous drugs are prescribed on a daily basis having the basic function of reducing inflammation. The root of many auto-immune disorders (e.g. rheumatoid arthritis) is inflammation, which is out of control, effectively treated with steroids. But is this really optimal when healing requires acute inflammation in many situations, as part of the complex chain of events leading to repaired tissues.

The acute type of inflammation is seen when someone sprains their ankle, with the characteristic redness, warmth, swelling, and pain noted. This is very different from chronic inflammation, whereby the suffering individual experiences pain most days, and for many months, with little outward sign there is a problem. The differences are tremendous to millions of Americans.

Regenerative medicine is a newer approach, and refers to the goal of regenerating healthy, new tissue. These techniques, of which there are a growing number, harness the power of stem cells. These are a unique cell that can form any new cell type, be it skin, muscle, bone, nerve. These methods are being used daily all across the country, to treat even old injuries, arthritic joints, with excellent success. These therapies have the potential to revolutionize medicine.

Surprisingly, one technique has been practiced well before we developed the concept of regenerative medicine. Prolotherapy (shortened from the word “proliferation”) has been in use for musculoskeletal medicine for three-quarters of a century. Its success revolves around the concept that acute inflammation is part of healing, an idea only recently accepted into general practice. Prolotherapy is a non-surgical technique, in which a substance is injected into the injured area, and it acts to stimulate acute inflammation, in effect, jump-starting the process of healing.

The benefits of prolotherapy are many, not least of which is the lack of side effects and complications. Because the liquid injected is not a drug but a naturally occurring material, there can be no drug-to-drug interactions. Most studies were done with three injections total, typically a few weeks apart. The results are not immediate since it leads to the gradual process of healing, which doesn’t occur overnight.

Our healthcare system seems happy to prescribe medications for the symptoms you’re experiencing, resulting from the prior drug you were given. Have pain in a joint or extremity, there’s certain to be pill to alleviate it. But answers are harder to arrive at, and covering up the problem does not often lead to resolution.

Healing of some chronic, haunting injury may seem challenging to achieve. But these new approaches seem able to do just that, producing a stronger tendon, maybe even growth of new cartilage. The promise of regenerative medicine is considerable, perhaps improving the fitness of America by allowing more seniors to walk better painlessly. It might serve to reduce the GI bleeds and heart disease resulting from years of anti-inflammatory meds.

The proof is in the performance of clinical trials, which cost millions. Only small scale research has been performed to date on prolotherapy, and the results exciting. But who will fund these expensive trials? Certainly not the drug companies who stand to lose billions. Regardless, knowledgeable physicians utilize this method regularly to achieve startling results in the treatment AND resolution of numerous acute and chronic painful problems of the musculoskeletal system.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.