Advances in Regenerative Medicine: High-density Platelet-rich Plasma and Stem Cell Prolotherapy For Musculoskeletal Pain

October 2011 | Practical Pain Management rolotherapy is a method of regenerative injection treatment designed to stimulate healing.1 Prolotherapy is used for the treatment of chronic musculoskeletal pain, inclucing ligament, tendon and joint injuries, as well as osteoarthritis. The term prolotherapy is short for proliferation therapy, as it stimulates the proliferation and repair of injured tissue. Traditional dextrose prolotherapy originated in the 1930s and continues to be used successfully. In the 2000s, inoffice platelet-rich plasma (PRP) prolotherapy was introduced. This method uses a patient’s own blood, centrifuged to concentrate growth factor–rich platelets as the proliferation formula. In the past few years, physicians have began using adult stem cells, harvested from an individual’s fat tissue or bone marrow during an in-office procedure, then combined with the individual’s PRP as the proliferation formula for injection into injured musculoskeletal tissue. This newest form of prolotherapy, known as stem cell prolotherapy, is used in difficult cases or where accelerated musculoskeletal healing is desired. Popular media reports have been emerging that cite the use of stem cell prolotherapy in professional athletes such as Bartolo Colon, starting pitcher for the New York Yankees, who had the procedure successfully done for a rotator cuff injury earlier this year.2 Our article will review the history, science, methodology, and evidence for these types of prolotherapy, and offer a treatment algorithm.