Ilker Solmaz

Pain is a symptom caused by a disease process and/or tissue injury. With the prolongation of life expectancy in humans, the incidence of degenerative joint diseases and as a result pain has increased. Unfortunately, a method of treatment that stops or reverses progression by affecting the pathogenesis in these diseases has not been developed. Physical therapeutics such as medicine and physical rehabilitation often are prescribed for patients suffering with pain. Recently, in addition to these routine therapies used in pain treatment, many regenerative injection-based therapies, including prolotherapy (PrT) or platelet-rich plasma (PRP) have been widely used. PrT is using for damaged or degenerated connective tissue healing, such as ligaments, tendons, and cartilage. The combination of local inflammatory effect, stimulation of local growth factor release, and down regulation of neuropathic inflammation can be defined as the mechanism. As a result of these, joint instability and ligament laxity reduce and pain decrease. PRP is the cellular component of the plasma. Although PRP is used for the same reasons as PrT, it can be used in acute cases unlike PrT. This chapter is intended to understand the use of regenerative injection therapies (PrT and PRP) better in the treatment of pain.

Introduction: This case report aims to discuss the clinical and radiological outcomes of prolotherapy at a patient whom to total knee prosthesis had been planned but surgery couldn’t be performed due to co-morbidities. Case Presentation: A 72 year old woman presented with severe pain at her knees for over 5 years. Treatment methods include weight loss, decreasing the weight bearing on the joint, stretching exercises, nonsteroid anti-inflammatory and steroid drugs, and physiotherapy. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was applied to measure the osteoarthritis level of the patient: Pain level; 25 points, stiffness level; 10 points, Physical function loss; 80 points, and total WOMAC 115 points. At radiological evaluation, the patient was diagnosed as grade IV osteoarthritis due to significant osteophyte presence and complete joint space narrowing. Six sessions of knee prolotherapy protocol was applied to the patient, one session monthly. Conclusions: Significant improvement was noted at WOMAC scale (Pain level; 5 points, stiffness level; 2 points, Physical function loss; 15 points, and total WOMAC 22 points). Osteoarthritis level of the patient was improved to grade I at radiological evaluation after a year. Our case is the report that presents radiological evidence in addition to clinical findings of improvement of osteoarthritis level. As a result of this case report, further studies aiming to offer a different minimally invasive treatment option to the patients before surgery may be performed. We are in the opinion that prolotherapy may be preferred more commonly as an efficient method once the importance of ligamentous structures at pathogenesis of osteoarthritis is established. Keywords: Osteoarthritis, Knee; Degeneration; Treatment

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.