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Feature Article:
Prolotherapy:
An Interview with Dr. John Panet, DC, ND
Dr. John Panet is a naturopathic doctor who has practiced in Vancouver, BC since 1998. He specializes in the treatment of chronic pain and musculoskeletal impairment. Dragon’s Medical Bulletin decided to interview Dr. Panet so our readers can benefit from his expertise on prolotherapy.
Editor: How did you first become interested in prolotherapy?
Dr. Panet: Initially, I was a chiropractor for many years, and sometimes saw patients with chronic musculoskeletal conditions that were unresponsive to conservative therapies, such as massage, acupuncture, and massage. It became my on-going interest to find out why some people would have a more permanent response to treatment and others would not. Those who were unresponsive would require an on-going maintenance program, but I always felt there was more to be learned as to why the healing wasn’t complete. Then a friend of mine developed a chronic paresthesia in his arm after a neck injury.
Conservative treatment did not help him and he was advised by an anesthesiologist to travel to the United States to receive prolotherapy, which resolved his symptoms and improved his function greatly. I was intrigued by this unfamiliar treatment and started taking courses through the osteopathic medical associations and different groups that teach prolotherapy. What I learned was that it was not only the skeletal structure that causes pain, but that the myofascial tissues, like the ligaments and muscles are also involved. Prolotherapy improves the body’s structural stability by repairing damage to the ligaments and tendons, and that improves a patient’s functional capacity, often allowing the patient to go back to work or activities without pain and with a better range of motion.
Editor: What type of conditions is prolotherapy indicated for?
Dr. Panet: Anything from a strained or sprained neck or back (secondary to a lifting injury or whiplash), sports injuries like rotator cuff or tendinosis, or any kinds of functional impairment within the musculoskeletal system.
Editor: What conditions are contra-indicated?
Dr. Panet: Generally, inflammatory joint or bone conditions like rheumatoid arthritis, cancer, metabolic bone diseases, or bone/joint infections, diabetes.
Editor: What can a patient expect after prolotherapy?
Dr. Panet: After treatment, there is usually an inflammatory phase for a few days. This is due to the solutions injected into the fibro-ossseous junction where muscle tendons or the ligaments are attached to the bone. The inflammation signals healing and allows new collagen to be produced and repair the damage.
Editor: Are there any side-effects?
Dr. Panet: The biggest thing to watch out for is the risk of infection, but if proper technique is used in prepping the patient and drawing up solutions (utilizing isopropyl alcohol and betadine), the risk of infection is quite low. It is also important to check if the patient is allergic to any of the anesthetics used.
Editor: In general, how soon can you see improvement?
Dr. Panet: Generally four to six treatments over a period of two to three months would give you a good idea as to how the patient will respond. Most people, if carefully selected and treated properly, can probably expect 85-90% improvement, if their issues are due to joint or ligament laxity.
Editor: Do you have any advice for a doctor who would like to become proficient in prolotherapy? Which courses should they take and which organizations should they contact?
Dr. Panet: The number one thing is to know your anatomy, and review it, review it, review it. It cannot be stated enough that knowledge of anatomy is the key to every successful outcome. It is also essential to understand the mechanism of injury and how it applies to that individual’s dysfunction. There are many prolotherapy courses, but I think the best ones have the pro-sections or a human anatomy portion and go through the orthopedic and functional testing. A few organizations offer basic courses that are helpful: the Hermwall-Hacket Foundation, the American Academy of Musculoskeletal Medicine, the American Academy of Orthopedic Medicine and the Naturopathic Academy of Therapeutic Injections (NATI).
Editor: How many years of practice before one can become proficient at it?
Dr. Panet: It would probably take a doctor a few years of studying anatomy, focusing on patients with musculoskeletal conditions and preceptoring with other doctors who have done prolotherapy for years. It helps to realize that you don’t know it all and continue to get more education and training.
Editor: What advice would you give to doctors who are just starting to practice prolotherapy?
Dr. Panet: The main thing is to start treating only what you are comfortable with and know the anatomy of that area of the body well. Even when done properly, the risk is still there. You should consider the possible reactions a patient may have to a procedure, and be prepared for them. Know what you are doing and know it well, because that will reduce the chance of treatment failure and liability issues. Beginner prolotherapists should probably start with the peripheral parts of the body first, like the hands, the feet, the elbows and the shoulders. And as you get more comfortable, expand to other areas of the body, but only treat to your education and experience level.
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BIO
Dr. Panet has received post-graduate medical training in prolotherapy through the American Academy of Osteopathy, The American College of Osteopathic Sclerotherapeutic Pain Management, and the University of Wisconsin (post-graduate medical continuing education). He has performed several thousand injections with positive clinical outcomes.
You may visit Dr. Panet's website at: www.prolo.ca
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