A: Prolotherapy has been around for decades. It involves injecting sugar water (dextrose), salt water (saline) or some other substance, such as platelet-rich plasma, into or around the joint. The theory is that this process creates localized targeted inflammation that leads to natural repair and joint stabilization.
A review of 10 studies in the British Medical Bulletin (June 1, 2017) concluded, “Moderate evidence suggests that prolotherapy is safe and can help achieve significant symptomatic control in individuals with OA [osteoarthritis].” This treatment usually is not covered by insurance, and out-of-pocket costs can be hundreds of dollars.
For other nonsurgical approaches to alleviating knee pain, we offer our Guide to Alternatives for Arthritis. Access to this online resource may be purchased at www.PeoplesPharmacy.com.
Q: I am a retired medical provider with a suggestion. Dry eyes are caused in part by age-related changes in our tear films. The outer oily layer thickens and blocks the meibomian glands that make it. As a result, they don’t secrete it as readily, and it’s not available to stabilize the water layer. Consequently, the tear film evaporates too easily.
Applying warm tap water compresses for three to four minutes while gently massaging the eyelids will soften those oils in the glands. Then the glands secrete more oil, which helps stabilize the tear film. The warm compresses also increase blood flow to the lids to help them heal.
This should be done three times a day for two weeks, then twice a day for two weeks, and then every morning. Artificial tears without benzalkonium can add significant relief. This takes time and effort, but in my experience it works.
A: Warm compresses are a classic treatment for dry eyes caused by meibomian gland dysfunction. You are right that when these oil-secreting glands get plugged, the tear film deteriorates.
Japanese researchers report that a warm compress containing menthol improves tear film volume and stability, and eases dry-eye symptoms (Scientific Reports, April 5, 2017). A machine that warms the eyelids and provides gentle pressure (LipiFlow) has received Food and Drug Administration approval. A single treatment can provide dry-eye relief up to a year (Clinical Ophthalmology, July 26, 2016).
One drawback of the machine treatment is expense. The office procedure can run to hundreds of dollars, while your recommended compress treatment is free.