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The DO | Patient Care | In the Field

Q&A: New DO at MSUCOM integrates prolotherapy into OMM practice

All new practicing physicians face a plethora of decisions and hurdles to clear. But those DOs who plan to practice integrative medicine confront even greater challenges, especially with regard to reimbursement and recognition.

Dr. Blakemore

Peter J. Blakemore, DO, has carved a niche for himself in MSUCOM’s OMM department, being the only DO who also does prolotherapy. (Photo courtesy of Dr. Blakemore)

One such physician, Peter J. Blakemore, DO, completed a two-year residency in neuromusculoskeletal medicine/osteopathic manipulative medicine (NMM/OMM) a year ago through the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing. Like many young DOs, Dr. Blakemore chose to become employed right out of residency, but he intends to start his own practice in the future. Staying on at MSUCOM as an assistant professor for health programs, he practices and teaches students and residents in the OMM clinic and through the NMM/OMM consultation service at McLaren Greater Lansing Hospital in Lansing.

Carving a niche for himself in MSUCOM’s Department of OMM, Dr. Blakemore is the only DO on the faculty who does prolotherapy, a process designed to alleviate musculoskeletal pain through the injection of certain aqueous solutions into ligaments and tendons. According to the American Osteopathic Association of Prolotherapy Regenerative Medicine, prolotherapy works by irritating torn or stretched ligaments and tendons, inducing inflammation that stimulates the body’s natural healing mechanisms to produce new connective-tissue fibers.

Prolotherapy, however, remains controversial in the medical community. Medicare and most private health insurers do not cover the modality, considering it “investigational.” After conducting a systematic review of the published literature on prolotherapy’s effect on low back pain, the Cochrane Collaboration found “conflicting evidence” of the modality’s efficacy. Three of the five studies reviewed by Cochrane indicated that prolotherapy alone is not an effective treatment for low back pain, while two studies reported chronic pain alleviation when prolotherapy is combined with spinal manipulation and exercise.

Nevertheless, prolotherapy is gaining adherents among MDs and DOs in the specialties of pain medicine, physical medicine and rehabilitation, and sports medicine. And the American Academy of Osteopathy (AAO) recognizes that prolotherapy can be an effective adjunctive treatment.

Dr. Blakemore’s interest in prolotherapy predates by several years his decision to go to med school. While in high school in the 1990s, he worked as a lab technician and assistant for an Oak Park, Ill., medical practice specializing in prolotherapy. Then as an undergraduate student at Bob Jones University in Greenville, S.C., he volunteered on medical missions in a rural underserved part of Illinois, working with osteopathic physicians who used both osteopathic manipulative treatment and prolotherapy to alleviate patients’ musculoskeletal problems, as well as with MDs who did only prolotherapy.

After learning more about osteopathic principles and practice, Dr. Blakemore decided that the profession’s whole-patient approach and belief in the interplay of mind, body and spirit best meshed with his own worldview. In 2008, he graduated from the University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine, a college that hosts an annual prolotherapy seminar sponsored by the AAO, in addition to having a strong OMM program. He then served a traditional osteopathic rotating internship at Samaritan Medical Center in Watertown, N.Y.

Following is an edited interview with Dr. Blakemore.

Why did you become an employed physician?

Although I want to start a solo OMM specialty practice in the future, I’m very happy to be employed by a large university. I wanted regular paychecks so I could start paying back my student loans. I also wanted time to prepare for the NMM/OMM board certification examination, which would have been difficult to do while getting a new practice off the ground. I became board certified in NMM/OMM this past December.

What’s more, my relatively regular hours allow for a personal life. I enjoy spending time with my wife and two young children while also having time for hobbies such as reading, hiking, cycling and running.

So when an employment opportunity presented itself to me at MSUCOM, when I was finishing my NMM residency, I didn’t hesitate to pursue it. I have a very high regard for the program here and the faculty. As the only DO at MSUCOM who does prolotherapy in addition to OMM, I have a distinct niche in terms of patient care and teaching.

Dr. Blakemore

“My extra training in prolotherapy sets me apart from most DOs, but it doesn’t make me more unconventional since we all to some extent are going against the grain of traditional medicine.”

—Dr. Blakemore

As part of McLaren Greater Lansing Hospital’s NMM/OMM consultation service, I’m part of a team that sees patients after cardiothoracic surgeries and gastrointestinal procedures. We use a lot of less forceful techniques on these patients since they are coming right out of surgery—myofascial release, balancing techniques, the Still technique, and rib-raising to get the rib cage working again. It depends on the patients’ overall health and mobility. We also treat many nonsurgical patients who have back pain and neck pain, using techniques to improve the healing physiology that are specific for each case.

What are the main issues you face as someone who is integrating prolotherapy into the practice of OMM?

The main challenge is obtaining needed information and education and, in turn, educating patients about prolotherapy and OMM. Second, many insurance plans don’t cover prolotherapy even when they do pay for osteopathic manipulation, so it can be difficult integrating the two modalities from a payment policy standpoint. Medicare doesn’t cover prolotherapy, and a lot of insurance companies make their decisions based on Medicare policies.

To avoid the insurance headaches, some DOs who do OMM and prolotherapy run cash-based practices. I haven’t decided what I will do yet when I go into private practice because I see the advantages of accepting insurance in terms of giving more patients access to care and building one’s practice and reputation. But like every other physician, I’m concerned about being paid for my services.

The Centers for Medicare and Medicaid Services and others consider prolotherapy too experimental. What’s your response to those criticisms?

CMS and many private insurers consider it experimental even though prolotherapy has been around for more than 60 years. Earl Gedney, DO, George S. Hackett, MD, and Gustav A. Hemwall, MD, pioneered and developed the procedure the 1940s and 1950s. The effectiveness of prolotherapy is well-documented but with small case studies, not with huge 1,000-person studies or large randomized controlled trials. Medicare did a meta-analysis of prolotherapy research more than a decade ago and concluded that there was not enough documentation to warrant payment.

Yet today, many people are turning to prolotherapy for chronic pain management. It is much less invasive and expensive than surgery and not potentially addictive like narcotic pain medication. Prolotherapy in combination with osteopathic manipulation saves money by reducing the need for surgery and pain medication. The two modalities are very helpful in addressing sports injuries and the musculoskeletal issues of aging baby boomers, among other things.

Do you consider what you do to be alternative medicine?

I prefer the term integrative medicine because it doesn’t seem to have the negative connotations that alternative medicine does. The problem is that many people in the broader medical community consider anything that is not traditional medicine to be alternative. So just by being a DO and doing osteopathic manipulative treatment, I am already practicing alternative medicine in the eyes of many people. In this part of Michigan, we aren’t considered too alternative, fortunately. At MSUCOM, we have a large clientele, and many traditional physicians refer patients to us.

My extra training in prolotherapy sets me apart from most DOs, but it doesn’t make me more unconventional since we all to some extent are going against the grain of traditional medicine.

In MSUCOM’s NMM/OMM residency program, trainees are required to at least be familiar with the technique of prolotherapy and its basis. So within the specialty of OMM, prolotherapy is recognized and respected. For more than 10 years, the AAO has sponsored CME courses in prolotherapy.

Prolotherapy is also a common modality in physical medicine and rehabilitation, pain medicine and sports medicine, embraced by both DOs and MDs in these specialties. So it is not something out there on the fringe.

Integrative medicine specialists sometimes incorporate acupuncture, herbal medicine, music therapy, yoga and other therapies into their practices. Do you use any of those modalities?

No, I’m not doing those things. But I am aware of them and in favor of them in some cases. I prefer to stick with what I’m trained in and what has worked for me.

How did you become trained in a modality that is not part of the standard osteopathic medical education curriculum?

It is crucial to spend time with experts in what you are trying to learn. I worked for a leading prolotherapy physician, physiatrist Ross A. Hauser, MD, part time in high school and intermittently after that and later served elective rotations under him while a student at UNECOM. Dr. Hauser founded and is currently the senior editor of the Journal of Prolotherapy, for which I have written several articles.

As a college student and in med school, I also assisted with prolotherapy medical missions, working with DOs who mentored me, including Timothy L. Speciale, DO, from New York state. And during my NMM residency, I spent a month training under Mark S. Cantieri, DO, an OMM specialist in Mishawaka, Ind., who uses osteopathic manipulation and prolotherapy to treat patients for musculoskeletal pain and dysfunction.

Whatever a DO’s special interests, he or she should find out who the leaders are in that area of expertise, read what they’ve written, get to know them and arrange to train under them.

When did you decide to specialize in OMM?

I went to osteopathic medical school because I like osteopathic medicine’s holistic philosophy, and I had seen firsthand how palpatory diagnosis and osteopathic manipulation can help patients. So I knew that I wanted to practice OMM and do prolotherapy. But at first, it wasn’t clear to me how to get there. I considered doing a residency in physical medicine and rehabilitation before deciding on NMM/OMM, which is a better fit for someone who wants to mostly do manipulation.

I didn’t finalize where I would do my residency until I was in my rotating internship. I was accepted into three different two-year NMM/OMM programs but felt MSUCOM’s was the best for me because of the strong teaching component of the program and the Midwest location.

Since you are currently employed by an osteopathic medical college, have you considered a long-term career in academia?

My NMM residency at MSUCOM prepared me well for academia, but I know that I want to go into private practice eventually. I see myself teaching students and residents in the future but as an adjunct faculty member of an osteopathic medical school, not as a full-time faculty member.

But for right now, I’m happy working in a big university setting. I’m able to help a lot of patients with what I do.

cschierhorn@osteopathic.org

4 Responses

  1. Michael Markou,D.O. on Sept. 8, 2012, 10:08 a.m.

    I have been integrating platelet rich plasma injections into my practice for the past 3 years now. PRP works very much like prolotherapy but involves the injection of concentrated cells, ie growth factors and ciruculating stem cells to induce the healing cycle. My patients get 70-100% relief with just one injection,although some require serial injections of 2 or 3. I also utilize OMM in conjunction with the PRP in cervical, thoracic or lumbar pain. As far as reimbursment, I do accept insurance for the omm treatments but of course have a cash base on the PRP injections.

  2. Michael Markou,D.O. on Sept. 8, 2012, 10:14 a.m.

    I do not utilize saline prolotherapy injections only because I find that the results of PRP have been successful even in patients who have had prolotherapy in the past without success. Also the injection of concentrated healing cells that will induce the healing cascade further I find is in alignment with the Osteopathic principle of the body’s innate ability to heal itself.

  3. Georgeanne Freeman on Sept. 10, 2012, 8:31 p.m.

    I love having prolotherapy in my armamentarium against pain. I use it in conjunction with OMT and bill it as trigger point injections.

  4. Prolo on Sept. 11, 2012, 10:54 a.m.

    I applaud my fellow DO for his courage, but it signals a bad omen for our future in the fight for reimbursement. Had a DO sell you a teeth bleaching treatment, a chemical peel or botox yet? It’s coming.

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