Integrated medicine is an innovative concept that combines two approaches to medicine:

• the conventional one and
• that of selected complementary therapies such as osteopathy, craniosacral therapy, phytotherapy, homeopathy, traditional Chinese medicine, acupuncture, prolotherapy but also bioenergetic nutrition, psychotherapy and others.

It should not be confused with alternative medicine but stands beside modern diagnostic tests and classical medicine, without replacing it. Attentive to the topic of traditional medicine, the World Health Organization itself, after a previous study during the period 2002-2005, reintroduced a strategy for the period 2014-2023 for the development of traditional and complementary medicine, reaffirming its importance.

One of the strong points of integrated medicine is to consider the person as a whole and not to place the disease at the center of the treatment, while treating it, but the person as a whole.

Indeed, as PNEI (psycho-neuro-endocrine-immunology) teaches us, the assimilation of thousands of signals from our various organs and systems connected to each other is constantly achieved in our body. In this complex system, the disease can be seen as a process, with different stages, that the doctor must recognize by organizing the interventions according to the uniqueness of the person in front of him.

Based on this new scientific evidence, integrated medicine aims to offer a personalized, more complete and effective treatment plan.

Phytotherapy refers to the practice that involves the use of plants, or their extracts, for the treatment of diseases or for the maintenance of psychophysical well-being and is probably the oldest and most widespread way of human care.

According to a definition by the World Health Organization (WHO), a medicinal plant is considered to be any vegetable that contains substances that can be used for therapeutic or preventive purposes, or that are forerunners of pharmaceutical synthetic products. In fact, the drugs that are used today derive in large part from vegetable substances or have in any case been developed from them.

By analyzing the use of phytotherapy, WHO has distinguished three different areas of use: POPULAR, TRADITIONAL and MODERN.

• in the POPULAR use of plants there are no scientific data to prove their effectiveness, it is based on information collected on the field for anthropological research or from unofficial pharmacopeias or other texts
• TRADITIONAL use involves medicinal substances widespread in many countries around the world, which are found in the pharmacopeias of various countries; there are also substances based on basic pharmacological studies that make their effect plausible
• in MODERN phytotherapy, herbal substances are used with therapeutic indications recognized in many countries and supported by clinical studies, reported in international literature, which prove the effectiveness of a particular plant with respect to certain problems or diseases

Herbal meds are evaluated for their quality, safety and therapeutic efficacy properties, in the same way as all other drugs and must therefore be officially approved by the Italian Medicines Agency, the national authority responsible for the drugs control in Italy.

For an appropriate use of phytotherapy it is necessary to contact qualified operators and use good quality products, but it is also important that the patient always informs his doctor if he is taking herbal medicines, because there may be side effects resulting from the combination of herbal medicines and drugs.

Knowledge of the effectiveness and safety of herbal medicines, their mode of action and toxicity, is essential for a correct prescription.

Phytotherapy can be employed as an integrative medicine to support the conventional one, both as prevention or as treatment of different issues.

HISTORICAL BACKGROUND

Prolotherapy, aimed at the treatment of musculoskeletal disorders, was born in the 40s with the first documented cases by Dr. George Hackett, an expert in emergency surgery, traumatology and rehabilitation and pioneer of this technique, with more than 10,000 patients treated and success rates of over 80%. Doctor Gustav Hemwall, his student, began practicing prolotherapy under the teaching of Hackett in the early 1950s. To him, we owe the first research and the merit of having first classified the protocols of use and having perfected the technique of execution.

Although not well known, prolotherapy has for years been part of the therapeutic options proposed in numerous authoritative textbooks in the field of pain therapy and sports medicine. It is also included in the training courses of many graduate schools in sports medicine, physiatry and orthopedics in the United States.

In a monograph published in the indexed journal Physical Medicine and Rehabilitation Clinics of North America, infiltrative therapy with dextrose was included together with PRP (Platelet Rich Plasma) in the group of regenerative infiltrative therapies. The changes in tissue echogenicity, documented in several studies, demonstrate the ability to stimulate the physiological healing of connective tissue, accelerating and promoting the physiological stages of inflammation and tissue remodeling.

DESCRIPTION OF THE PROCEDURE

Prolotherapy derives from the English acronym proliferative therapy – prolotherapy and can also be defined as regenerative infiltrative therapy – Regenerative injection therapy (RIT). It is a method that belongs to the chapter of Regenerative Orthopedic Medicine. It is an infiltrative therapy employed for the treatment of chronic musculoskeletal pain associated with sprain trauma (capsular and ligament injuries up to the second degree) and tendinopathies (with and without partial lesion obviously if there is no surgical indication).

Recent studies extend the use of therapy not only at the peri-articular level but also in intra-articular treatment, representing a valid alternative to the most common therapies. It consists of dextrose infiltrations (or glucose, the solution commonly used in Italy) at concentrations ranging between 15% (extra-articular) and 25% (intra-articular) associated with local anesthetic (lidocaine or analog) and with a frequency of treatment varying between 2 and 3 weeks. The infiltration of substances with a hyperosmolar concentration is able to stimulate a low-grade inflammatory response in the treated tissues, and a consequent biochemical cascade favorable to the healing and regeneration of the damaged structure in the weeks following the treatment.

Prolotherapy induces, as a final biological pathway, the repair of lesions by depositing new collagen. The potential of prolotherapy to stimulate the release of growth factors, promoting the healing of soft tissues, has also been suggested as a possible mechanism and there are studies to support this theory: in vitro studies have in fact proven the ability of dextrose to stimulate the release of growth factors by mesenchymal cells by activating the genes that codify for growth factors by means of a transduction mechanism of the physicochemical signal (think of the osmotic effect of glucose on the cell wall) already within 20 minutes of exposure to glucose concentrations of 0.45% (in physiological conditions the basal levels are around 0.1%). In tendinopathies, an associated mechanism of action could be the sclerosing effect on the pathological microcirculation that is formed during the degenerative process through neoangiogenesis.