investigational or experimental therapy with an inconclusive evidence base. Consequently, they currently do not provide coverage for prolotherapy procedures. Medicare reviewers in 1999 determined at that time that practitioners had not provided "any scientific evidence on which to base a [different] coverage decision," and so retained Medicare's current coverage policy to not cover prolotherapy injections for chronic low back pain, but expressed willingness to reconsider if presented with results of "further studies on the benefits of prolotherapy." History The concept of creating irritation or injury to stimulate healing has been recorded as early as Roman times when hot needles were poked into the shoulders of injured gladiators. In 1840, French surgeon Alfred-Armand-Louis-Marie Velpeau published a paper detailing how he had injected an iodine solution into a hernia in order to create beneficial inflammation. American surgeon Joseph Pancoast later wrote that he had been performing this procedure (using either iodine or cantharides) since 1836. Another early American practitioner of this method was George Heaton. After World War 1, sclerotherapy came to be a common treatment for malformations of blood vessels and the lymphatic system. This involved injecting a therapeutic liquid to shrink them. By the late 1920s, this method was used to treat hernias. By the late 1930s, it was also used to treat ligamentous laxity. In the 1950s, George S. Hackett, a general surgeon in the United States, began performing injections of irritant solutions in an effort to repair joints and hernias. In 1955, Gustav Anders Hemwall became acquainted with George Hackett at an American Medical Association meeting and started practicing the technique. Hackett coined the term "prolotherapy" for the practice, a very early appearance being in his 1956 book Ligament and Tendon Relaxation (Skeletal Disability) Treated by Prolotherapy (Fibro-Osseus Proliferation). References Musculoskeletal system Orthopedic surgical procedures Regenerative biomedicine Alternative medical treatments