Prolotherapy is a complementary and alternative (CAM) treatment for joint and muscle pain.
What is Prolotherapy?
Prolotherapy is a CAM treatment that is a series of injections of an “irritant solution” into joints or muscles. The solution, typically sugar, can “trigger growth in the connective tissue”, and this can lead to less pain.1 The exact mechanism behind this treatment is unknown; however, pain signals are no longer sent once the weakened areas are strengthened.2 In general, this treatment is used when musculoskeletal issues have not been resolved through other therapies.
Other names for this therapy are “sclerosant therapy, sclerotherapy, regenerative injection therapy, “proliferative” injection therapy and nonsurgical ligament reconstruction”. The solution is injected into the soft tissue, and natural healing is thought to occur as a result of the inflammatory response. The idea is that new blood vessels will form and strengthen the injured tissue, therefore reducing pain. Physicians can be trained in prolotherapy by such organizations as the American Academy of Sclerotherapy and the American Association of Orthopaedic Medicine. Medical doctors who receive the training include physiatrists, orthopedic surgeons, anesthesiologists, neurosurgeons, and osteopaths. Other groups involved with this treatment are the American Academy of Physical Medicine and Rehabilitation and the International Spinal Injection Society.3
What is it Used For?
Historically, it is thought that the idea of irritating or injuring an area in order to promote healing originated in Roman times. In the 1930s, type of therapy was used to treat “ligamentous laxity”. The injections generally contain dextrose, glycerine, lidocaine, sodium morrhuate, and phenol. Treatments are usually given “every two to six weeks for several months”.4 It can be used for pain management, neck pain, back pain, and for particular conditions, such as sciatica, whiplash, sacroiliac issues, and degenerative disc disease.5 There are a few types of this CAM treatment, including Platelet Rich Plasma Prolotherapy (PRP), Dextrose Prolotherapy, and Biocellular Prolotherapy. The latter takes adult stem cells from the patient’s body.6
Is it Effective?
The success rates of this treatment have been anecdotally reported to be as high as 80-90% effective. Physicians have reported improvements in back pain, reduction in injury recurrence, and increased ligament, tendon, and joint strength. Success seems to be based on proper diagnosis, follow-up therapy compliance, and physician skill levels.7 The point of this therapy is to provide an alternative to cortisone shots, NSAIDs, arthroscopy, and narcotics.8 According to the American Association of Orthopaedic Medicine, “Inflammatory prolotherapy will likely be the most cost effective form of prolotherapy“. Another type being investigated is “growth factor injection prolotherapy”.9