What is Prolotherapy?
Prolotherapy is known as a complementary and alternative (CAM) method of treatment for joint and muscle pain. This CAM treatment is a series of injections of an “irritant solution” into joints or muscles. The solution, typically made of sugar, can trigger an aided growth in the connective tissue, and this can lead to less pain.1 The exact mechanism behind the effectiveness of this method of treatment is unknown. However, pain signals are no longer sent once the solution has strengthened the weakened areas.2
In general, this treatment is used when musculoskeletal issues have not been resolved through the patient’s pursuit of other types of therapies. Other names that this therapy might be known by 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 to the foreign solution. The idea is that new blood vessels will form and strengthen the injured tissue, therefore reducing pain.
Such organizations as the American Academy of Sclerotherapy and the American Association of Orthopaedic Medicine can train physicians in prolotherapy. 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 through inflammation originated in Roman times. In the 1930s, this type of therapy was used to treat “ligamentous laxity”. The injections generally contain the ingredients dextrose, glycerin, lidocaine, sodium morrhuate, and phenol. Treatments are usually given to patients somewhere between every two and six weeks over the course of several months.4 It can be used for pain management, neck pain, back pain, and for other particular applicable 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 for use in the treatment.6
Is Prolotherapy Effective?
The success rates of this treatment have been anecdotally reported to be as high as 80-90% effective. Physicians have reported cases where patients experienced 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 the skill levels of the physicians administering the solution.
Diagnosis is usually done through x-ray in order to see if the painful area is viable for this particular type of treatment.7 The point of this therapy is to provide a safer and hopefully more effective alternative to such traditional methods of treatment like 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 of therapy being investigated is growth factor injection prolotherapy.9 Generally, the pain associated with the injection itself may vary in levels depending on the solution itself, the structure or joint being treated, and the skill of the physician who is administering the injection. There may be a temporary increase in pain with mild swelling and stiffness following treatment, though this discomfort usually passes fairly quickly.
Patients might take mild pain relievers or prescribed medication for this temporary pain. It is not recommended that anti-inflammatory drugs, such as aspirin and ibuprofen, be used for pain relief as they suppress the intentional inflammation of the treatment.10 Patients are also recommended to apply ice to the area of the injection about three to five times a day for about twenty minutes for each application as needed. Moderate exercise, such as walking, is encouraged, but strenuous work or exercise, such as heavy lifting, is not. Prolotherapy injections work well with a good follow-up physical therapy program. The reduction in pain allows the patient more freedom to further treat the underlying problem without being as inhibited.11
There have been very few reports of side effects from prolotherapy. Research on prolotherapy is not extensive enough. There is the possibility of possible side effects that have yet to be discovered, and they are probably much less common. The worst known reported side effect, which has only occurred in rare cases, is the development of an infection at the site of the injection. This infection will likely be evident through fever and pain, and it is generally easy to treat with the help of antibiotics. As previously mentioned, the injection site is likely to indicate more pain than there was prior to the treatment before it begins to feel better.12