Prolotherapy is a controversial technique for reducing soft tissue related pain. Prolotherapy uses a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.
Prolotherapy was initially described by Hippocrates when treating soldiers with shoulder injuries. Hippocrates would insert a hot poker into the shoulder joint and felt that this stimulated healing.
Dextrose solutions are intended to stimulate production of connective tissue. Supporters feel that these treatments restore strength and stability to ligaments and joints.
The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. This improved connective tissue texture may relieve pain. Prolotherapy has been used to treat a number of painful musculoskeletal conditions, such as osteoarthritis and chronic back pain. A typical course of treatment is six to 10 sessions, sometimes with multiple injections at each session.
Prolotherapy is known to cause some pain at the injection site, but this is typically mild and temporary. As with any injection, there is a risk of infection, bruising, bleeding or tissue damage. Theoretically, nerve damage is also possible but has not been reported.
The response to treatment varies from patient to patient. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. Prolotherapy is often combined with other types of treatment such as massage, physical therapy or joint manipulation.
A number of studies using prolotherapy have reported conflicting data regarding its effectiveness in treating chronic pain. Some studies have shown a benefit while others have not.
Different practitioners use different types of solutions, so not all forms of prolotherapy are the same. As a result of this variability, the possible effectiveness of prolotherapy remains unclear.
Because it is invasive, patients may want to consider other options such as ultra high frequency electrical stimulation (available at the Arthritis and Osteoporosis Center of Maryland), laser, or even Botox prior to prolotherapy.
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