Prolotherapy

Prolotherapy is a controversial regenerative medicine treatment aimed at causing irritation or minor damage to tissue with hope of stimulating the body’s healing mechanisms. During this treatment, small amounts of an irritant solution are injected at the site of painful and degenerated tendon insertions, joints, ligaments, and adjacent joint spaces during several treatment sessions to promote the growth of normal cells and tissues. Irritant solutions used for prolotherapy often contain highly concentrated dextrose. More recently, autologous cellular solutions, such as platelet-rich plasma (PRP), bone marrow, or adipose tissue, are also being used.

Prolotherapy remains unproven at present. Studies show that it offers modest pain relief, but many experts say evidence of its effectiveness and safety is still lacking. A recent systematic review and meta-analysis published in the clinical journal of orthopedic trauma by Wee and his colleagues (2021 May 20;19:108–117) concluded prolotherapy in knee osteoarthritis confers potential benefits for pain, but the studies had a high risk of bias. Based on two well-designed studies, dextrose prolotherapy may be considered for knee osteoarthritis (strength of recommendation B). This treatment is safe and may be considered for patients with limited alternative options (strength of recommendation C).

Similarly, a recent publication in the Journal of Back and Musculoskeletal Rehabilitation by Hauser et al. (2022;35(4):701–712) concluded that non-biologic prolotherapy or cellular prolotherapy, including platelet-rich plasma (PRP), can be beneficial in restoring spinal stability and resolving chronic low back pain.