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.


Prolotherapy involves the injection of an irritant solution into a joint space, weakened ligament, or tendon insertion to relieve pain. Procedure is frequently done under ultrasound guidance to view the structures. Although procedure is tolerated by most easily, you may be offered light sedation. Treatment sessions are generally given every two to six weeks for several months in a series ranging from three to six or more treatments. Many patients may need treatment at less frequent intervals until treatments are rarely required, if at all.


Risks and complications of kyphoplasty may include:

Contraindications for patients to receive prolotherapy injections may include:

  • Local abscess
  • Bleeding disorders
  • Patient on anticoagulant medication
  • Known allergy to prolotherapy agent
  • Acute infections such as cellulitis
  • Septic arthritis

Relative contraindications include:

  • Acute gouty arthritis
  • Acute fracture

Side Effects

Reported side effects are generally mild and temporary

  • mild pain and irritation at the injection site (often within 72 hours of the injection)
  • numbness at the injection site
  • mild bleeding
  • lightheadedness
  • allergic reactions to the agent used
  • bruising
  • infection
  • nerve damage

Credits & Sources:

  1. PubMed
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