Prolotherapy

A complementary medical approach for treating many types of musculoskeletal pain that involves injecting substances that promote tissue proliferation into tendons and ligaments. The approach has been touted for treating arthritis, back pain, neck pain, fibromyalgia, sports injuries, whiplash, carpal tunnel syndrome, tendinitis, torn tendons, ligaments, and cartilage, herniated disks, and sciatica.

According to proponents of prolotherapy, its use dates back to 400 BC, when the Greek physician Hippocrates used it to treat soldiers and athletes with dislocated or torn shoulder joints. He would stick a hot poker into the joint, scar tissue would develop, and the shoulder would end up stronger. In its modern-day manifestation, prolotherapy involves injecting an “irritant” solution — often dextrose, or a combination of dextrose, glycerin, and phenol — into ligaments. These injections are believed to trigger a benign inflammatory process that promotes the growth of new, healthy tissue.

Recently-reported research on the effectiveness of prolotherapy has been conflicting and inconclusive. A study reported in the March 2000 issue of Alternative Therapies in Health and Medicine evaluated prolotherapy in people with osteoarthritis (OA) of the knee. After 12 months (6 injections) of prolotherapy, the researchers found a 44% decrease in knee pain, a 63% decrease in swelling complaints, an 85% decrease in the frequency of knee buckling, and a 14-degree increase in the knee’s range of movement. X-rays also suggested improvement in the severity of OA. In a study reported in the December 1999 issue of Rheumatology, three once-weekly prolotherapy injections failed to effectively treat individuals with chronic back pain. And in a systematic review of the effects of prolotherapy on low back pain published in the October 2004 issue of Spine, researchers found conflicting results after pooling data from studies that compared prolotherapy with “control” injections, either alone or in combination with other treatments. They pointed out that the conclusions were confounded by the differing techniques employed and the use of other treatments. There was no evidence that prolotherapy injections were any more effective than control injections when used alone — but prolotherapy seemed to have some advantage when the injections were combined with other treatments.

People typically have pain and swelling at the injection site for 2–3 days following prolotherapy. While the approach is generally safe, there are potential risks, including nerve damage and inflammation, so anyone considering prolotherapy should find a practitioner skilled and experienced in its use. The practitioner should have training in the technique and should be a medical doctor (MD), doctor of osteopathy (DO), naturopath (ND), or a physician’s assistant (PA) working under a doctor’s supervision. Although some insurance companies cover prolotherapy, Medicare does not.

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts.

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