Prolotherapy – Types, Mechanism and Uses

What is Prolotherapy?

Prolotherapy is a procedure where the non-pharmacological and non-active irritant solution is injected into the body for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.

Prolotherapy is claimed to repair the weakened sites and produce new fibrous tissues.

Other names are

• Proliferation therapy
• Regenerative injection therapy
• Proliferative injection therapy

Types of Prolotherapy

Growth factor injection

In this procedure, a growth factor is injected which affects the growth of a certain cell line (For example injection of erythropoietin to increase red blood cells)

Growth factor stimulation

In this procedure, a substance that causes the body to produce growth factors is injected. Humans cells exposed to as little as 0.3% dextrose produce growth factors such as platelet-derived growth factor, transforming growth factor-beta, epidermal growth factor, basic fibroblast growth factor, and connective tissue growth factor.

Inflammatory

This involves the injection of a substance that causes activation of the inflammatory cascade to produce growth factors. Examples of solutions in current use are 12.5%-25% dextrose, phenol-containing-solutions, and sodium-morrhuate-containing solutions. Sodium morrhuate is the sodium salts of the fatty acids in cod liver oil

Solutions commonly used are

• Dextrose
• Lidocaine
• Phenol
• Glycerine
• Cod liver

How Does It Work?

Prolotherapy is claimed to work by re-initiating the inflammatory process that deposits new additional fibers to repair a perceived injury and strengthen the area so that it no longer sends the pain signals.

Multiple sessions may be required given every3-6 weeks.

Uses

• Arthritis
• Back pain
• Neck pain
• Fibromyalgia
• Sports injuries
• Carpal tunnel syndrome
• Chronic tendonitis

Contraindications

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

Special Note

There is no concrete scientific evidence available on the effectiveness of prolotherapy. Recently a systematic review has hinted that prolotherapy is effective in Tennis Elbow.

References

• Wikipedia
•  Reeves, K.D. and K. Hassanein. Randomized prospective placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumbs and finger (DIP, PIP and Trapeziometacarpal) joints: Evidence of clinical efficacy. Jnl Alt Compl Med, 2000; 6(4): 311-320
• Ongley, M.J., et al. A new approach to the treatment of chronic low back pain. Lancet, 1987; 2: 143 – 146.