Prolotherapy - Abdi Waluyo Hospital

Written by: dr. Alexandra Francesca Chandra, MRes

Prolotherapy is an injection therapy using a natural irritant solution, most commonly hypertonic dextrose, for chronic musculoskeletal injury. Basically, the injections of small volumes of an irritant solution at multiple painful points (such as ligament and tendon insertions, and in joint spaces) will trigger a local healing process in the injected area. The term prolotherapy comes from an injection therapy called proliferant therapy which was commonly used in 1950.^1,2

Purpose of Prolotherapy

Prolotherapy is meant to reduce joint pain by injecting a natural irritant solution that induces a local healing reaction in the injected area. This irritant solution functions not only as nutrition but also as a trigger to bodyâ€™s natural capability to repair the damaged tissues.^1-3

Safety and Effectiveness of Prolotherapy

Several studies have confirmed that prolotherapy is a safe alternative to manage joint pain, other than medications. It can also be used in some medical conditions when it is not severe enough that surgery is necessary.^2,3

Many studies showed that prolotherapy is effective in reducing joint pain as it repairs / strengthens the joint tissues. Because prolotherapy relies on the natural capability of the body to heal / regenerate itself, it is believed to improve joint stability and permanently repair joint functions. This is what differentiates prolotherapy from painkillers since painkillers are only temporary.^1-3

Medical Conditions Suitable for Prolotherapy

Several joint-related complains that can be treated with prolotherapy include:^2,3

Low back pain
Hip pain
Knee pain
Shoulder pain
Other joint / ligament pain

The followings are some medical conditions commonly treated with prolotherapy:^2,3

Knee osteoarthrosis
Tennis elbow
Tendonitis (inflammation of the tendon)
Rotator cuff injury
Arthritis

Mechanism of Action of Prolotherapy

Prolotherapy involves an injection of irritant solution (like hypertonic dextrose) to the targeted joint area that cause pain. After the injection, this solution will induce a temporary inflammatory reaction in the area. The activated inflammatory cells will come to the injected area and cause a chemical reaction that leads to new cell growth and repair of the damaged joint / tendon / ligament. Along with the tissue repair (healing) process, the joint / tendon / ligament will become more stable and stronger, hence the pain disappears. Thus, a precise injection is crucial in prolotherapy so that it directly targets the area that need the most repair.^1-3

The Procedure of Prolotherapy

Before prolotherapy, a doctor will firstly evaluate the patient. Patients with joint pain due to chronic disease that has reached a certain level of severity may not be suitable for prolotherapy and may be advised to take other alternative therapies. The doctor will perform a physical examination of the joint and evaluate the joint in question with appropriate imaging, such as an X-ray / CT scan to assess its location and severity.

If prolotherapy is recommended, the patient should stop taking anti-inflammatory drugs, both steroids (eg prednisone, methylprednisolone) and non-steroids (eg aspirin, ibuprofen, diclofenac, celecoxib) for 2-3 days before the procedure. This is because these anti-inflammatory drugs can inhibit the effectiveness of prolotherapy.⁴

The prolotherapy procedure begins with sterilization of the injection site with an alcohol swab or other sterile cleaning fluid. Then, hypertonic dextrose solution is injected into several points targeting the joint gaps, tendons, and ligaments that are affected. This procedure can also be performed with ultrasound guidance so that the injection site is more precise.

Frequency of Prolotherapy

The frequency of prolotherapy varies depending on the abnormality / disease and its severity. In general, prolotherapy can be done in about 5 to 6 sessions with an interval of 1-2 weeks between injection sessions. In one session, doctors usually perform several injections at different points around the target joint area. The number of these points depends on how large the area of the affected / abnormal joint.

Side Effects of Prolotherapy

The solution injected is dextrose, so the side effects are minimal as it rarely interacts with other drugs that the patient may be taking. Even if the odds are low, here are some possible side effects:⁴

Infection at the injection site
Swelling / pain / redness in the injection site immediately after the procedure
Fever (if infection occurs)

It is possible for temporary side effects (e.g. swelling/pain) to occur immediately following the procedure, so the affected joint may feel worse before beginning to feel better.⁴

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References

Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, et al. Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial. Ann Fam Med [Internet]. 2013 May 1;11(3):229 LP â€“ 237. Available from: http://www.annfammed.org/content/11/3/229.abstract
Distel LM, Best TM. Prolotherapy: A Clinical Review of Its Role in Treating Chronic Musculoskeletal Pain. PM&R [Internet]. 2011 Jun 1;3(6S):S78â€“81. Available from: https://doi.org/10.1016/j.pmrj.2011.04.003
Reeves KD, Sit RWS, Rabago DP. Dextrose Prolotherapy: A Narrative Review of Basic Science, Clinical Research, and Best Treatment Recommendations. Phys Med Rehabil Clin N Am. 2016 Nov;27(4):783â€“823.
Fletcher J. What is prolotherapy and what is it used to treat? Medical News Today. 2017 Dec 17;