Introduction to Prolotherapy

What is prolotherapy?

Prolotherapy is an injectable solution usually made up of a sugar compound, a local anesthetic, distilled water and specific vitamins and minerals. The physician injects the solution directly into an area that needs more healing or stability. Often times, past injuries or surgery never fully heal or just don’t heal correctly. When the fluid solution is injected, the sugar compound, usually dextrose, irritates the area just enough to cause a small inflammatory response. The body brings a fresh blood supply through increased circulation with nutrients to the agitated area so healing can begin. The sugar is easily absorbed by the cells into the body and the new cells are already in the area ready to restart some of the healing process toward the old injury. Prolotherapy works best and is most often used in joints and joint areas.

What treatments look like

First, the doctor will examine the area that may need additional healing or strengthening. Most people complain of pain in areas that didn’t heal correctly because the tissue is still damaged or the miss-healed tissues are not allowing the joint to work properly. Keep in mind, joint areas that didn’t heal fully are not necessarily painful, they might just be loose. The physician I worked with, Dr. Amber Belt, would examine how loose the joint is and then test to find the tenderer and painful points marking them with pen. She then mixes the solution in a rather large syringe. In joints, she injects dextrose, the sugar, and lidocaine, the local anesthetic. In more fleshy areas, her solution consist of dextrose, lidocaine, distilled water, and vitamin B-12 -- which she has found helps tissues heal. With a needle long enough for the area of treatment, she injects the solution deep into the most painful and loose points of the area. The injection time only lasts a few seconds, and the patient is quickly out of pain. For ideal outcomes, treatments are suggested to take place every two to six weeks until the area is healed. Depending on the patient and their situation, treatments may last a few months, or indefinitely, as in the case of pain relieve for arthritis or other causes of chronic pain.  Treatment is as individual as the patient and his or her pain they he or she are seeking relief for.  

Side effects

The doctor should first make sure the patient isn’t allergic to anything in the injection solution. This is highly unlikely, unless the patient knows specifically that they are allergic to local anesthetics like lidocaine. The injections can be particularly painful but tend to be less painful the more the procedure is done and as the area heals. Immediately after the injection, the local anesthetic begins to numb the area. Though the area is “numb”, it will often feel achy and “squishy”. The “squishy” sensation is especially noticeable inside the joint where it is filled with fluid that would not normally be there. In the day or two following, most people find the area particularly sore. After the soreness subsides, the area seems to returns to what the condition was before. The aimed effects of the treatments are not usually noticeable for a few months of persistent treatment. Prolotherapy should not worsen the condition or cause permanent harm.

Intended outcomes

Since the treatments I witness didn’t immediately relieve pain, I wasn’t quite sure what I was looking for to tell if this was a viable way to relieve pain. At first when I heard that the solution had a local anesthetic, I thought that must be the relief causing variable in this type of treatment. Though the local anesthetic does relieve some pain, it is intended for the discomfort of the injection and the hours following. After enough treatments, the healed tissues that used to send alarm pain signals to the brain no longer have to. This type of treatment takes time and patience and won’t give most people that quick relief that some are seeking. This type of treatment, in time, will help heal and relieve pain for the long-term in some cases. Prolotherapy is not ideal for acute injuries; there is no use to remind the body of a new injury. Many patients find it successful in treating old injuries and as an alternative to surgery. As I talked to patients early on in their treatment program, they weren’t noticing the positive effects immediately; the majority of these patients, however, remained hopeful and patient, knowing their healing and relief would come in time. As I talked to the patients well into their treatment plans, I asked what they had noticed change in their body and how they could tell if the prolotherapy had been successful. Common answers included increased range of mobility without pain, delayed onset of pain, and fewer sharp pain episodes. The further the patient was along in their treatment plan, it seemed the more promising and positive the results became. Over and over again I heard stories of people not only avoiding surgeries such as total knee replacements, but also being pain-free and able to move in ways they had not moved in many years, sometimes even decades. The positive outcomes are across the board. I am currently in the process of evaluating literature and writing a systematic review to help fully conclude the effects of prolotherapy.

Prolotherapy can help treat pain and range of motion associated with arthritis, old injuries, trigger finger, and carpal tunnel. Almost all joint and joint areas can be treated with prolotherapy according to Dr. Belt; hips, knees, feet, shoulders, and even fingers can be treated. Prolotherapy can be more successful in some cases if it is accompanied with physical therapy for that targeted area.