Prolotherapy is a very specific type of medical procedure. It’s an injection that targets to treat connective tissue injuries or damage in the musculoskeletal (muscle, bone, joints and nerves) especially to provide back pain relief.

What Prolotherapy Does

What it aims to do is promote a healing response in small tears and weakened tissues, with the overall goal to decrease back pain and improving function.

Prolotherapy is also called

1. sclerosant therapy,
2. sclerotherapy, or
3. regenerative injection therapy

That being said, prolotherapy is mostly used in pain management and the treatment of a number of painful conditions such as neck pains and back pains due to spine-related issues such as degenerative disc disease (DDD), sciatica, sacro-iliac issues and whiplash, to mention a few examples.

The theory behind prolotherapy is that back pain comes from the triggering and/or activation of sensitive ligaments or tendons. The basis is that this causes tissue laxity in these areas, which in turn leads to chronic pain and other illnesses such as arthritis.

When the patient undergoes prolotherapy, there is a natural healing response that begins and it starts to repair soft tissues by stimulating an inflammatory reaction (kind of re-starting the healing process). As a result, there is new blood vessel formation that can

• create stronger joints
• reduce back pain

Ancient Therapy

Interestingly, prolotherapy has been traced back to a long time ago…even ancient times. Though this is the case, it’s not a common practice in the United States and many countries because many medical practitioners consider it as alternative as compared to mainstream.

This is also because medical schools do not teach or train this particular method of pain management.

The good news is that there are more studies coming up that show’s the effectiveness of prolotherapy for back pain…but patients who are considering this treatment need to first ask their physician if they are trained and experienced in the procedure.

Note: not everyone is suitable for prolotherapy for their chronic back pains.

Who Performs Prolotherapy for Back Pain?

Like all invasive procedures, you will want someone who has both received proper training as well as have experience performing the prolotherapy procedure.

The professionals that usually can do prolotherapy for spine conditions includes:

1. physiatrists
2. anesthesiologists
3. orthopedic / spine surgeons
4. neurosurgeons

Prolotherapy Training

There are a number of reputable organizations that provide educational programs and training on prolotherapy for doctors. This includes:

1. American Association of Orthopaedic Medicine
2. American Academy of Sclerotherapy

Other organizations that may be contacted about the procedure and doctors who perform prolotherapy for back pain include:

1. International Spinal Injection Society
2. American Academy of Physical Medicine and Rehabilitation

What is Known about Prolotherapy Outcomes for Back Pain?

Prolotherapy is a procedure that stimulates and heals chronic pains and conditions.

There has been multiple reports which shows a good 80% – 90% success rates when performed by physicians who are trained in this technique, but studies haven’t been able to prove anything about back pain as of yet.

Anecdotal reports suggest improvements such as:

1. Reduction or elimination of back pain
2. Increased strength of the ligament, tendon, or joint capsule
3. Reduced recurrence of injury to the treated site
4. Improved or return to normal function

Factors that may be key for a successful outcome include:

1. Proper diagnosis of the location of the sprain or strain
2. The willingness of the patient to complete follow-up therapy
3. The clinical skill of the physician in performing the injection

Disclaimer and Warning

The most important thing to note is that no one can know for sure what happens in prolotherapy.

Unfortunately there are no objective medical evidence and none of the tissues been published as to how injection goes into painful soft tissue during the procedure (this means more research needs to be done).

What is Prolotherapy Treatment for Chronic Back Pain?

Prolotherapy is often used for chronic back pain, and what happens is that a natural irritant agent is injected using a very fine needle near/at the site of injury.

Typically this is a soft tissue be it ligament, tendon, muscle or cartilage that has been injured or torn away from the bone or joint.

The irritant agent can be either

1. Sugar (dextrose or glucose) alone or in combination with glycerin and phenol
2. Sodium morrhuate (a purified derivative of cod liver oil)
3. others

The injection will be mixed with a local anesthetic (typically procaine or lidocaine) to decrease the pain experience and increase comfort as well.

How many prolotherapy sessions (shots) do I need?

This depends on the severity and response to prolotherapy injections.

The minimum is at least 3 to 30 over a period of 6 months. So if you need more, you will be given more, if you dont, then it’d be lesser.

Recovery after Having Prolotherapy

Patients who are about to have prolotherapy may be advised to:

1. take pain killers for 1-5 days after the procedure (but it cannot be aspirin or anti-inflammatory as that will hinder the healing process)
2. do cold therapy by applying cold packs to the injection site 3 times a day for about 10-15 minutes
3. do gentle exercises such as walking (but not do strenous intensive workouts with heavy lifting)
4. physiotherapy program to support the healing by strengthening and mobilizing and even providing pain relief physiotherapy

Is there indications for prolotherapy?

There are no specific treatment guidelines or protocols (yet), currently prolotherapy is commonly used to treat back pain that’s caused by chronic ligament or tendon sprains (though some physicians use it early as well).

Note: approximately 90% of people with acute back pain get better within 6-8 weeks combined with physiotherapy and do not require additional prolotherapy treatment.

Candidates for prolotherapy might include patients with back pain who:

1. back pain is recurrent or getting worse
2. had back surgery with no or little pain relief
3. joint pain that is worse with exercise and better with rest
4. back ligament, tendon or joint pain or weakness over last 2 months
5. been on painkiller for a while

Potential Risks and Complications of Prolotherapy

Most of the risks are fairly mild such as swelling, stiffness, pain, headache – these typically disappear after 1-3 weeks at most.

In some rare circumstances, there can be more serious complications such as

• Spinal fluid leak
• Permanent nerve damage or paralysis
• Pneumothorax

Where To Next?

• Go to Home / Start
• Learn and find out more about your pains (bones, muscles, joints, tendons, ligaments, nerves etc) at Pain Conditions & Injuries
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• Contact us