Prolotherapy Review: Appropriate Use, Types, Effectiveness and Costs

Prolotherapy using dextrose and platelet-rich plasma (PRP) are two regenerative injection therapies used to treat chronic musculoskeletal pain and injuries. While both aim to stimulate the body’s natural healing processes, they differ in their composition and mechanisms of action.

Dextrose Prolotherapy

Dextrose prolotherapy involves injecting a sugar-based solution, typically containing 12.5% to 25% dextrose, into damaged or weakened connective tissues[1]. The mechanism of action is thought to involve:

1. Initiating a local inflammatory cascade
2. Triggering the release of growth factors
3. Promoting collagen deposition
4. Strengthening connective tissues
5. Improving joint stability

Dextrose prolotherapy is generally less expensive than PRP and typically requires 4-6 treatment sessions[2]. It has been used to treat a wide range of musculoskeletal conditions, including osteoarthritis, tendinopathies, and ligament injuries.

Platelet-Rich Plasma (PRP) Therapy

PRP therapy utilizes a concentration of the patient’s own platelets, which are rich in growth factors and other bioactive proteins[2]. The process involves:

1. Drawing the patient’s blood
2. Centrifuging to isolate and concentrate platelets
3. Injecting the platelet-rich solution into the affected area

PRP is believed to enhance healing by delivering a high concentration of growth factors directly to the injured tissue. It typically requires fewer treatment sessions (2-4) compared to dextrose prolotherapy but is generally more expensive[2].

Comparative Effectiveness

Research comparing the two treatments has yielded mixed results:

1. For osteoarthritis, some studies suggest that both dextrose prolotherapy and PRP can improve functional outcomes and reduce pain, with PRP potentially showing superior results in certain cases[1][4].

2. In tendon injuries, an in vivo study found that both PRP and dextrose prolotherapy promoted healing, with PRP demonstrating superior effects[3].

3. A meta-analysis revealed that dextrose prolotherapy was more effective in reducing chronic pain compared to saline injections or exercise, and showed comparable results to PRP or steroid injections[4].

Considerations for Treatment Choice

When deciding between dextrose prolotherapy and PRP, several factors should be considered:

1. Cost: Dextrose prolotherapy is typically less expensive than PRP[2].
2. Number of treatments: PRP usually requires fewer sessions[2].
3. Preparation complexity: Dextrose prolotherapy is simpler to prepare compared to PRP, which requires blood drawing and processing[4].
4. Specific condition: Some conditions may respond better to one treatment over the other.
5. Patient factors: Individual health status, preferences, and contraindications should be considered.

Both dextrose prolotherapy and PRP therapy offer promising options for treating chronic musculoskeletal pain and injuries. While current research shows benefits for both treatments, more long-term studies are needed to fully elucidate their comparative efficacy across various conditions. Patients should consult with their healthcare providers to determine the most appropriate treatment based on their specific needs and circumstances.

What Prolotherapy Will Not Help

It’s important to note that prolotherapy is primarily used for musculoskeletal conditions and joint pain, for example, caused by accident injuries or normal wear and tear as in osteoarthritis. It is not typically effective for systemic or infectious diseases. Here are some conditions that prolotherapy will likely not help:

1. Lyme disease: As a bacterial infection, Lyme disease requires specific antibiotic treatment and is not addressed by prolotherapy.
2. Other tick-borne infections: Similar to Lyme, other tick-borne diseases such as babesiosis or anaplasmosis would not be treated with prolotherapy.
3. Systemic autoimmune disorders: Conditions like lupus, rheumatoid arthritis, or multiple sclerosis are not suitable for prolotherapy treatment
4. Chronic fatigue syndrome: This complex disorder is not addressed by prolotherapy
5. Fibromyalgia: While fibromyalgia can cause widespread pain, it’s not a condition typically treated with prolotherapy
6. Neurological disorders: Conditions such as Parkinson’s disease or Alzheimer’s disease are not appropriate for prolotherapy
7. Infectious diseases: Viral, bacterial, or fungal infections that cause systemic symptoms are not treated with prolotherapy
8. Metabolic disorders: Conditions like diabetes or thyroid disorders are not addressed by prolotherapy
9. Cancer: Prolotherapy is not a treatment for any type of cancer
10. EMF damage: In cases where damage to human tissues such as oxidative stress and calcium ion channel triggering are caused by environmental telecommunications or other electromagnetic radiation, prolotherapy may be of limited value unless the patient is removed from the location causing the damage.
11. Psychiatric disorders: Mental health conditions such as depression or anxiety are not treated with prolotherapy.

Certain conditions such as these require specific medical treatments tailored to their underlying causes and mechanisms. Prolotherapy is primarily used for musculoskeletal pain and injuries, and is not designed to address systemic, infectious, or non-musculoskeletal conditions.

Comparative Costs of Prolotherapy Types

1. Dextrose Prolotherapy:
   • Cost per Session: Typically ranges from $150 to $400 per session.
   • Number of Sessions: Generally requires 4-6 sessions for effective treatment.
   • Total Cost: The overall cost can range from $600 to $2,400, depending on the number of sessions needed and the specific clinic’s pricing.
2. Platelet-Rich Plasma (PRP) Therapy:
   • Cost per Session: Typically ranges from $500 to $2,000 per session.
   • Number of Sessions: Usually requires 2-4 sessions.
   • Total Cost: The overall cost can range from $1,000 to $8,000, depending on the number of sessions and the clinic’s pricing.

Read More
^{[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9989868/
[2] https://www.selphyl.com/post/prolotherapy-vs-prp-comparing-two-treatments-to-heal-chronic-pain
[3] https://www.e-jvc.org/journal/view.html?doi=10.17555%2Fjvc.2023.40.2.93
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861898/
[5] https://caringmedical.com/what-is-prolotherapy-with-platelet-rich-plasma/}