Prolotherapy (sometimes referred to as proliferative injection therapy) is a regenerative injection modality aimed at helping reduce chronic pain caused by weakened connective tissue. 

Its primary goal is to stimulate the body’s innate ability to heal by using a natural irritant, which causes the increase of collagen at the site of application. 

Connective tissues, such as ligaments, that help stabilize a joint do not experience good blood supply. When ligaments or joints are injured, they naturally take a long time to heal, if they ever fully heal. This causes them to be weak and can lead to chronic joint pain. 

Why Prolotherapy is helpful:

Prolotherapy is most helpful for those with chronic persistent injuries that have not responded to conservative treatments. It also is helpful for those who want to explore interventions other than surgery, but are looking for relief. 

It can be helpful for chronic partial or full dislocations of joints due to hypermobility and sometimes helpful for osteoarthritis, because introducing more fluid into the joint can provide extra cushion. 

Prolotherapy Injections:

One of the services offered here at NFM Health, Inc. by Dr. Sabin Gilman is prolotherapy injections of the upper and lower extremities. 

This typically involves using a needle to inject a formula (it varies, but can be procaine/lidocaine, saline and 12.5-25% dextrose) directly at the attachment site of tendons/ligaments to bones and/or directly into the joint capsule. 

The goals are to cause inflammation, which is part of the healing process,  and to cause proliferation, which will lead to strengthening and repairing of connective tissue. 

Risks/contraindications:

It is not a therapy for everyone. Risks will be discussed in detail with each patient; contraindications, which can be case dependent, will also be discussed. Some examples are implanted metal at injection site, pregnancy, uncontrolled diabetes, infection, skin infections, inflammatory/autoimmune arthritis, generalized or centralized pain, and allergy to solution. Contraindications to procaine include pseudocholinesterase deficiency, pregnancy, myasthenia gravis, and lupus.

What to expect:

The first appointment will typically involve obtaining a solid medical history, assessing the areas of concern, making a diagnosis if one has not been made (which may include imaging), reviewing contradictions, risks, benefits, and developing a plan. 

Depending on various factors, the joint may or may not be injected until the second or third visit. There may be some stinging, discomfort, numbness, and bruising associated with the injections. 

The joint can often feel heavy, achy, and stiff after the injection, but any sensation typically resolves over the course of the day. 

Some may notice an immediate effect but it often takes a minimum of 3-5 injections in the same joint. These should be spread over 4-6 weeks. 

Success is dependent on many factors, such as general health, re-injury/aggravation, nutritional and other underlying deficiencies that impact the ability to heal. Healing connective tissue can take weeks to months, even years. 

Price/Insurance:

Prolotherapy injections are a separate charge outside of the visit cost. Insurances do not cover them but I can/will bill them for the visit portion. The cost is dependent on the time it takes for the actual procedure, and is $60 for up to 15 minutes, $100 for 16-30 minutes, and $150 for 31-60 minutes.