When you're hurting, especially if it's chronic pain, it's natural to look for treatments that can make the pain stop. But what if the source of the pain involves a tendon, ligament or joint that has been injured, weakened or damaged by wear and tear?
When rest, physical therapy or other conservative treatments haven't provided enough relief, it may be time to consider a different approach. Prolotherapy shows promise as a nonsurgical option for reducing pain while supporting your body's natural healing response.
What Is Prolotherapy?
Proliferation therapy, or prolotherapy for short, is an injection-based treatment used for certain types of musculoskeletal pain. Instead of simply numbing a painful area, prolotherapy involves injecting a dextrose-based solution (a form of sugar) into or around targeted joints, tendons, ligaments or other connective tissues.[1, 2]
Prolotherapy is often included in the growing field of regenerative medicine because it takes a different approach to pain. Rather than focusing only on temporarily relieving symptoms, the goal is to support your body's natural healing response in the painful or injured area. Studies have shown promising results for reducing chronic musculoskeletal pain, particularly when tendons, ligaments or joints are involved.[2, 3]
How Does Prolotherapy Work for Pain?
When the dextrose solution is injected into a targeted area, it creates a mild, controlled irritation that triggers a localized inflammatory response. That response may stimulate the release of growth factors and other processes involved in collagen production, tissue repair and remodeling. The goal is to strengthen and support injured or weakened tissue while improving pain and function.[2, 3]
Where Is Prolotherapy Used?
So, where can this type of treatment make a difference? Prolotherapy may be considered when pain involves a tendon, ligament or joint, particularly when the problem has become chronic or hasn't responded well enough to more conservative treatments.[3, 4]
Tendon and Ligament Pain
Tendons and ligaments can become painful following injury, repetitive stress or degeneration. Research on prolotherapy has included tendon and ligament-related pain, including tennis elbow, Achilles tendinopathy, plantar fasciitis and rotator cuff tendinopathy.[3, 4]
Osteoarthritis and Joint Pain: Can Prolotherapy Help Arthritis?
Knee osteoarthritis is one of the most studied uses for dextrose prolotherapy. Research has shown promising improvements in pain and function, making prolotherapy one nonsurgical option that may be considered for some patients with arthritis-related joint pain. [3]
Chronic Back and SI Joint Pain
Prolotherapy for back pain may be considered in some cases, including chronic pain associated with the sacroiliac (SI) joint and degenerative changes.[4] This does not mean prolotherapy is appropriate for every aching back. Identifying the cause of your back pain is an important part of determining whether an injection treatment makes sense.
TMJ Pain
Prolotherapy may also treat temporomandibular joint (TMJ) pain, particularly when joint instability or hypermobility contributes to symptoms. Research has found improvements in pain and joint function following dextrose prolotherapy, suggesting it may offer another nonsurgical treatment option for some patients with painful TMJ disorders.[3]
Are There Any Downsides to Prolotherapy?
Prolotherapy is generally considered safe when performed by an experienced medical provider, but it isn't the right treatment for every type of pain or every patient.[2, 5]
Other things to consider include:
- Temporary soreness: Pain, stiffness, swelling or bruising can occur around the injection site following treatment. [2, 5]
- More than one treatment: Prolotherapy often requires a series of injections, and improvement may happen gradually rather than overnight.[1, 5]
- Injection-related risks: As with other injection procedures, there is a small risk of infection or injury to nearby nerves or tissues. [5]
Most reported side effects are mild and temporary, and serious complications with dextrose prolotherapy are uncommon.[1, 2] A pain management specialist can determine whether your diagnosis and the source of your pain make prolotherapy a good treatment option.
Are Prolotherapy Injections the Right Treatment for My Pain?
Living with chronic pain can make it tempting to focus on one question: What will make this stop hurting? But effective pain management starts one step earlier by figuring out what is hurting and why.
For some patients with chronic tendon, ligament, joint or arthritis-related pain, prolotherapy offers a nonsurgical treatment option that works with the body's natural healing response rather than focusing only on temporary symptom relief.
An interventional pain management specialist can identify the source of your pain, review treatments you have already tried and determine whether prolotherapy treatment may help you move more comfortably and get back to the activities pain has interrupted.
Disclaimer: This content is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Pain conditions and treatment options vary from person to person, so always talk with a qualified healthcare provider about what’s right for you. If you experience sudden or worsening pain, or symptoms like numbness, weakness, chest pain, shortness of breath, or changes in bladder or bowel control, seek medical care right away.
Resources
- Prolotherapy. Cleveland Clinic [Internet]. Accessed September 10, 2026. Available from: https://my.clevelandclinic.org/health/treatments/22426-prolotherapy
- Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med (Seoul) [Internet]. 2021 Jan;16(1):81-95. doi: 10.17085/apm.20078. Epub 2020 Dec 16. PMID: 33348947; PMCID: PMC7861898. Accessed September 10, 2026. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7861898/
- Taheem Y, Suvar T. Prolotherapy: Review with Background History, Mechanism of Action, and Current Evidence. ASRA Pain Medicine News [Internet]. 2022;47. doi.org/10.52211/asra080122.035. Accessed September 10, 2026. Available from: https://asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2022/07/29/prolotherapy-background-history-mechanism-of-action-and-current-evidence
- Rabago D, Yelland M, Patterson J, Zgierska A. Prolotherapy for Chronic Musculoskeletal Pain. American Family Physician – AAFP [Internet]. 2011;84(11):1208-1210. Accessed September 10, 2026. Available from: https://www.aafp.org/afp/2011/1201/p1208
- Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016 Jul 7;9:139-59. doi: 10.4137/CMAMD.S39160. PMID: 27429562; PMCID: PMC4938120. Accessed September 10, 2026. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4938120/
