Prolotherapy Injections: How Sugar Water and Anesthetic Might Help with Your Chronic Pain

Prolotherapy has been gaining attention in recent years as a treatment option for chronic musculoskeletal pain and joint instability. It is a regenerative injection therapy that stimulates healing by triggering the body’s inflammatory and repair processes. Understanding how prolotherapy works, which conditions it treats best, who makes a good candidate, and potential risks can help clarify its role in pain management.

How Does Prolotherapy Work?

Prolotherapy involves injecting an irritant solution, most commonly dextrose and an anesthetic, into damaged ligaments, tendons, or joints. Unlike other therapies that directly supply growth factors (like PRP), prolotherapy’s mechanism lies in causing a controlled, mild inflammatory reaction. This inflammatory stimulus recruits immune cells releasing cytokines and growth factors like platelet-derived growth factor and transforming growth factor-beta. These signals promote fibroblast proliferation and new collagen formation, leading to stronger, more stable connective tissue. This tissue remodeling ultimately improves joint stability and reduces pain.​

Indications Best Treated With Prolotherapy

Clinical studies show prolotherapy reduces pain and improves function, particularly in patients who have not responded to other conservative treatments. It has reasonable evidence for use in ligament or tendon injuries but remains under continuing investigation for wider applications.​

• Chronic tendon pain or tendinopathy, especially where other treatments have failed​

• Ligamentous laxity, joint instability, or painful ligament sprains and strains​

• Knee osteoarthritis with chronic pain (mild to moderate cases are most commonly studied)​

• Chronic low back pain, including sacroiliac joint dysfunction and instability​

• Shoulder instability or rotator cuff tendinosis​

• Epicondylitis (tennis elbow/golfer’s elbow) and similar enthesopathies​

• Plantar fasciitis​

• Chronic joint pain in fingers, elbows, ankles, or hips related to osteoarthritis or instability​

• Pain and dysfunction after sprains or repeated minor trauma where healing is incomplete

Who Are Good Candidates?

Good candidates are people with persistent musculoskeletal pain or joint instability that has not improved after physical therapy and other treatments. Patients should not have active infections, bleeding disorders, or allergies to anesthetics. Caution is also taken with those who have diabetes.

People looking to avoid surgery and willing to undergo multiple injection sessions spaced over weeks often benefit most.

How to Prepare for the Injection

I ask all patients to stop taking all NSAIDs (Advil, ibuprofen, etc.) and high-dose aspirin, unless medically necessary. These agents can blunt the effect of the immune system, which we want firing at full force.

What to Expect During the Procedure

A general assessment, including your vitals, will be performed. Your prolotherapy will be prepared according to the percentage discussed during your initial assessment. (The percentage generally varies from 15% to 25% and can affect how great a flare response an individual may experience- more below.)

The injection will be performed under ultrasound guidance, and the injection is generally well-tolerated and not uncomfortable. We will discuss this at length before the procedure.

Most people choose to drive themselves home after the procedure, but if you are sensitive to needles or have any concerns, having a ride planned is always a good idea. Most people can also return to their daily activities immediately after the procedure.

Potential Risks

Prolotherapy is generally considered safe but has risks similar to any injection procedure — pain and swelling at the injection site, minor bruising, and occasional infection.

Serious complications are rare, but patients should seek care promptly if they experience severe pain, signs of infection, or allergic reactions.

What to Expect After the Procedure and the Flare Response

Because it stimulates inflammation, temporarily increased pain or stiffness is common but usually resolves within days. This is known as the “flare response” and can vary between people. Usually, it’s a new ache or pain near the treated site, but it’s generally different from the pain being treated. Some people experience this for 1-3 days, and on rare occasions, for longer. We will discuss this at length before your procedure.

You are advised not to take NSAIDs at least 5 days after treatment, but can take Tylenol, if needed. Most people do well with applying heat to the area to reduce pain.

You should take it easy for a few days after the injection but can start full range of motion activity within the first week. A plan to return to activity and exercise will be devised with your physiotherapist to maximize the benefits of prolotherapy.

A Final Recap!

Prolotherapy is a regenerative injection therapy that uses controlled inflammation to stimulate connective tissue healing. It’s most effective for chronic pain and instability related to ligament, tendon, or joint damage. With a good safety profile and growing clinical support, it presents an option for patients seeking non-surgical treatments for difficult musculoskeletal conditions. As with any therapy, you must discuss your potential risks and benefits with your medical provider.

While research is ongoing to better define protocols and expand indications, prolotherapy could be an option to consider to harness your body’s own healing capabilities for musculoskeletal pain.

Dr. Lorna is performing a prolotherapy injection of the right ankle joint.

Learn more about other injections on my page!

Learn more about cortisone injections here.

Learn more about Platelet-rich plasma (PRP) here.

Platelet Rich Plasma Injections: A Potential Option to Get You Out of Pain

Platelet-Rich Plasma (PRP) injections have gained significant attention in recent years as a promising treatment for various musculoskeletal, soft tissue, and joint injuries. The technology has improved so much over the last decade, and research is also showing this.

As a naturopathic doctor, I love PRP injections because you are using your body’s own platelets to heal yourself. I’m going to touch on some frequent questions I get in my practice, and hopefully help you learn a bit more about this regenerative injection.

How Does PRP Work?

PRP is produced by drawing a small sample of your blood and spinning it in a centrifuge to concentrate the platelets. Platelets, which are blood cells essential for healing, are separated from other blood components through this high-speed spinning process.

PRP is typically quantified by the total platelet count delivered (usually in billions) or by the fold increase compared to baseline. This is calculated by dividing the platelet concentration per milliliter in the PRP by the platelet concentration in the patient’s native blood. Generally, a minimum of 1 billion platelets per milliliter is desired, with an average target of at least 1.5 billion per milliliter. For patients aged 55 and younger, aiming for a 7- to 10-fold increase over baseline is recommended, while those over 55 may benefit from a 15-fold or higher increase. A more concentrated PRP delivers a larger number of platelets and growth factors to damaged tissues, enhancing the natural healing process. Simply put, a higher platelet dose correlates with better clinical outcomes.

At Agile Integrated Health, We use the technology to get these higher platelet concentrations over baseline.

When injected into an injured area, activated platelets release growth factors and proteins such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF). These growth factors stimulate tissue repair by enhancing cell proliferation, new blood vessel formation (angiogenesis), and collagen production. Essentially, PRP boosts the body’s natural healing process to facilitate tissue regeneration and recovery.​

Indications Best Treated With PRP

• Chronic tendon injuries (e.g., tennis elbow/lateral epicondylitis)

• Osteoarthritis, especially of the knee

• Achilles tendonitis and tendinopathy

• Patellar tendonitis (jumper’s knee)

• Rotator cuff tendon tears and tendinitis

• Plantar fasciitis

• Hamstring injuries

• Ligament sprains and partial tears

• Muscle strains and tears

• Chronic tendinosis and degenerative tendon conditions

• Cartilage degeneration and damage

• Inflammatory joint conditions not responsive to other conservative treatments

• Post-traumatic joint pain and inflammation

• Joint instability or chronic joint pain related to soft tissue and ligament involvement

Who Are Good Candidates?

In the acute phase of an injury (freshly injured), PRP is often timed to coincide with the body's healing stages about 1 to 2 weeks after injury or surgery.

In the chronic phase of an injury, good candidates for PRP are those who have experienced persistent pain or injury for several months (typically 3-6 months or longer), who have not fully responded to conservative treatments such as physical therapy or NSAIDs, and who prefer to avoid or postpone surgery.

Patients should also be in generally good health without severe anemia, blood disorders, active infection, or cancer, as these conditions can affect the quality and safety of PRP therapy.​

How to Prepare for a PRP Injection

I put people on a special diet prior to receiving a PRP injection. I recommend following this for at least 10 days, if not for 4-6 weeks before the procedure. It is best to follow a balanced, nutritious diet to optimize healing and platelet function, as well as optimize other lifestyle factors that greatly imact the quality of your blood.

4-6 weeks before the injection

• Eat a diet rich in fresh vegetables, fruits, whole grains, and high-quality proteins to support overall health and tissue repair.

• Focus on nutrients that promote blood and cell health, such as iron (found in leafy greens, beans, and lean meats), vitamin C, and vitamin B complex.

• Avoid alcohol, caffeine, and nicotine before the procedure as these can impair platelet function and blood flow.

• Stop anti-inflammatory medications like NSAIDs and aspirin about 1 week prior, as they interfere with platelet activity (always consult your doctor first).

• Avoid highly processed, sugary, and fried foods that may promote inflammation and slow healing.

• Adhere to a plant-based diet or reducing animal fats 24 hours before to reduce inflammation and improve blood quality.

• Address stress, axiety and depression to the best of your ability by making time for relaxation, meditation, prayer. Seek joy in the weeks leading up to your procedure.

• Prioritize getting good quality sleep leading up the procedure, aiming for at least 8 hours per night.

• Maintain good hydration by drinking plenty of water in the days leading up to the procedure, which helps circulation and blood collection.

Day of procedure:

• Go for a 4-minute bout of high-intensity exercise 30-minutes before drawing blood for the platelet-rich plasma injection. A short, high-intensity bike or jog/sprint can increase the total platelet count and TGF-β concentration.

• Eat and drink before the procedure. Come well hydrated!

What to Expect During the Procedure

A general assessment including your vitals will be performed. Your blood will be drawn and in under 20 minutes, your platelet-rich plasma is prepared.

The injection will be performed under ultrasound guidance, and it isn’t uncommon for the injection itself to be uncomfortable. We will discuss this at length prior to the procedure.

It’s a good idea to have someone to pick you up and take you home after the procedure in case you are too uncomfortable to do so. Many people, however, choose to drive themselves. It’s also generally a good idea not to have something planned later that day in case you need the additional rest.

Potential Risks

While PRP is considered relatively safe because it uses a patient’s own blood, there are still potential risks. Mild to moderate complications may occur at injection sites, including pain, swelling, and rarely infections. More serious complications such as infections or allergic reactions, have been reported but are rare.

What to Expect After the Procedure

Some soreness is normal for a few days after your treatment. This pain is caused by the inflammation triggered by the platelets, which is part of your body’s healing process.

Rest and take it very easy for the first several days.

Pain may fluctuate during the first 2–3 days, and then should gradually improve. You may have days with more or less pain—this is a typical part of healing.

You may use Tylenol (take 1 or 2 tablets every 4–6 hours as needed) to help with discomfort.

Apply heat to the area for pain relief.

Do not take any non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or full-strength aspirin, for at least 3 to 7 days. These medications can interfere with the healing effects of the PRP by blocking necessary inflammation.

• For activity:

  • During the first 2 days, keep moving with light activities such as short walks, but avoid formal exercise.

  • On day 3, begin gently moving the limb or joint through its full range of motion without resistance.

  • Between days 7 and 14, start isometric exercises with the limb and slowly increase resistance as tolerated. Gradually increase your activity level—movement helps healing if done carefully. For cardio, try cross-training activities such as swimming, deep water running, stationary bike, elliptical, or walking as you are able.

  • Continue working with your physiotherapist to maximize progress.

A Final Recap!

PRP injections leverage concentrated growth factors from your own blood to stimulate healing in tissues. It’s best suited for chronic tendon and soft tissue injuries, certain types of osteoarthritis, and people seeking alternatives to surgery. While generally safe, PRP treatments carry risks that require careful patient selection and procedural sterility. As research evolves, the indications and protocols for PRP continue to be refined to maximize benefits and minimize harm.

This emerging treatment is a great example of harnessing the body’s natural healing capabilities for orthopedic and sports medicine. Those considering PRP should have a thorough discussion with their healthcare provider to understand if it is appropriate for their specific condition and health status.

If you want to learn more about other injections, be sure to visit this webpage often.

Learn more about prolothearpy here.

Learn more about cortisone injections here.