Prolotherapy is an injection whose primary intent is to repair connective tissue (that is, ligament, tendon or cartilage). The term Proli is Latin for “to grow.”
Dextrose injection stimulates a brief arachidonic acid pathway inflammation (AA). After an injury, the body naturally uses AA inflammation to try to repair the damage. With prolotherapy there is no significant damage, because there is no stretching or tearing of fibers, but the body still begins a repair process, which allows the structure to become stronger and tighter rather than first becoming weaker and looser. Healing can take months, but some patients get better quickly. This is likely because dextrose and other solutions have effects on nerves as well.
There are other solutions that stimulate the AA type of inflammation, such as phenol, and they are also called prolotherapy. However, when cells are removed from the human body and then reinjected, that is “biologic repair injection.” The primary goal is still repair but it is by use of tissue from living (biologic) sources. This includes injection of whole blood, stem cell injection and platelet rich plasma injection.
Perineural Injection Therapy
There is another type of inflammation that has been recognized, and that is called neuropathic inflammation. This type of inflammation is produced by special small sensory nerves that are protein producing (“peptidergic”).
These nerves normally produce proteins that can be healing or damaging. When produced damaging proteins that is called “neuropathic inflammation” . There are many scientific articles published each month on this type of inflammation. Dextrose injection in low concentration (5%) reduces neuropathic inflammation. This does not stimulate AA inflammation as in prolotherapy; the primary intent is to treat nerves, not ligaments, tendons, or cartilage.
There are no safe oral medications (so far) to treat neuropathic inflammation, because they cause high body temperature in clinical trials. Injection method is proven safe for neuropathic inflammation.
Perineural Injection Types:
1. PERINEURAL SUBCUTANEOUS INJECTION (PSI). It has been clinically observed that injection of dextrose (commonly with 5% dextrose) under the skin is analgesic to nerve pain, usually completely, and within seconds. This typically needs to be repeated but after several treatments leads to progressive benefit, and according to ultrasound follow up shows evidence of stimulating healing of deeper structures.
2. PERINEURAL DEEP INJECTION (PDI): Injection in a deeper region where it has to go around objects or through layers called “fascia” is also utilized, as it is at those points that nerve irritation can occur as well. This stretch by fluid, which had been recently found to be better done with dextrose than lidocaine alone, is called hydrodissection.