You are possibly a candidate for dextrose prolotherapy. Prolotherapy is used to treat many cases from headaches to foot pain and many other fascial and musculoskeletal pain-related issues in between. Prolotherapy is commonly used to treat headaches, neck pain, shoulder pain, back pain, abdominal wall muscle pain, hip pain, knee pain, ankle pain, and foot pain. We also often use to treat hamstring injuries and other muscle injuries that do not get better quickly. During your consultation, we will review your medical history images examine you and determine if dextrose prolotherapy is an appropriate option.

Dextrose prolotherapy involves injecting sugar, or dextrose into the areas that are causing pain. This procedure has been done for over 90 years without a single documented complication. Dextrose is FDA-approved for injecting into your blood vessels; therefore, is considered safe for injection. We do not inject into your blood vessels but inject into areas that are causing pain with the use of an ultrasound machine that allows us to see damaged areas.

When dextrose is injected into areas that cause pain, the unhealthy cells die when exposed to high concentrations of dextrose. The healthy cells survive the “dextrose storm” and reproduce to create healthy tissue. Think of it as a home invasion. The walls and tiles are gutted and replaced with new walls and tiles. Stem cells and healthy growth factor cells support healthy tissue growth.

In our clinic, we use ultrasound to review and evaluate the areas that are causing the pain. Once identified we used the ultrasound to guide the prolotherapy injection into fascial planes, muscles, tendons, ligaments, or joints. Each procedure lasts typically no longer than 10 to 15 minutes. It may involve multiple injections in order to adequately treat the entire region that is causing pain.

In most cases, the injections are not painful but can be uncomfortable. We used the smallest needle possible in order to inject the areas of interest. In addition, we mix lidocaine with dextrose to provide a numbing effect in the areas that are causing you pain after each procedure. This numbing effect typically lasts 3 to 4 hours but also helps us know if we hit the areas that are causing the pain.

Soreness may occur from days to weeks. The level of soreness is mild to moderate. Remember, that in many cases we are also performing a hydrorelease or hydrodissection. This procedure involves injecting dextrose prolotherapy in between fascial adhesions (knots). Because we are breaking up scar tissue, you may experience more soreness for a longer period of time. We do recommend that you eat a full meal and are well-hydrated prior to your procedure to avoid potential lightheadedness after the procedure.

If you experience severe soreness, please send us a portal message to update us.

Dextrose prolotherapy injections are not the same as cortisone injections. Cortisone injections are anti-inflammatory injections that are best used in areas of acute or recent injury. Many times we will perform cortisone injections before starting prolotherapy to reduce inflammation if noted doing your ultrasound evaluation. Cortisone does have many side effects that are not necessarily beneficial for tissue healing; therefore, we typically do not recommend more than 2 treatments of cortisone injections.

It usually takes less than 15 minutes to administer the prolotherapy. There is no recuperation period, and you may leave the office immediately.  Often you will be in the office for an hour or more on the first visit to review your medical history, to take a physical, go over your medical reports and labs, and have time to ask questions and have the answers fully explained.

If you have a tendency to get lightheaded during injections or if getting prolotherapy in your lower extremities, you may want to come to the clinic with a driver.

For the first two days or so you may feel an achy soreness in the areas of the injection.  For the first three weeks, you may feel the same, better or worse as the healing process proceeds.  Any noticeable increase in strength, decrease in pain, improvement in sleep, or change in other symptoms is evidence that the healing process has been triggered.

Do not be alarmed if you have a robust inflammatory response that makes your pain worse than before the injection. This is a good sign that the healing cascade has started.

Although dextrose prolotherapy has been used for nearly a century, research in this area is poor for a variety of reasons. However, statistics show that 85-90% of all patients treated with dextrose prolotherapy receive at least a 50% benefit when treated between three and ten times. There is no evidence of a condition becoming permanently worse from receiving treatments. Also, because actual healing occurs, it is anticipated that long-lasting or even permanent relief of one’s pain can take place. If an area is re-injured, more treatments may be necessary for the future.

During your prolotherapy treatment session, we want to teach new tissue how to grow healthy and respond in a healthy manner. We more than likely will send you to physical therapy to begin retraining your body and improving your biomechanics so the injured tissues heal properly. After your injection, take it easy for 2 days and then you can return to light exercise.

If you feel pain during an activity, back off of it.

The number of treatments varies with each patient but you will likely need 4-6 sessions. Some cases require more treatments. In many cases patients notice improvement after the first or second treatment; however, more often improvement is noted after the third or fourth treatment.
One of the most difficult aspects of prolotherapy is that it takes many months to heal areas that have been damaged for so long. While other treatments, such as steroid injections or medications provide a Band-Aid that causes immediate relief, dextrose prolotherapy relies on the body healing itself for more permanent relief.

Other than soreness, there have been no documented complications from dextrose prolotherapy. Dextrose is FDA-approved to inject much larger volumes and veins and is commonly used to treat low blood sugar. Dextrose prolotherapy involves injecting much smaller volumes of dextrose into areas that are not blood vessels. Therefore, there is no systemic adverse side effect from dextrose injections.
Anytime a needle is stuck through the skin there is a risk for excessive bleeding, nerve damage, muscle damage, lung puncture, or infection. However, we use a very clean technique and ultrasound guidance to ensure a safe injection. At the time of your visit, we will discuss other possible risks that pertain to your specific case.

However, complications are rare, and ultrasound guidance is used to ensure safe and proper needle placement.

The solutions used in dextrose prolotherapy are very safe and the amounts used are within manufacturer guidelines.

Because dextrose prolotherapy causes inflammation, you will often note some bruising, pain, stiffness, and swelling in the area after receiving Prolotherapy.  Typically this lasts 1 to 7 days.  On rare occasions, it lasts longer.  Lasting longer is not necessarily bad, some people just have a more robust inflammatory response.  Since the treatment works by inflammation, lingering pain after dextrose prolotherapy can be a sign of healing.  If the pain is severe after dextrose prolotherapy, then call  504-988-8010 or send a portal message and provide us with an update.  Dextrose prolotherapy should not cause excessive, severe pain.  Severe pain after dextrose prolotherapy, especially accompanied by a fever, could indicate an infection.  If you have a fever or any other concerning signs or symptoms, please call the office or go to the emergency room/urgent care immediately.

 

Yes, a light meal and plenty of water are recommended prior to the procedure. This will improve the lightheadedness that you may experience during the procedure.

Unfortunately, most insurance carriers do not cover this service.  Even though more and more physicians are realizing the tremendous pain relief dextrose prolotherapy provides patients, this is still not a covered therapy.  Each session is $485 self-pay due prior to each treatment session. You will need a minimum of 4 sessions.

We recommend submitting your receipt to your insurance company for reimbursement or application to your deductible. You may also use a flexible spending account (FSA) or health savings account (HSA) to pay for the treatments tax-free.

It is difficult to explain why these procedures are not covered by medical insurance. Dextrose prolotherapy treatments have been done for many decades with good benefits. It is challenging to perform robust clinical trials on dextrose prolotherapy because funding for research for alternative and regenerative treatments is limited if the treatments are not profitable in the modern medical environment.
The Center for Medicare Services (CMS) did perform a review on dextrose prolotherapy and determined that more research is needed, although the research presented did support the beneficial use and safety of dextrose prolotherapy. Our clinic is working to raise funding to further prove the safety and benefit of dextrose prolotherapy treatments in improving pain.

Although CMS and insurance companies consider dextrose prolotherapy “experimental,” it is not. Dextrose prolotherapy has been done for many years with good results and extreme safety.

 

Think of it like changing a tire. If the alignment is off and the tires are pushed too much she will wear out quicker than it should. If tires are rotated and driven at appropriate speeds then a tire will last a long time. In many cases, dextrose prolotherapy treatment can be permanent.

The average cost is between $400-$1000 per treatment. Tulane Institute of Sports Medicine charges $485 per treatment. This cost covers the entire visit including exam, ultrasound exam, ultrasound-guided injection, and any other evaluation or treatments needed during that visit.

Prolotherapy is not taught in medical school. Ultrasound evaluation of orthopedic injuries is also not taught in medical. Fortunately, many are becoming more aware of the benefits of dextrose prolotherapy in treating chronic pain.

Soreness generally means the treatment is working and is a good sign of healing. If you are severely sore, please send us a portal message or call the office. If concerned, do not hesitate to go to the Emergency Room or Urgent Care.

Remember, complications from dextrose prolotherapy treatments are extremely rare; however, if concerned, again seek medical treatment.

If you just received prolotherapy from our clinic, here are our post-prolotherapy injection instructions.