Evidence it Works: Prolotherapy for Pain Relief

By Dr. Sharon Gurm

Is pain or loss of mobility keeping you from the activities you enjoy? A simple, non-surgical treatment (offered at our clinic) could resolve your pain and improve your range of motion – significantly – and the research to prove its place as a safe and effective therapy is mounting.

New Research on Prolotherapy for Osteoarthritis of the Knee

Results of a randomized controlled trial (RCT) of 98 adults suffering from osteoarthritis of the knee were published in the May/June issue of the Annals of Family Medicine. Lead researcher Dr. David Rabogo MD, PhD at the University of Wisconsin found patients who were treated with prolotherapy, involving several injections of dextrose solution at painful sites in and around the knee, had greater and more sustained pain relief than the placebo group receiving saline injections and the home exercise group. Patients in the treatment groups received 4-5 sessions each.

More than 50% of the patients in the prolotherapy group improved by at least the minimal clinical importance, compared to only 30% of the saline group and 24% of the exercise group.

Participants in the prolotherapy group reported consistent improvement across all the various parameters evaluated: pain score (frequency and severity), stiffness score and function score. Near-maximum improvement was achieved by 26 weeks and remained stable at the 52-week follow up. The fact that the most significant gains were in the functional subscales is especially noteworthy, since improved function – not just pain reduction – is of greatest importance to patients.

The study authors concluded the ‘RCT of adults with symptomatic knee osteoarthritis found substantial, consistent and significant improvements’ in the prolotherapy treatment group.

The study is one of many demonstrating the effectiveness of prolotherapy for pain syndromes affecting one or more joint structures in the body. It also shows that prolotherapy has a distinct biological effect (significantly outperforming the placebo and exercise-only groups) and has a clear therapeutic role in the treatment and management of osteoarthritis.

Prolotherapy and neural therapy treatments have significantly improved my chronic upper back and neck problems. From the first treatments, I experienced a greater range of motion when turning my head and with further treatments I found my posture seemed to naturally improve and I could do more activities (such as weight training, jogging, and jump rope) without experiencing the usual pain and discomfort that often accompany them. I highly recommend prolotherapy and neural therapy to anyone who is looking to reduce chronic neck and pain issues. – Lisa Zosiak

How Exactly Does Prolotherapy Work?

Although not all the mechanisms for prolotherapy are fully understood, we know the dextrose solution acts as a ‘proliferant’, meaning it generates a local, site-specific response initiating a temporary inflammatory reaction that re-engages the body’s healing systems to stimulate growth and formation of new ligament and tissue matrix in areas where it has become weak.

By strengthening the tendons, ligaments and related tissues, the joint in question becomes more stable thereby reducing long-term chronic and recurring inflammation and minimizing stress and strain on the entire musculoskeletal structure of the body.

What Else Can Be Treated with Prolotherapy?

In my practice, I have used prolotherapy to successfully treat a number of chronic and acute injuries, including those of the spine (disc bulges, degenerative disc disease, nerve impingement) and various joints such as the elbow, shoulder, wrist, sacroiliac, hip, ankle and jaw.

Often, patients will notice improvement after just one session, requiring an average of 3-4 prolotherapy sessions to resolve most conditions.

Identifying the true source of dysfunction is critical to resolve the chronic pain issue – is the low back pain a result of hip dysfunction affecting the sacroiliac joints and causing pelvic instability that leads to low back pain? A thorough and comprehensive history and orthopedic examination (in addition to appropriate imaging if needed) will reveal the real source of the problem. After treating the instability, care must be taken to re-engage the body with appropriate exercise, active rehabilitation and a long-term program to maintain integrity to the joint and muscular components involved.

The Complexity of Chronic Pain

In certain cases, chronic pain can be very complex. Sometimes we can diagnose these conditions as rheumatoid arthritis, lupus, anklyosing spondylitis, psoriatic arthritis, polymyalgia rheumatica or other autoimmune disease, but in many cases I see, there is no actual ‘textbook’ diagnosis. I refer to these situations as chronic pain syndromes because they are multi-factorial in origin. Often, several joints are involved and pain can be chronic and sustained or remitting and relapsing in an episodic way.

Multiple systems are usually dysfunctional in the chronic pain and chronic inflammation situation. These individuals often report symptoms of chronic fatigue, sleep disturbance and digestive problems. Some may even experience intermittent ‘flu-like’ symptoms and compromised circulation (i.e. Raynauld’s Syndrome).

To successfully resolve the chronic pain syndrome in these situations requires a whole-person approach that addresses more than just the perceived local areas of pain. A complete assessment of diet, nutritional deficiencies, digestive and immune function, hormones, toxicity and stress are some of components of a comprehensive evaluation process I perform when a patient presents with a chronic pain syndrome.

Subsequent treatment involves a combination therapeutic approach of treating and restoring balance to all these healing systems in order to resolve the pain syndrome and establish optimal health and functionality.

Chronic pain is exhausting and has significant impact on quality of life. I believe life is too short to be suffering. Don’t accept that pain is what you have to deal with because you have a ‘condition’ or because you are ‘aging’. There are answers outside what is offered by the confines of conventional (allopathic) medicine. Seek with open awareness and you shall find.

Since coming to see Dr. Gurm I have shown vast improvement in my back and hip pain.  Having had dual discectomy/laminectomy surgery on my lumbar spine, and having been diagnosed with degenerative disc disease, as well as bi-lateral sacroiliitis – the prolotherapy has worked wonders for my chronic pain. Along with my surgery I have been also been to multiple acupuncturists, spine decompression, and physio therapists with minimal to no change.  The prolotherapy is the only thing that has worked with permanent results. It is not only the therapy aspect that has been a great experience, but also Dr. Gurm’s approach.  She is extremely smart, professional, friendly, and takes genuine interests in your issues and how to correct them. Stephen Hendricks – October 2012

If you decide to try prolotherapy, be sure to seek an experienced naturopathic physician or medical physician who is board-certified in prolotherapy to ensure maximal safety and beneficial outcomes.

For more information on Prolotherapy and how it can help you – call the clinic at 604-949-0077 and schedule an appointment!

Dr. Sharon Gurm, ND is the founder and clinical director of Port Moody Health. In her private practice, she has a special focus on providing integrative cancer care, in addition to treatment of chronic pain syndromes, hormone imbalance and autoimmune disorders. Dr. Gurm is board-certified in prolotherapy (trained at the University of Wisconsin Sports Medicine Division), oxidative therapies, chelation therapy, intravenous therapies, acupuncture and prescriptive authority. She has additional certification in many other healing modalities, including trigger point injections (neural) therapy, autonomic response testing and psychokinesiology.



  1. Rabago D, Patterson J, et al. Dextrose prolotherapy for knee osteo-arthritis: a randomized controlled trial. Ann Fam Med, 2013; 11(3):229-237.
  2. Rabago D, Lee KS, et al. Hypertonic dextrose and morrhuate sodium injections (Prolotherapy) for lateral epicondylosis (tennis elbow): results of a single-blind, pilot-level, randomized controlled trial. Am J Phys Med Rehabil, 2013; 92(7):587-96.
  3. Cusi M, Van der Wall H. Spect/CT findings in a large cohort with sacroiliac joint incompetence (siji). Br J Sport Mes, 2013; 47(10): e3.
  4. Rabago  D, Slattengren  A, Zgierska  A.  Prolotherapy in primary care practice.  Prim Care,  2010; 37(1):65–80.
  5. Rabago D, Yelland M, et al. Prolotherapy for chronic musculoskeletal pain. Amer Fam Physician, 2011; 84(11):1208-1210.
  6. Degenais S, Yelland MJ, et al. Prolotherapy injections for chronic low-back pain. Cochrane Database Sys Rev, 2007; (2): CD004059.
  7. Staal JB, de Bie RA, et al. Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine, 2009; 34(1): 49-59.

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