Prolotherapy safety

Ross Hauser, MDRoss Hauser, MD

“Side effects related to prolotherapy for back and neck pain, such as temporary postinjection pain, stiffness, and bruising, are common and benign. ” 1

Prolotherapy safety

In now nearly seven decades, no serious side effects from Prolotherapy have been reported in the medical literature despite millions of prolotherapy treatments given. Prolotherapy is not dangerous, Prolotherapy cures chronic pain. The Journal of the American Medical Association reported a fatality from Prolotherapy in 1959. The patient had a history of terrible low back pain and  sciatica on both sides for 15 years. She received injections of zinc sulfate in 2.5 percent phenol solution. She immediately developed some lower extremity paralysis and was hospitalized. The report states that she regained almost complete use of her legs within a few days. Apparently some four months after the Prolotherapy she goes to the hospital because of nausea, vomiting and low back and leg pain. She is taken to the operating room and exploratory neurosurgery is performed at the base of her head. She had a marked hypotensive (low blood pressure) episode during the operation and an adrenaline compound was needed to keep her blood pressure up. Immediately after the operation her pupils were barely reacting to light. The author noted that he thought this was due to cerebral anoxia due to the prolonged period of hypotension during the operation. Several hours later the patient died. Does this look to you like a patient died after Prolotherapy? She did not develop the symptoms that led to her hospitalization, on October 27, 1957, until four months after she received the Prolotherapy. She obviously died because of the surgical procedure causing her blood pressure to drop—the author of the article admits it in the text. The author noted, “An attempt at surgical correction of this apparently hopeless situation resulted in death. This technique of precipitating fibro-osseous proliferation [He is talking about Prolotherapy] appears to be neither sound nor without extreme danger.”

A similar erroneous conclusion might have been “neurosurgery appears to be neither sound nor without extreme danger.” I would not, of course, say this because neurosurgery can save lives. However, a case of a Prolotherapy side effect is reported. The side effect appears to have resolved within a few days. The person is then admitted to the hospital four months later and dies during surgery. Because of this, “experts” considered all Prolotherapy as extremely dangerous. This, of course, is published in one of the most prestigious medical journals to “warn” everyone about it.

Another prestigious medical journal, Journal of Neurosurgery, published a report of three cases of side effects related to Prolotherapy in 1961. Never did the physicians state what was injected in any of the three cases. In reality, an improper solution was used. The typical Prolotherapy solutions were not what was used in these cases. But because one physician used a different solution, the natural conclusion was that all Prolotherapy is highly dangerous. The conclusion in this article was “…it is clear that injection of sclerosing solutions into the region of the spine is a highly dangerous procedure.” Imagine if a totally incompetent neurosurgeon was performing brain surgery, not following standard protocols of treatment and people were dying or left paralyzed. Would it be right for someone to write an article in a medical journal regarding these cases and then state that neurosurgery is a farce and extremely dangerous because everyone is going to die or become paralyzed?

How could Dr. George Hackett, a great pioneer of Prolotherapy, have a 90 percent cure rate without even one side effect, yet these other physicians report four cases of people receiving significant side effects? The answer is easy. The physicians who caused these side effects did not follow the cardinal rule of Prolotherapy. Do not inject around the spine unless the needle is touching the bone. Additionally, they did not use the standard solutions of the day, such as Sylnasol. The authors of these articles (including the editors of J.A.M.A. and Journal of Neurosurgery) should have made it extremely clear that standard Prolotherapy protocol was not followed in each of these cases. A more reasonable conclusion would have been that all Prolotherapy doctors are not created equal. Prolotherapy is a very safe procedure if standard protocol and solutions are used, but serious side effects are possible if these are not followed.

See Also

Prolotherapy Risks Because Prolotherapy causes inflammation, the person will often note some bruising, pain, stiffness and swelling in the area after receiving Prolotherapy. Typically this lasts 1 to 7 days…If the pain is severe after Prolotherapy, then call the office where the Prolotherapy was done.

Dagenais S, Ogunseitan O, Haldeman S, Wooley JR, Newcomb RL. Side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain: A survey of practitioners. Arch Phys Med Rehabil. 2006 Jul;87(7):909-13.

More Prolotherapy research citations can be found on this page on our site Prolotherapy research. To learn more about Prolotherapy and if it is the right treatment for your hip pain, please read our article Prolotherapy information for patients.

Prolotherapy side effects

Ross Hauser, MDRoss Hauser, MD

Before looking at Prolotherapy side effects, let’s understand that every medical procedure has risks – but so does living with chronic pain! Let’s look at some of the risks when a person lives with chronic pain.

Risks associated with living with chronic pain:

  • Being miserable
  • Going into financial ruin because of an inability to work
  • Having incredible stress
  • Not sleeping
  • Ruined overall health
  • Marriage collapse
  • Developing additional health problems due to toll the pain is taking on the body
  • The collapse of the family
  • Never being able to enjoy sports again
  • Loosing the ability to be independent
  • Never running again
  • Never being able to take long walks
  • Possible addiction to pain medications
  • Decreased ability to travel due to restrictions in movement
  • Increased weight due to immobility

The risks of living with chronic pain are enormous. I did not talk about just losing the ability to enjoy life. The ability to enjoy life is being lost every day a person suffers from pain. Chronic pain often leads to host of other medical conditions including depression, anxiety, sleeplessness, chronic fatigue, hormonal deficiencies and many others. The psychological toll it takes on the person and their family and friends is enormous. So what is the person to do?

The person can opt for a host of treatments including chiropractic high velocity manipulation, physiotherapy, osteopathy, acupuncture, hypnosis, herbs, vitamins, exercise, massage, electrical stimulation, pain pills, surgery, arthroscopy, cortisone shots, trigger point shots, nerve blocks and many others. All treatments have potential benefits and potential risks.

Prolotherapy side effects

Here are some of the side effects of Prolotherapy:

  • Bleeding in the area
  • Bruising in the area
  • Increased pain
  • Swelling
  • Stiffness
  • Joint effusion
  • Infection
  • Puncture of the lung
  • Spinal headache
  • Nerve Injury
  • Tendon/Ligament Injury

Because Prolotherapy causes Inflammation, the person 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 inflame more easily. Since the treatment works by inflammation, lingering pain after Prolotherapy can be a sign of healing. If the pain is severe after Prolotherapy, then call the office where the Prolotherapy was done. Prolotherapy should not cause excessive, severe pain. Severe pain after Prolotherapy, especially accompanied by a fever, could indicate an infection.

Infection after Prolotherapy is the most serious side effect

The risk of infection after Prolotherapy is between 1 and 1000 to 1 and 10,000 procedures. The most common infection with Prolotherapy is an infection in the skin. This type of infection typically responds to an antibiotic taken by mouth. If a joint or blood infection results, then intravenous antibiotics will typically be needed for six weeks.
Since some of the risks with Prolotherapy relate to the actual technique done, it is important to go to a clinic with a lot of experience. Surely a doctor can stick a needle into a nerve, ligament, or tendon and cause injury. A doctor can stick the needle into the lung when doing the thoracic vertebrae or ribs. A doctor could also stick the needle into the spinal canal when doing any area of the spine and cause a cerebrospinal fluid leak. This is known as a spinal headache (which is a headache when you sit up). The risks of these side effects are rare, but do occur.

In the entire history of Caring Medical, I know of one patient who had a puncture of the lung who needed hospitalization. She refused to go to the hospital after I recognized the problem because someone had to take care of her dog. One of my staff volunteered to watch her dog, and this patient was in the hospital for only two days. She continued to be a client of Caring Medical.

I have taken care of numerous customers from around the country who come to Caring Medical because they have experienced a puncture of the lung from another office. None of these clients had a puncture of the lung after I did the Prolotherapy. But I did tell the clients that just because they received a puncture of the lung in the past, does not mean the technique of Prolotherapy was bad. Everyone’s anatomy is different. Surely if a lung rides high (above first rib) or if a nerve is in an unusual spot, these structures can be hit even though the Prolotherapy technique was good.

There are risks associated with everything you put into your body. All you have to do is look up any of the risks for any anti-inflammatory medications (even over-the-counter medications) to realize even taking them can cause serious risks. For me, I have had numerous Prolotherapy sessions and have treated many family members and friends. I understand that every procedure has risks, but so does not having the procedures. Compared to surgery, Prolotherapy in my opinion is much safer, and in most instances, a better option, with far less risks. I desire not to have chronic pain. I understand living with pain carries its own risk. For me, the potential benefits of Prolotherapy far outweigh the risks. If you continue to suffer with chronic pain or a painful condition is limiting your ability to do the things you want to do, I recommend that you seriously consider Prolotherapy.