REGENERATIVE INJECTION THERAPY

How prolotherapy is thought to work

The proposed mechanism is straightforward: hypertonic dextrose creates a brief, controlled local irritation at the injection site. The body responds with an inflammatory healing cascade — increased local circulation followed by tissue repair and remodeling over a series of treatments. This mechanism is proposed based on laboratory and clinical observation; it is not definitively established, and research on prolotherapy is ongoing.

CONDITIONS WE TREAT

Conditions we treat with prolotherapy

The strongest clinical evidence for prolotherapy is in tendinopathies. We offer it for:

• Tennis elbow (lateral epicondylitis) and golfer’s elbow
• Plantar fasciitis and Achilles tendinopathy
• Rotator cuff tendinopathy
• Chronic ligament sprains and joint instability pain (ankle, knee, wrist, SI joint)
• Knee osteoarthritis — offered as a lower-cost injection option. Note on this one: keep expectations measured; clinical trials have shown mixed results for knee arthritis, with some studies showing benefit and others showing little difference from saline injection. We will tell you honestly whether it is a reasonable option for your case.

YOUR VISIT

What to expect

Your first visit is a consultation with ultrasound evaluation of the painful area to confirm prolotherapy is appropriate. If we proceed, treatment is a series of injections, typically 3 to 6 sessions spaced about 4 weeks apart. Each session takes roughly 15 to 30 minutes and is performed in our Riverside or Menifee clinic. Many patients notice improvement by the third session; full benefit builds over the course of treatment.

• No blood draw is required (unlike PRP)
• Ultrasound guidance is used for precise placement
• Temporary soreness or a pain flare for 1 to 7 days after injection is expected — this is part of the treatment response, not a complication
• Avoid anti-inflammatory medications (NSAIDs) around your treatment dates, since the therapy depends on an inflammatory response; acetaminophen is acceptable
• You can drive yourself home and resume normal activity the same day

COMPARING OPTIONS

Prolotherapy vs. PRP

Both are regenerative injection therapies, but they differ in important ways. Prolotherapy uses a dextrose solution and requires no blood draw. PRP uses concentrated platelets from your own blood. Prolotherapy generally costs less per session but typically involves more sessions. High-quality head-to-head trials are limited, and neither treatment has been shown to be clearly superior across the board. At your consultation, Dr. Guiang will recommend the approach that best fits your condition, prior treatments, and budget — sometimes both are used at different stages.

INVESTMENT

Pricing

Prolotherapy is an elective, cash-pay treatment and is not covered by insurance.

• $300 per session
• 4-session deal: $1,000
• Note: HSA/FSA cards are accepted.

Important notes

• These treatments are elective and are not part of our regular insurance-based pain management practice. Patients are responsible for the full cost.
• Dextrose and lidocaine are FDA-approved medications; using them for prolotherapy is an off-label use, not an FDA-approved indication.
• The evidence for prolotherapy is mixed and condition-dependent. Results vary from patient to patient, and no outcome can be guaranteed.
• Prolotherapy is a treatment option, not a promise to avoid surgery. We will give you an honest assessment of whether it fits your case.

QUESTIONS

Frequently asked questions

Does prolotherapy hurt?

You will feel the needle sticks and a brief sting from the solution. Post-injection soreness for several days is normal and expected.

How many sessions will I need?

Most treatment plans are 3 to 6 sessions spaced about 4 weeks apart, decided at your consultation based on your condition and response.

Is it safe?

Serious complications are uncommon in published studies, and prior reviews have not revealed substantial adverse effects. As with any injection, risks include bleeding, bruising, infection, and nerve irritation — we use ultrasound guidance and sterile technique to minimize these. The safety evidence base is limited by small study sizes, which we disclose openly.

Can I combine it with other treatments?

Yes. Prolotherapy is often sequenced with PRP, red light therapy, or peptide therapy as part of a broader plan.

Book a prolotherapy consultation

Meet with Dr. Guiang at our Riverside or Menifee clinic to find out whether prolotherapy is right for your pain.