Irwin Abraham, M.D. & 

Chronic Injury Medicine


Prolotherapy is the injection of a growth-stimulating dextrose/glucose, the body’s own natural substance, into the body’s tissues to create new natural tissues. We inject into tendons, ligaments, some muscles, and joints. The most common substance used in Prolotherapy is dextrose, the same sugar that is in the blood. We use dextrose mixed with a local anesthetic and sterile water. This safe substance is introduced with a local anesthetic into the areas of injury.

It takes time for traditional Prolotherapy injection to work in the body. First, the solution injected will send a signal for cells to come to the site of injections. Then these cells mature and divide to become the tissue-creating cells needed to grow new fibers. This process takes about 6 weeks for most people to experience a good result. Some areas, such as the shoulder or the elbow, take longer, and some areas, like the wrist, improve more quickly.

Dr. Abraham uses prolotherapy for these areas:

  • The back of the head
  • The jaw joint-known as the TMJ
  • The cervical spine & joints
  • The thoracic (upper back) spine and ribs
  • The lumbar (lower back) spine
  • Hips, buttocks, sacrum, and tailbone
  • Shoulders and collarbone
  • Elbows, Wrists, hands, and fingers
  • Knees and kneecaps
  • Legs, ankles, feet, and toes

Timeline of injection, recovery, and improvement:

  • Day 1: Day of Prolotherapy injection.
  • Day 1: After injection expect soreness and perhaps pain.
  • Day 2: Decreasing soreness or pain.
  • Day 3: Further decease of soreness.
  • Days 3-7: Usually all soreness is gone and mild improvement is felt.
  • Weeks 2-3: Usually the same as the original level of discomfort before the Prolotherapy.
  • Weeks 3-4: More discomfort as part of the healing process, possibly more than the original level of discomfort. Often patients experience little to no increase in pain, but some patients experience much pain.
  • Weeks 5-6: Expect gradual improvement.
  • Weeks 7-8: Expect improvement week by week.
  • Months 2-3: If you fail to keep improving, then another set of Prolotherapy is needed. The patient may benefit by the use of a stronger solution for the second and possibly later sets.

Neural Prolotherapy

In recent years, Dr. Abraham and other physicians have been utilizing a process called either neural prolotherapy or as it has become more commonly known, PSI, for perineural subcutaneous injection. This is a process which relies on the same principles of the deeper injections associated with prolotherapy, but instead primarily targets the nerves near the surface of the skin.

Neural prolotherapy is a very new type of prolotherapy. The rationale is that that chronic pain will switch on the activities of certain nerves. These specific nerves are in every bundle of nerves traveling under the skin throughout the body. These switched-on nerves, known technically as “C” fibers, will then transmit messages of pain for months to years. We can turn off the pain message by injecting a small amount of a dilute sugar (glucose) solution into the nerves in the skin over an injury. Dr. Abraham has utilized this therapy for 3 years now and neural prolotherapy has gained quite a prominent place in his practice.

The relevant nerves for treatment are found by gently patting on the skin. Neural prolotherapy uses 5% concentration of glucose injected to the near vicinity of the nerves. The glucose literally turns off the pain message of the C fiber, and this can work very quickly. Most often the patient notices that she or he feels better as soon as the injections are completed.