PROLOTHERAPY IN CHRONIC MUSCULOSKELETAL PAIN: STRUCTURAL AND REGENERATIVE BIOMODULATION

Prolotherapy, which offers a regenerative alternative to the catabolic limitations of conventional approaches in the management of chronic musculoskeletal pain, stimulates the body’s natural repair mechanisms in a controlled manner by injecting irritant or biological solutions into damaged connective tissues. Grounded in the concept of biotensegrity (tensional integrity), this approach focuses on ligament laxity–induced joint instability, with the objective of interrupting the pathological cycle at a structural level. The osmotic shock and sterile inflammation created by hypertonic dextrose triggers the release of growth factors, fibroblast activation, and type I collagen synthesis, thereby promoting tissue regeneration. Currently, these treatment protocols, enriched with regenerative agents such as PRP, stromal vascular fraction (SVF), exosomes, and collagen in addition to dextrose, demonstrate longer-term and restorative results compared to placebo and corticosteroids in conditions such as chronic tendinopathies, osteoarthritis, and spinal instability. The aim of this review is to critically present the historical development of prolotherapy, an evidence-based biomodulation strategy targeting anabolic healing rather than symptomatic suppression, along with its mechanisms of action.