Health Technology Reviews
Key Messages
What Is the Issue?
- Musculoskeletal conditions are a leading cause of chronic pain and disability among adults, affecting function, quality of life, and participation in daily activities. These conditions contribute to health care use and societal costs in Canada.
- Dextrose prolotherapy is an injection-based treatment used for certain types of acute and chronic musculoskeletal pain. The procedure involves injecting an irritant solution — most commonly hypertonic dextrose — into ligaments, tendons, or joint spaces to stimulate a localized inflammatory response. This response is intended to promote tissue repair, collagen deposition, and strengthening of connective tissue, which may improve joint stability and reduce pain over time.
What Did We Do?
- We conducted a rapid review to summarize evidence that compared the clinical effectiveness and safety of dextrose prolotherapy to any comparators not involving prolotherapy for adults with an acute or chronic musculoskeletal condition.
- We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published between January 1, 2024, and March 23, 2026.
What Did We Find?
- We identified 5 systematic reviews (SRs) addressing the clinical effectiveness and safety of dextrose prolotherapy in adults with an acute or chronic musculoskeletal condition.
- For knee osteoarthritis, 1 SR found that evidence for the effectiveness of dextrose prolotherapy versus placebo or other comparators was uncertain or inconclusive, with studies reporting mixed findings and no consistent pattern of benefit.
- For plantar fasciitis and other foot pain, 2 SRs found that dextrose prolotherapy may improve pain outcomes compared to placebo (normal saline injections) and physical therapy (PT). The evidence on the effectiveness of dextrose prolotherapy versus extracorporeal shockwave therapy, phonophoresis, or platelet-rich plasma showed no statistically significant differences between groups in assessed outcomes. Corticosteroid injections may provide better short-term and similar medium-term results in pain and function outcomes compared to dextrose prolotherapy.
- For shoulder pain, 2 SRs indicated that the evidence for the effectiveness of dextrose prolotherapy versus placebo (normal saline injections), PT, or corticosteroid injections was uncertain or inconclusive, with studies reporting mixed findings and no consistent pattern of benefit.
- For lateral elbow tendinopathy, 1 SR found that evidence on the effectiveness of dextrose prolotherapy compared to corticosteroid injections and extracorporeal shockwave therapy was uncertain or inconclusive, with studies reporting mixed findings and no consistent pattern of benefit. A comparison of dextrose prolotherapy versus hyaluronic acid injection or PT showed no statistically significant differences between groups in assessed outcomes, but dextrose prolotherapy may improve pain-related functioning compared with placebo (normal saline injections). Receiving dextrose prolotherapy compared to being on a wait-list was associated with greater improvement in pain-related functioning and physical performance over 4 months.
- For low back pain, 1 SR showed that the effectiveness of dextrose prolotherapy versus placebo (normal saline injections) or corticosteroid injections was uncertain or inconclusive, with studies reporting mixed findings and no consistent pattern of benefit.
- For temporomandibular joint dysfunction and pain, 3 SRs found that dextrose prolotherapy may improve pain-related functioning, physical performance, and pain intensity compared to placebo (normal saline injections). Dextrose prolotherapy may improve pain intensity compared to autologous blood injection but showed no between-group differences or inconclusive results for physical performance. Dextrose prolotherapy resulted in greater improvements across many included outcomes versus comparators (e.g., low-level laser therapy, occlusal splints).
- Two SRs reported that adverse events associated with dextrose prolotherapy were generally infrequent and described as mild and transient.
What Does This Mean?
- The certainty of the evidence was generally low and unclear, and findings were inconsistent across populations, comparators, and outcomes.
- Although some studies reported benefits associated with dextrose prolotherapy for certain musculoskeletal conditions, particularly for some temporomandibular joint disorders and possibly for plantar fasciitis, these findings were often limited to specific outcomes or time points. The broader evidence for many common musculoskeletal conditions remains uncertain and should be interpreted in the context of the methodological and evidence limitations.
- Widespread implementation should be balanced against current evidence limitations, resource implications, equity considerations, and clinical practice in the context of Canada.