621: Feasibility and Safety of Prolotherapy for Localized Myofascial Pain in a Pain Fellowship Setting

Topic: Education, Societal Impact, and Others
Subtopic: Education of pain care

Background and Aims: Localized chronic musculoskeletal pain is pain lasting three months or more. Musculoskeletal pain is characterized by localized, focal pain reproducible on palpation of a taut muscle band. Musculoskeletal disorders affect approximately 1.7 billion people worldwide. Prolotherapy, aimed at stimulating healing of muscle and connective tissue, has been shown to reduce pain compared with control interventions. Additionally, patient–clinician interaction, including therapeutic touch, can influence pain perception and perceived benefit. The primary objective of this study is to evaluate the feasibility, safety, and short-term effectiveness of low-volume dextrose prolotherapy for adults with localized myofascial pain within a pain fellowship training environment.

Methods: DESIGN: Prospective, ongoing case series.

SETTING: Non-ACGME-accredited pain fellowship, outpatient clinic.

PARTICIPANTS: Planned enrollment of 10–20 adults with localized myofascial pain >3 months, with focal tenderness and palpable muscle firmness.

INTERVENTION: Low-volume intramuscular injections of 10–12.5% dextrose in saline, landmark-based, excluding face, hands, feet, genitals; 0.5–2 mL per site.

OUTCOMES: Primary—change in numeric pain score (0–10) at ~1 month. Secondary—muscle tightness, focal tenderness, adverse events. Feasibility assessed by procedure completion, tolerance, and follow-up.

ANALYSIS: Descriptive statistics; responders could repeat injections monthly up to five sessions.

Results: The first enrolled participant demonstrated clinically meaningful improvement of 60% reduction in pain following the initial injection, supporting procedural feasibility. Data collection for subsequent injections and additional participants is ongoing. No adverse events have been reported to date. Outcomes are descriptive and not powered for statistical inference, and are intended to inform feasibility, safety, and hypothesis generation rather than to establish efficacy.

Conclusions: Low-volume dextrose prolotherapy in a pain fellowship setting provides early data on the feasibility and safety of the procedure. Descriptive information of early post-procedure findings are presented to show improvement in both subjective reports of pain and objective measures of muscle tenderness, with no adverse reactions to date. The low-risk nature of prolotherapy makes it an ideal "hands-on" training opportunity to reinforce the musculoskeletal exam and patient-centered care. Repeated injections could provide a cost-effective alternative for managing localized myofascial pain and help reduce opioid use. Results from this study support feasibility, safety, and educational benefit as opposed to establishing efficacy.

References: 1. Bae G, Kim S, Lee S, Lee WY, Lim Y. Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis. Anesth Pain Med (Seoul). 2021;16(1):81-95. doi:10.17085/apm.20078

2. Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med. 2010;23(5):640-646. doi:10.3122/jabfm.2010.05.090296

3. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press (US); 2011.

4. World Health Organization. Musculoskeletal conditions. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions. Accessed February 15, 2026.

5. Simons DG, Travell JG, Simons LS. Myofascial pain syndromes: current concepts. N Engl J Med. 2001;345(16):1184-1191. doi:10.1056/NEJMra012125

6. Oka T, Suzuki K, Tanaka K, Okuyama K, Kitagawa T. Effectiveness of combined regenerative medicine and exercise therapy for patients with knee osteoarthritis: a scoping review. Front Rehabil Sci. 2025;6:1612615. doi:10.3389/fresc.2025.1612615

7. Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Riess H. The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2014;9(4):e94207. doi:10.1371/journal.pone.0094207

8. Li Z, Zhuang J, Zhang S, et al. Therapeutic effects of traditional Chinese exercises on musculoskeletal pain: a systematic review and meta-analysis. Pain Res Manag. 2021;2021:5584997. doi:10.1155/2021/5584997

9. Wang X, Luo H. Effects of traditional Chinese exercise therapy on pain scores, sleep quality, and anxiety-depression symptoms in fibromyalgia patients: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2024;25(1):99. doi:10.1186/s12891-024-07194-7

10. Jang JH, Han J, Na C, Park HJ. Effects of acupuncture on cartilage degradation and joint pain in osteoarthritis. Perspect Integr Med. 2024;3(3):134-141. doi:10.56986/pim.2024.10.002

Presenting Author: Juan Antonio Valadez
Submitting Author: Juan Valadez

Senior Author: Juan Antonio Valadez

IASP 2026 Global Year theme of Neuropathic Pain: No

• Mauro Zappaterra: MD, PhD - Synovation Medical Group