What is the recommended dextrose concentration for prolotherapy (proliferative therapy)?

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Last updated: June 2, 2025View editorial policy

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From the Research

The recommended dextrose concentration for prolotherapy is 20%, as it has been shown to be the most effective concentration in recent studies, including a 2023 study published in Clinical Rheumatology 1.

Key Points to Consider

  • The use of dextrose prolotherapy has gained popularity in the management of osteoarthritis, aiming to harness its regenerative and proliferative properties.
  • A 2023 study compared the effectiveness of prolotherapy with dextrose concentrations of 5%, 10%, and 20% in patients diagnosed with knee osteoarthritis, and found that 20% dextrose concentration was the most effective 1.
  • The solution is typically prepared by mixing 50% dextrose with 1% lidocaine and sterile saline to achieve the desired concentration.
  • Treatment protocols generally involve injections every 2-6 weeks for a total of 3-6 sessions, though chronic conditions may require additional treatments.
  • The mechanism of action involves creating a controlled inflammatory response that stimulates the body's natural healing processes.
  • The dextrose solution works by causing osmotic stress to local cells and attracting growth factors and inflammatory mediators to the area, which then promotes collagen deposition and tissue repair.

Important Considerations

  • Higher concentrations may produce a stronger proliferative effect but can also cause more post-injection discomfort, so practitioners often balance efficacy with patient tolerance when selecting the appropriate concentration.
  • A 2022 study published in the Journal of Back and Musculoskeletal Rehabilitation found that 5% dextrose prolotherapy was effective in treating chronic low back pain and lumbar disc herniation, but the 2023 study found that 20% dextrose was more effective 2, 1.
  • Further studies with standardized protocols and long-term follow-up are needed to address potential biases and confirm the effectiveness of dextrose prolotherapy.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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