FAQs

Please take a moment to read our frequently asked questions if you want to know more about the procedure, what makes it unique and what ailments are best suited for this treatment. If you still have questions, please contact us directly.

What areas of the body can be treated?

Almost any painful joint area can be treated if that area is deemed to have an appropriate problem after an evaluation. This includes pain in the knees, shoulders, neck, TMJ, back, elbows, wrists, fingers/toes, hips, ankles and feet. In addition, painful or injured or sprained ligaments, tendons, muscles, knee meniscus, shoulder or hip labrum and sciatica-as well as joint osteoarthritis (OA)-are generally all problems that can be considered for treatment. However, the specifics to each patient history and issue need to be evaluated on an individual basis to determine if a person is a good candidate to receive Prolotherapy treatment.

How long do treatments last? Are they permanent, or will need maintenance?

Prolotherapy is a regenerative treatment that stimulates repair. Think of a skin cut that has healed. Once the skin has healed, it has healed. After a treatment course is completed, the patient is “graduated,” and maintenance is not required. However, this does not make the person bionic! It is possible to re-injure the site, and that does sometimes occur; in those cases, a person would come back for a “tune-up.” In some cases, the problem treated has a structural abnormality to begin with, and we can only go so far with treatment. In those cases, a patient may want to come back periodically for treatment. However, in most cases, patients do not need to come back for maintenance; when the are done with a course of treatment, they are done. During the time I have been practicing this procedure (Dr. Speciale has been practicing this procedure for 30 yrs.), I have had patients come back after several years have gone by; however, in the majority of cases, these patients are coming back to consult and treat a different problem area; in most cases, the originally treated joint is still doing well.

What if I have been told I am “bone on bone?” Can I still be a candidate for treatment?

The diagnosis of “bone on bone” is unfortunately given to many patients, but can mean different things. Often, this term refers to a small portion of a joint, with most of the joint in good shape, and this person may very well be an excellent candidate for Prolotherapy treatment. Other factors are which joint is affected by the “bone on bone” situation. The knee, for instance, is a very forgiving joint; it can have a large portion of “bone on bone” and still do very well with Prolotherapy treatment. On the other hand, the hip is a very unforgiving joint, so even a small amount of “bone on bone” may make this patient difficult to treat. The bottom line is not to feel discouraged if you are told “bone on bone,” and you have an interest in Prolotherapy treatment; it is usually worthwhile to get a consultation and evaluation.

Does medical insurance cover this treatment?

As discussed earlier, with a few exceptions, most insurance companies do not cover regenerative injection therapies such as Prolotherapy. If you have a PPO insurance plan that pays for out-of-network physicians, you might (I repeat, “might”) be able to get some reimbursement for a portion of the office visit, depending on the terms of your policy (PPO stand for “Preferred Provider Organization,” a type of insurance with more flexibility). Other insurers, such as Medicare, have made it clear that they will not cover any aspect of Prolotherapy treatment. However, even though standard medical insurance coverage itself does not generally cover these procedures, payment with health savings accounts is almost always accepted.

What forms of payment are accepted?

Dr. Speciale accepts cash, check and all major credit cards. We also accept Health savings account or Flex savings account (if in the form of a credit/debit card).

How much does Prolotherapy cost?

Please give our office a call and we will gladly send you a copy of our price list. Prices differ depending on the body part being treated.

Will I need to take time off from work after the treatment?

This will depend on the area being treated, the type of job you have (physical or not). In most cases, it is a good idea to be able to have the option to rest the day after the procedure. However, as long as the job is not physical, a person can return to work almost immediately. If there is a physical aspect to the job that may re-injure the treated area, this can be discussed with the physician and a specified period of time, usually a few days to a week, can be arranged to be taken off after a procedure.

How long will my appointment be? How long do procedures take?

Dr. Speciale’s initial consultation is scheduled for 90 minutes. This allow time for the doctor to take a thorough history, do the diagnostic ultrasound, and then go over the findings/results and options. Time for the actual procedure will depend on which formula is used. Comprehensive Dextrose Prolotherapy treatments are scheduled for 1 hour. Platelet-Rich Plasma Prolotherapy procedure appointments are scheduled for 1 ½ hours, as blood needs to be drawn, centrifuged, and then injected. Biocellular procedure (Lipoaspirate Stem Cell or Bone Marrow Stem Cell) appointments are scheduled for 2 hours, as there is the added step of tissue extraction.

Do you give pain medication before a treatment?

A fast-acting, local anesthetic is used prior to each injection for PRP or Biocellular Prolotherapy, For Dextrose Prolotherapy, there is also a local anesthetic that is mixed into the formula. In most cases, that is all that is needed for patients to tolerate procedures well, without sedation or other pain medication. However, if a patient is particularly anxious or pain intolerant, a light oral sedative or pain medication can be given prior to treatment. Be sure to discuss this with the physician providing your treatment if you feel you will need to take something prior to the procedure.

Will I be able to drive myself home?

In most cases, yes (unless you have taken medication prior to treatment). However, for your first treatment, we recommend having someone accompany you to drive you home afterward. This is because while most people feel fine and will have no problem driving home after a treatment, other individuals may have some discomfort and prefer not to have to drive. After the first treatment, you will then see what is involved and how you feel, and decide if you need a driver afterward.

Does Prolotherapy stimulate cartilage repair?

In the past, the answer to this was unclear. However, over the past 10 years, evidence has emerged that supports that Prolotherapy can indeed stimulate cartilage growth and repair. A 2016 study of patients with moderately severe knee osteoarthritis (OA) demonstrated evidence of cartilage building effects after Dextrose Prolotherapy. Platelet-rich plasma (PRP) has also been shown to protect against cartilage damage and to play a part in its regeneration, as well as slow the progression of OA. And multiple investigations, in both basic research and clinical studies, have demonstrated the effectiveness of using adult stem cells for cartilage repair.

Can Prolotherapy make a condition worse?

In 30 years of performing this procedure-and in knowing many other physicians who offer it- I have not seen or heard of patient whose condition worsened as a result of Prolotherapy treatment when performed by a properly trained physician. Some individuals experience a significant level of temporary after-treatment pain or discomfort and may feel as thought they are worse for a while after a treatment, before they get better. This is somewhat expected; however, I have always seen after-treatment discomfort resolve, and when it does, most people feel improvement, with only a small percentage experiencing no change (however, ultimately not worse than prior to treatment).

That said, every patient is different, and in all medical procedures, there is always some risk. So be sure to ask your physician about both the likely and unlikely potential consequences of Prolotherapy treatment. It’s also important that you are comfortable with the physician doing the procedure. I am a big believer in trusting your gut.

I’ve heard that Lidocaine (a local anesthetic) can be toxic to platelet-rich plasma or adult stem cells and should not be used. Is this true?

The answer is not clear-cut; however, there has been concern in recent years that lidocaine might reduce the effectiveness of platelet-rich plasma or be toxic to stem cells. Because of this, many practitioners use more cell-friendly local anesthetics (such as procaine or ropivacaine) when doing advance Prolotherapy procedures. Also, the local anesthetic is not, in most cases, mixed directly with the platelet-rich plasma or adipose/bone marrow cells when doing advanced Prolotherapy, but rather injected separately. Therefore, there is reduced risk that the anesthetic will interact directly with the formula.

I see a lot of advertisement about clinics offering platelet-rich plasma and stem cell therapies. Are all these treatments the same?

The use of regenerative therapies has exploded in the last 10 years, and in some ways, it is like the “Wild West”. Although many orthopedic and sports clinics and doctors now offer these therapies, there is a wide variation of methods practiced. One issue is that while treatment should be tailored for each individual, some facilities offer more of a “one-size-fits-all” approach. This can be effective in simple, straightforward cases; however, the more complex a case is, the more important it is that the physician analyzes pain referral patterns and gets a correct diagnosis before proceeding to treatment. Other issues are that protocols vary, as well as the type and method of preparation of platelet-rich plasma used, or the type of stem cell source is being used. The bottom line is not all facilities offer the same treatment. *Remember, Dr. Speciale has over 30 years’ experience in all types of Prolotherapy/Regenerative Medicine, Hemwall/Hacket Comprehensive Dextrose Prolotherapy, Platelet-Rich Plasma Prolotherapy and Biocellular Prolotherapy (both Lipoaspirate and Bone Marrow Stem Cell).

What if I’m taking aspirin or anti-inflammatory medication (NSAIDs) when I begin treatment?

Because all the various forms of Prolotherapy are intended to stimulate inflammation in order to promote healing, the recommendation is to not take NSAIDs while getting treatment. If you are taking a baby aspirin for your heart, this can continue during Prolotherapy treatment, as the low dose will not affect treatment results. If you are taking a higher dose, this should be discussed with your physician prior to treatment. Regarding other NSAID medication, some patients may need to take these for some other reason, such as headaches that, for that person, may only respond to that type of medication. The advanced formulas (platelet-rich plasma and biocellular) seem to be more forgiving of briefly taking NSAIDs, especially if timed so that they are not taken during the most critical periods of healing. Of course, this should be discussed with your treating physician prior to treatment so a plan of action can be determined.

What if I’m taking a blood thinner or other anti-platelet medication? Will these interfere?

There is some controversy regarding whether anti-platelet medication interfere with the therapeutic ability of PRP. Many studies indicate no effect or minimal effect; others indicate a negative effect. Regardless, most physicians agree that it is not wise to discontinue these medications and that Prolotherapy, including PRP and Biocellular Prolotherapy, may usually still be done as long as there is no excessive bleeding time. If the patient is taking coumadin, a blood thinner which requires monitoring, we ask for a copy of the last 6 to 12 months of your blood monitoring testing (called an “INR”, which stands for International Normalized Ratio”) to see that your levels are stable. If there are any questions about a patient’s history or ability to go through a Prolotherapy treatment, the patient may be asked to clear the procedure with his/her primary care physician, internist, or specialist prior to treatment.


Most info is from Dr. Ross Hauser at Caring Medical- Fort Myers, FL

Why can’t I get these injections at my other doctor’s office?

Prolotherapy is more than just “shots.” It is highly specialized procedure. To heal pain, you need a Prolotherapist who understands the importance of a comprehensive approach and knows that just injecting one or two ligaments, or just an intra-articular injection, is not generally enough. Becoming a high-level Prolotherapist takes time and training under another high-level Prolotherapist to learn this technique. Not just attending a weekend course on theory or with cadavers. Patients who have more complicated cases and/or are serious about Prolotherapy need a provider that specializes in Prolotherapy and that has been trained thoroughly in ligament anatomy and does not solely rely on guidance from a machine. Although, Dr. Speciale uses a Musculoskeletal Ultrasound to aid in diagnosis and treatment. Dr. Speciale, learned from the pioneer of Prolotherapy, Dr. Gustav Hemwall.


My doctor said Prolotherapy isn’t going to help me.

Many doctors do not fully understand how Prolotherapy works, or even worse, have never heard of it! They may assume that one shot of PRP or Biocellular cells is the same as Comprehensive Hemwall/ Hacket Prolotherapy. If they think Prolotherapy is new, it shows they do not understand the decades of research and patient results supporting its use in chronic pain, sports injuries, and arthritis. Because it is a specialized treatment, providers must take it upon themselves to learn after graduating. It is huge undertaking to do it the right way, just as is any medical sub-specialty. Thus, it is typically not well understood by doctors who do not specialize in chronic pain care, or who have only tried one-shot PRP.