If you’ve been told that platelet-rich plasma (PRP) could help your arthritic knee, aching shoulder, or stubborn tennis elbow – and then paused when you heard the price – you’re not alone. PRP is rarely covered by insurance, and because every treatment involves drawing and processing your own blood, it sits at the higher end of office-based injection therapies, with pricing that varies widely from clinic to clinic.⁸ For patients who need a series of injections, or who have more than one painful area, the cost adds up quickly.
Before you shelve the idea of treatment altogether, there’s an older, simpler relative of PRP worth knowing about: prolotherapy. The two treatments share the same underlying goal, they’re used for many of the same conditions, and in head-to-head research prolotherapy has repeatedly held its own. It is not a watered-down consolation prize. It’s a legitimate treatment with its own body of clinical-trial evidence, one that happens to cost a fraction of the price.
Here’s what patients should understand about how the two compare.
Two treatments, one core idea
Cortisone (steroid) injections relieve pain by calming inflammation, but they don’t repair anything, and the relief tends to fade over weeks to months. Prolotherapy and PRP take the opposite approach. Both belong to a family sometimes called proliferative or regenerative injection therapy, and both work on the same premise: a chronically painful tendon, ligament, or arthritic joint is often a place where the body’s healing process has stalled. Rather than quieting the area, these injections deliberately deliver a brief, controlled stimulus at the exact site of the problem – a wake-up call intended to restart the repair process.
The difference between them is mainly what gets injected, and what that costs.
What is prolotherapy?
Prolotherapy uses a concentrated dextrose solution, which is essentially medical-grade sugar water, usually mixed with a small amount of numbing medicine. It is injected precisely into the painful joint and into the spots where ligaments and tendons anchor to bone. The dextrose acts as a mild, short-lived irritant that triggers a local healing response in the tissue.
Physicians have used prolotherapy for more than 80 years.² It is typically delivered as a series of treatments, commonly three to six sessions spaced several weeks apart, because each session builds on the last. In our practice, prolotherapy is performed under ultrasound guidance, so the solution goes exactly where it needs to go.
What is PRP?
Platelet-rich plasma starts with a draw of your own blood. That blood is spun in a centrifuge to concentrate the platelets, the cells responsible for clotting and for releasing the growth factors that orchestrate tissue repair. The resulting concentrate is injected into the same kinds of targets: an arthritic joint, a degenerated tendon, a strained ligament. Most PRP protocols involve one to three injections.
PRP costs more than prolotherapy for concrete reasons: it requires a blood draw, a single-use processing kit, centrifuge equipment, and additional preparation time for each treatment. You are paying for a more elaborate product, not necessarily a more elaborate result.
What the research actually shows
This is where the “prolotherapy is just the cheap version” assumption falls apart.
Knee arthritis. Two blinded, randomized controlled trials (the gold standard of clinical research) have tested dextrose prolotherapy against saline (salt water) injections. In a University of Wisconsin trial of 90 adults, prolotherapy produced clinically meaningful improvements in pain, function, and stiffness that were still present a full year later, outperforming both blinded saline injections and a home exercise program.¹ A second trial of 76 patients, published in the Annals of Family Medicine in 2020, found that dextrose injections reduced pain and improved function and quality of life compared with blinded saline injections at one year, with no adverse events reported.²
What about prolotherapy head-to-head against PRP? The results are mixed in an instructive way. One randomized trial found that both groups improved substantially, with PRP scoring somewhat better on a standard arthritis index.³ Another randomized trial found no significant difference between the two on the same measures.⁴ The American Academy of Orthopaedic Surgeons reviewed both studies and concluded that the evidence is insufficient to clearly support the superiority of either PRP or prolotherapy for knee arthritis.⁵ That is a neutral, national orthopedic organization declining to call prolotherapy the inferior treatment.
Tennis elbow. A 2025 randomized trial published in the American Journal of Sports Medicine followed just over 200 patients for two full years across four treatment groups. PRP produced the largest improvement in arm-function scores, and prolotherapy also produced significantly greater improvement than physiotherapy.⁶ In plain terms: both injection therapies beat conservative care, with PRP ahead by a margin.
Rotator cuff (shoulder) pain. In a blinded randomized trial of 73 patients with chronic rotator cuff tendinopathy, dextrose injections placed directly on the painful tendon attachments produced superior long-term pain improvement and patient satisfaction compared with blinded saline injections, and everyone in the study also received physical therapy.⁷
The honest pattern across the evidence: both treatments help, and help durably. When differences appear, they tend to favor PRP by a modest margin; in several studies, no meaningful difference is found at all. Researchers are still working out how much of each treatment’s benefit comes from true tissue repair versus other healing pathways, but the improvements measured in well-designed, blinded trials are real. Nothing in this literature supports the idea that choosing prolotherapy means settling for a treatment that doesn’t work.
The cost difference
Neither treatment is typically covered by insurance. Medicare has a longstanding policy excluding prolotherapy from coverage, and most commercial insurers consider both therapies investigational, so patients generally pay out of pocket for either one.¹⁰ That makes the price difference worth understanding clearly.
The gap comes down to what goes into each treatment. PRP’s blood-processing steps are what drive its price, and national surveys of U.S. practices show that PRP pricing varies widely from clinic to clinic as a result.⁸ Its use has nonetheless grown significantly nationwide over the past decade.⁹ Prolotherapy requires none of that processing. The solution itself is simple and inexpensive, which is why it consistently sits at the low end of the regenerative-injection spectrum.
Even accounting for the fact that prolotherapy usually requires more sessions than PRP, a full prolotherapy course frequently costs less than a course of PRP, and often dramatically less when multiple body regions need treatment. Because pricing depends on the condition, the body region, and the number of areas treated, we quote costs individually; our staff is happy to walk you through the numbers for your specific treatment plan before you commit to anything.
| Prolotherapy | PRP | |
|---|---|---|
| What’s injected | Concentrated dextrose (sugar) solution | Concentrated platelets from your own blood |
| Typical course | 3–6 sessions, several weeks apart | 1–3 injections |
| Relative cost per session | Lower — simple solution, no processing | Higher — blood draw, processing kit, and prep time ⁸ |
| Insurance coverage | Generally not covered ¹⁰ | Generally not covered ⁸ |
| Best-studied uses | Knee arthritis, tennis elbow, rotator cuff and other tendon/ligament pain ¹ ² ⁶ ⁷ | Knee arthritis, tennis elbow and other tendinopathies ⁵ ⁶ |
One more practical point: choosing prolotherapy first closes no doors. If you get a partial response and want to pursue PRP or another orthobiologic treatment later, nothing about a prolotherapy series prevents that. Many of our patients use it exactly this way, as a sensible, lower-cost first step.
So which one is right for you?
There is no universal answer, which is why this is a conversation rather than a menu. The factors we weigh together include your specific diagnosis and its severity (moderate knee arthritis, for example, has the largest PRP research base), how many areas need treatment (treating several regions with PRP multiplies the cost quickly, while prolotherapy can cover more territory affordably), your budget, and how you feel about more visits with a lower per-visit cost versus fewer visits at a higher one.
Our commitment is to tell you honestly when we believe PRP is worth the additional investment for your particular problem, and when prolotherapy is likely to get you where you want to go for considerably less money.
Safety and what to expect
Both treatments have excellent safety profiles. Prolotherapy uses a sugar solution; PRP uses your own blood. Neither randomized knee-arthritis prolotherapy trial reported any adverse events.¹ ² The most common experience after either treatment is soreness or a temporary flare lasting a few days, which is expected, because a mild inflammatory response is precisely what the treatment is designed to create. For the same reason, we ask patients to avoid anti-inflammatory medications such as ibuprofen or naproxen around the time of treatment, since those drugs work against the healing response we’re trying to stimulate. As with any injection, rare risks include infection and bleeding.
Improvement with either therapy is gradual, unfolding over weeks as tissue responds. Neither is a quick fix in the way a cortisone shot can be. The tradeoff is that the goal is lasting change rather than temporary relief.
The bottom line
Prolotherapy is not “discount PRP.” It is an established injection therapy with more than 80 years of clinical use and its own randomized-trial evidence in the knee, elbow, and shoulder, which is evidence strong enough that a major orthopedic organization declines to rank it below PRP.⁵ If the cost of PRP has kept you on the sidelines, prolotherapy may be the reasonable, evidence-supported path forward.
If you’ve previously been recommended PRP and cost was the obstacle, ask us whether prolotherapy is an appropriate fit for your condition. We’re happy to walk through the evidence, the pricing, and the plan that makes sense for you.
This article is for general education only and is not medical advice. Individual results vary, and no injection therapy is right for every patient or every condition. Please consult a qualified physician about your specific situation.
References
- Rabago D, Patterson JJ, Mundt M, et al. Dextrose prolotherapy for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2013;11(3):229-237. https://pubmed.ncbi.nlm.nih.gov/23690322/
- Sit RWS, Wu RWK, Rabago D, et al. Efficacy of intra-articular hypertonic dextrose (prolotherapy) for knee osteoarthritis: a randomized controlled trial. Ann Fam Med. 2020;18(3):235-242. https://www.annfammed.org/content/18/3/235
- Rahimzadeh P, Imani F, Faiz SHR, et al. The effects of injecting intra-articular platelet-rich plasma or prolotherapy on pain score and function in knee osteoarthritis. Clin Interv Aging. 2018;13:73-79. https://pubmed.ncbi.nlm.nih.gov/29379278/
- Eroglu A, Sari A, Durmus B. Platelet-rich plasma vs prolotherapy in the management of knee osteoarthritis: randomized placebo-controlled trial. Turk J Sports Med. 2016;51(2). https://journalofsportsmedicine.org/full-text/152/eng
- American Academy of Orthopaedic Surgeons. Platelet-Rich Plasma (PRP) for Knee Osteoarthritis: Technology Overview. https://www.aaos.org/globalassets/quality-and-practice-resources/biologics/technology-overview_prp-for-knee-oa.pdf
- Lhee SH, Lee KR, Lee DY. Comparing the use of physiotherapy, shockwave therapy, prolotherapy, and platelet-rich plasma for chronic lateral epicondylosis: a prospective, randomized controlled trial with 2-year follow-up. Am J Sports Med. 2025. https://journals.sagepub.com/doi/10.1177/03635465251361515
- Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dextrose prolotherapy versus control injections in painful rotator cuff tendinopathy. Arch Phys Med Rehabil. 2016;97(1):17-25. https://pubmed.ncbi.nlm.nih.gov/26301385/
- The cost variability of orthobiologics. Orthop J Sports Med. 2019. (A survey of 1,345 U.S. practices documenting wide practice-to-practice variability in PRP pricing.) https://pmc.ncbi.nlm.nih.gov/articles/PMC6931181/
- Trends in utilization, demographics, and costs of platelet-rich plasma injections: a ten-year nationwide investigation. 2023. https://pubmed.ncbi.nlm.nih.gov/36755520/
- Joint Pain Authority. Does Medicare cover prolotherapy? (Medicare coverage exclusion for prolotherapy.) https://jointpainauthority.com/insurance/medicare-prolotherapy/
About the Author: Phil Rozek
