<unk>  ("Proliferative Injection Therapy") involves injecting an otherwise non-pharmacological and non-active proliferant or irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. In 2005, Robert D. Sheeler, MD (Medical Editor, Mayo Clinic Health letter), who first learned of<unk>  through C. Everett Koop’s interest in the treatment, listed ankles, knees, elbows, and sacroiliac joint in the low back as areas most likely to benefit from<unk>  treatment and stated that "unlike corticosteroid injections — which may provide temporary relief —<unk>  involves improving the injected tissue by stimulating tissue growth."
Stimulation of tissue growth by dextrose<unk>  was confirmed by Mayo Clinic researchers (Biomechanics Laboratory, Division of Orthopedic Research, and Department of Neurology),(Oh 2008, Yoshii 2009, Yoshii 2011, Yoshii 2014), who performed four controlled studies (three blinded) to determine if dextrose could thicken and strengthen a rabbit ligament without inflammation and with production of normal tissue without any scarring. Their purpose was to thicken the ligament that is responsible for producing carpal tunnel syndrome so that they would have an animal model for research.  In the process, results in every study showed that 10% dextrose injection, compared to saline injection, consistently resulted in a increase in total energy absorption and tensile load tolerated by the ligament (transverse carpal ligament equivalent) before rupture. The ligament approximately doubled in thickness and, histologically, normal tissue was seen without scarring.  This proliferation effect with normally organized fibrosis (growth of connective tissue) in the absence of scarring distinguishes<unk>  from sclerotherapy.<unk>  is often used as an treatment option rather than antiinflammatory approaches (such as steroids or non steroid antiinflammatory drugs [NSAIDS]) in the presence of chronic pain involving ligaments and tendons, as chronic changes in ligaments and tendons are primarily degenerative in nature rather than primarily inflammatory. (Scott 2015).<unk>  is also used as an alternative in the presence of chronic pain involving joints, in which histologic findings are also primarily degenerative.  Lack of benefit in general with anti-inflammatory approaches on the clinical course of osteoarthritis is emphasized by a recent clinical  trial of saline versus steroid (triamcinolone) injection in knee osteoarthritis showing unequivocal acceleration of cartilage loss with quarterly injection of steroid for 2 years in comparison with a saline control injection, reported in JAMA. (McAlindon 2017)<unk>  has enjoyed increased acceptance within the medical community, especially in light of the focus being given to regenerative medicine as a discipline. Eighteen randomized controlled trials were found on PubMed as of June, 2017. (see Evidence Based Medicine section below)
Prolotherapy
Dexamethasone implant
Vaginoplasty
Vasectomy
Hymenorrhaphy
Vaginectomy
Otoplasty
Labiaplasty