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These disruptions lead to water and sodium influx, potassium efflux, cell swelling, membrane potential changes, and eventual cell lysis, which then releases intracellular contents, eliciting an inflammatory phenotype through DAMP release and triggering immune responses (Murao et al., 2021)

There have been rare reports of more severe reactions to prolotherapy, such as ligament rupture or spinal headaches, when injections were done in delicate areas or not using image guidance

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