Prolotherapy 3

State of the Art Prolotherapy Theatre

Prolotherapy 1

Sclerosant Injections to Ligaments

Prolotherapy 2

Reduces the Risk of Recurring Back Pain

Prolotherapy 4

Neural Prolotherapy

Prolotherapy Research

Prolotherapy Procedure
Prolotherapy is usually performed on 3 occasions initially with 1-3 weeks between each treatment. A further course of 3 treatments is used if the first course is subjectively or objectively helpful on a VAS pain scale but the improvement is incomplete. A common proliferant solution in the UK is a 50/50 mixture of P-2-G and 1% lidocaine. P-2-G contains phenol 2%, glycerol 25% and dextrose 25%. A weaker solution that can be used is 12.5 - 25% dextrose diluted with 1% lidocaine.

The technique involves local anaesthetic to the skin, and sometimes the use of Entonox (nitrous oxide and oxygen), or intravenous sedation for anxious patients. The treatment can be performed with or without X-ray guidance, but has been performed for many years in the UK and USA without X-ray guidance and has resulted in a similarly low adverse reaction profile as for most other spinal injections.

Summary of Comments on Prolotherapy and Lumbar Fusion Research
Of the four published randomised controlled trials on prolotherapy, two show a positive benefit, albeit combined with an exercise programme and brief manipulative treatment (Ongley, Klein). The third (Yelland) shows a sustained benefit of both prolotherapy and placebo groups over 2 years to rival that of any surgical intervention. One is negative (Dechow) for the possible reasons stated in the discussion below, and it is important to note that all of these studies were performed on chronic back pain with an average duration of 7-10 years and that the patients were not highly selected.

The literature indicates that the enthusiasm for the use of this technique has endured for over half a century. Whilst it is by no means a panacea, prolotherapy offers a substantial chance for improvement. Many anecdotal cases with dramatic responses have greatly changed patients' quality of life and in some instances led to the avoidance of spinal fusion or disc replacement. Spinal fusion and disc replacement continue to generate controversy and in any event both of these interventions are far more costly with a significantly higher number of reported complications than prolotherapy.