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 References and Comments

Systematic Reviews
The evidence for the efficacy of prolotherapy is becoming clearer. Systematic reviews of prolotherapy refer to two major factors which make the evaluation of studies difficult. The first is the wide variety of compounds and protocols used for the injections and the second is the presence of co-interventions in the studies which demonstrate efficacy.

Rabago D, Best T, Beamsly M, Patterson J. A systematic review of prolotherapy for chronic musculoskeletal pain. Clinical J Sports Med. 2005; 15(5):376–380.
Yelland MJ, Mar C, Pirozzo S, Schoene ML, Vercoe P. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2004; (2):CD004059.
Dagenais S, Yelland M, Del Mar C, Schoene M. Prolotherapy injections for chronic low back pain. Cochrane Database Syst Rev. 2007; 2.
Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature. Spine J. 2005; 5(3):310-28.

Randomised Controlled Trials on LBP
A recent Cochrane review for the treatment of chronic low back pain found 4 high quality randomized controlled trials (RCTs) investigating prolotherapy in LBP.

Ongley 1987, Klein 1993. In 2 trials when prolotherapy was used in conjunction with spinal manipulation, exercise and other treatments, the protocol reduced pain and disability. Both of these studies demonstrated a statistically significant difference in patients reporting greater than 50% reduction of pain and disability after 6 months compared to the control group. Two systematic reviews came to similar conclusions.

Yelland 2004. This large, rigorous study used glucose alone (which is anecdotally less effective than P2G) versus saline, both groups made significant and impressive improvements in pain and disability scores (41% and 36% respectively, improvement at 1 year). The authors noted that the improvement was comparable to that reported after fusion surgery in the Swedish Lumbar Spine Study. Also it would appear that trauma caused by needling itself is actually likely to be an active part of prolotherapy treatment so the saline control injection was potentially an active treatment. This could explain the similar effects.

Dechow 1999. 74 patients from outpatient waiting list with chronic LBP (average age 45, duration median 10 years) randomised to 3 weekly injections of P2G (5ml)+5ml I% lidocaine or saline with local anaesthetic. This study used P2G versus anaesthetic injections (which anecdotally can also be therapeutic) with no associated rehabilitation. There were no statistically significant differences in outcome between groups. Radiculopathy, active litigation, obesity, co-morbidity were excluded but previous back surgery (11%) and hip arthritis not excluded. 39% were on benefits and 50% unemployed. They concluded that patient selection and combination with other treatment modalities may be factors in determining treatment success. More than 20 of the patients selected by the main investigator were deemed inappropriate for the trial by the operator (Davies) with greatest clinical experience of this treatment (personal communication). No placebo effect observed whatsoever which makes any trial of an injection treatment suspect (injections tend to provoke a strong placebo response).

Ongley M, Klein R, Dorman T, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987; 2: 143-146.
Klein R, Eek B, DeLong W, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993; 6: 23-33.
Yelland M, Glasziou P, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2003; 29: 9-16.
Dechow E, Davies R, Carr A, et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999; 38: 1255-1259.