Prolotherapy: A Clinical Review

Summary Article on Prolotherapy:
"Prolotherapy: A Clinical Review of its Role in Treating Chronic Musculoskeletal Pain"


A review article on prolotherapy by Dietel at al, published in the journal Physical Medicine and Rehabilitation in 2011 (online link), concentrated on evidence for treatment in low back pain, lateral epicondylosis, Achilles tendinosis and osteoarthritis. It concluded that prolotherapy is a “promising option for the treatment of painful musculoskeletal conditions, particularly when other standard treatments have proved ineffective.”  However, it erroneously said that the osteoarthritis studies on knee and fingers did not show statistical significance. The finger OA study clearly showed clinical and statistical significant improvement of dextrose over lidocaine injection for both grip pain and range of motion, and the knee OA showed multivariate significance for improvement of dextrose over lidocaine, although both groups improved, which is now being understood as related to real effects of injection (Injection is not a placebo). Note the study on Osgood Schlatter’s Disease (published in 2011) clearly shows that both dextrose and lidocaine are better than usual care and dextrose better than lidocaine.


Here is the reference and abstract.

Distel LM; Best TM   Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain [In Process Citation]   PM R 2011; 3(6 Suppl):S78-81.

AUTHOR'S ADDRESS:  Sports Medicine, The Ohio State University, Columbus, OH.

ABSTRACT:  Prolotherapy is a technique that involves the injection of an irritant, usually a hyperosmolar dextrose solution, typically in the treatment of chronic painful musculoskeletal conditions. Despite its long history and widespread use as a form of complementary therapy, there still are disparities over its optimal indications and injection preparations. There are, however, numerous studies available regarding the use and efficacy of prolotherapy for various musculoskeletal conditions. The most frequently published indication is in the treatment of chronic low back pain, but there are recent studies that examined its use in the management of refractory tendinopathies as well as osteoarthritis. There is growing evidence to suggest that prolotherapy may be helpful in treating chronic low back pain when coupled with adjunctive therapies, such as spinal manipulation or corticosteroid injections. There is also evidence to suggest that prolotherapy is effective in treating refractory tendinopathies, particularly for lateral epicondylosis and Achilles tendinopathy. Additional larger, randomized controlled trials are needed to make specific recommendations regarding ideal protocols and indications. There is emerging evidence for the use of prolotherapy as a treatment option for osteoarthritis; however, further studies are needed to conclusively demonstrate its efficacy. Overall, prolotherapy remains a promising option for the treatment of painful musculoskeletal conditions, particularly when other  standard treatments have proved ineffective. [Copyright 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.]

K. Dean Reeves, M.D. is a physician and medical researcher in the area of pain caused by arthritis, chronic sprains and chronic strains. His private practice is located in the greater Kansas City area of Roeland Park, Kansas.  He collaborates in research with other locations across the country and internationally, and is licensed in the states of Kansas and Missouri.

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Dr. K. Dean Reeves

No part of this site should be understood to be personal medical advice or instruction in how to perform injection therapy. A decision on treatment requires a good history and full examination and a knowledge of your treatment goals. Treatment decisions should be made in consultation with your personal healthcare professional and/or prolotherapist.