Recent publications co-authored by Dr. Reeves (2020 to the present)
2023 Review study showing benefit of dextrose prolotherapy for plantar fasciopathy (aka plantar fasciitis)
Dr. Hugo Fong and colleagues reviewed eight randomized controlled trials that evaluated the effectiveness of dextrose prolotherapy in plantar accumulate (fasciopathy is a better term since it is a degenerative more than an inflammatory condition) Pooled results factored steroid injection in the first few months, but dextrose injection outperformed steroid injection in the medium term (6-12 months). Like many review studies, the small studies on dextrose, which are primarily self-funded, have design limitation which limit the strength of the studies, and the strength of conclusions, but evidence continues to accumulate that dextrose injection is a better long-term solution than steroid injection for plantar fasciopathy.
2023 An App that helps physicians produce standardized platelet-rich plasma
Dr Ted Harrison from Sidney, Canada and colleagues developed PRPCalc2, a set of software tools to help physicians take study results from new publications, translate those results into their specific practice, and estimate yield and dosage of platelets without the benefit of an in-office hematology analyzer.
2023 Review study showing benefit from ultrasound-guided injection of both dextrose and platelet rich plasma in the treatment of carpal tunnel syndrome.
Dr. Stanley Lam from Hong Kong and colleagues reviewed article on all types of injection solutions used to treat carpal tunnel (steroid, dextrose and platelet rich plasma. They also reviewed articles on minimally invasive (mini-surgery) type approaches. Formal meta-analysis found that both dextrose and platelet rich plasma out-performed control injection with steroid or saline, and no serious adverse reactions were reported.
2023 A more accurate, and comfortable way to inject knees.
When treating knee arthritis with injection of dextrose, platelet rich plasma, or anything therapeutic, it is very important to inject in the correct place. Even using ultrasound guidance, injection may be inaccurate. Injection in other locations can be irritating rather than helpful, and much more uncomfortable. The method described and demonstrated in this article by Dr. Stanley Lam and colleagues reliably avoids injection in the fat pads of the knee.
2022 Treating those that fail surgery for carpal tunnel syndrome by ultrasound-guided injection of dextrose.
Dr. Ta-Chung Chao from the School of Medicine of the National Defense Medical Center in Taipei, Taiwan, and colleagues, retrospectively reviewed outcomes from consecutive patients he treated by freeing up the median nerve under ultrasound guidance (hydrodissection) who had all failed a first surgery for carpal tunnel syndrome (CTS), meaning symptoms were not relieved or came back. This is important information because the effect of current conservative management or revision surgery is unsatisfactory. He reviewed records on 40 consecutive patients and was able to capture data on 36 of 40. Symptom relief ≥ 50% was considered an effective outcome, while symptom relief < 50% was rated as a poor outcome. No patients reported worsening due to treatment. Nearly 2/3 (61.1%) of patients reported an effective outcome after a mean of 3.1 injections, with a post-injection follow-up mean of 33 (6–67) months. A significantly higher percentage of those with recurrent symptoms reported an excellent outcome, defined as a greater than 70% improvement (8/13 [61.6%] vs. 3/23 [13%], p = 0.006). Conclusion: Hydrodissection with 5% dextrose may result in a clinically important and durable benefit in those experiencing persistent or recurrent CTS after surgery.
2022 Dextrose protects nerves against degenerative proteins (Laboratory study)
Dr. Yung-Tsan Wu from Taiwan studied human nerve cells, and stressed by exposure to a protein that kills nerve cells or makes them stop functioning. The nerve were then surrounded by dextrose in various concentrations to observe if dextrose blocked the stress effects of the protein, called TNFα. It did. All it took to restore the metabolism of the nerve cells to normal was exposure 1/2 percent of glucose. The conclusion was that glucose (dextrose in humans) likely protects human nerves cells that are stressed.
2022 You can mix platelets and dextrose. Dextrose exposure may help platelets activate. (Laboratory study)
Many physicians that use platelet-rich plasma (PRP) for regenerative medicine injections inject dextrose in the same treatment session, because dextrose injection can treat larger areas. Some physicians may inject dextrose and lidocaine (anesthetic) in areas where PRP is to be injected, to improve comfort with PRP injection. Dr. Ted Harrison and colleagues found that, although a partial (20-30%) lysis of platelets occurred with initial exposure to dextrose, within 1 minute of exposure platelets were stable, even in high dextrose concentration. Note that partial lysis of platelets releases their growth factors and may be helpful. In addition, after 1 minute of exposure, 25% or high concentration of dextrose caused platelet size to increase 10-15% which may indicate that platelets were being pre-activated. In summary, mixing dextrose and platelets is reasonable to do and may enhance therapeutic benefit in the use of PRP injection.
2022 Dextrose prolotherapy improves pain and function in tennis elbow patients
Mengteng Zhu from the Chinese University of Hong Kong and colleagues reviewed 8 studies on the use of dextrose prolotherapy for tennis elbow (also called lateral epicondylosis). Dextrose prolotherapy outperformed active control treatments in both improvement of pain and improvement of physical functioning at 12 weeks post enrollment.
2022 A simple dextroe injection method of treatment may have a powerful effect in PTSD and complement other treatments
In 2022 I collaborated with several colleagues in the publication of a case report of a Marine veteran and former firefighter who had failed multiple medication trials and trials of customary therapy approaches. Clinically important improvements rapidly occurred in the PTSD severity scale (PTSD checklist), quality of life, and an anxiety and depression scale, and improvements were stable through 22 weeks. Anxiety benefit was observed within 20 minutes of injection. This treatment method, which uses a small needle injection just under a superficial muscle of the neck on each side, is well tolerated, and has potential as a supplementary treatment for standard of care treatments, and potentially for emergency care. Unlike stellate ganglion block, there is no anesthetic needed (only dextrose) and it can be done on both sides. Empirical results suggest this pattern and degree of improvement is typical. A randomized controlled clinical trial is to begin in late 2023.
2021 A simple self-treatment of chronic low back pain may be helpful based on a rapid testing method.
Dr. Helene Bertrand from the University of British Columbia in North Vancouver, Canada, and colleagues, developed a simple and objective measure for rotation of the sacroiliac joint that any practitioner, and potentially patient, can use to determine if their sacroiliac joint is rotated. This is followed by use of a simple corrective exercise which can be performed by the patients themselves or with the help of another. Use of this treatment outperformed usual care, and use of a sacroiliac belt provided intermediate benefit, not as much as the exercise, but more than usual care.
2021 Dextrose prolotherapy substantially improves pain in temporomandibular joint (TMJ) dysfunction.
Dr. Regina Sit. of the Chinese University of Hong Kong and colleagues reviewed ten randomized controlled trials of dextrose prolotherapy for TMJ dysfunction. Dextrose prolotherapy was significantly superior to placebo injections in reducing TMJ pain at 12 weeks, and up to 1 year in studies with longer follow-up.
2021 A single centrifuge spin increase the lymphycyte percentage compared with other white blood cells
This study, led by Dr. Ted Harrison from Sidney, British Columbia, Canada evaluated what happens to the proportion of various white blood cells during centrifugation in the process of making platelet rich plasma using five different single spin method. Each method used resulted in a significant increase in the proportion of lymphocytes and a decrease in granulocytes. Although this is preliminary work, it may be clinically relevant, because the distribution of white blood cells may affect clinical outcomes.
2020 Simple tiny needle injection of dextrose improved pain and dysfunction in patients with TMJ dysfunction
Drs. Miguel Zarate and Ricardo Frusso of Buenos Aires injected dextrose or lidocaine (anesthetic) in painful and dysfunctional jaws. Dextrose injection resulted in substantially more pain improvement by 3 months and at 12 months more dextrose than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040).
2020 Method, rationale, and examples of applications for dextrose treatment of nerve-based severe pain
Dr. Stanley Lam from Hong Kong and associates presented exploratory retrospective consecutive patient data in usual practice on outcomes from dextrose hydrodissection for chronic (mean 16±12.2 months) and severe pain (8.3 ± 1.3 on a 0–10 NRS scale), with 77% pain improvement to 2 months after the last treatment. The article focus was on describing methods and medical literature supporting this method of treatment. Lots of illustrations and fairly easy reading.
Link to Dr. Lam's article on method and rationale for dextrose hydrodissection to treat severe pain conditions.
2020 Comparing six single-spin methods of PRP preparation for cost, yield, and white and red cell counts.
Dr. Ted Harrison of Sidney, Canada, and associates studied six commonly used single-spin methods of preparation of platelet-rich plasma to determine their efficacy in capturing platelets and their variability. Yields for the six preparation methods (PMs) varied from 53(±18)% to 72(±13)%. Differences were observed for WBC count (1.8 to 14), Hematocrit (0.8 to 32), platelet concentration (568,000 to 1,062,000), and variable cost per billion platelets produced ($1.55 to $44.31).
Link to Summary abstract of Dr Harrion's article on yield and consistency for SINGle SPIN pRP Preparation
2020 Dextrose injection in arthritic knees improved pain, function, and quality of life
Dr. Regina Sit of the Chinese University of Hong Kong directed this study to show that small needle injection with dextrose improves knee pain and function in a level I (highest level of quality) randomized controlled trial. There are many other pain sources around the knee that, when included in treatment with dextrose, may result in more pain relief and functional improvement, but simple knee injection with dextrose is beneficial. The conclusion was that for pain and function, without requiring steroid injection. The conclusion was that "Intra-articular dextrose prolotherapy injections reduced pain, improved function and quality of life in patients with KOA compared with blinded saline injections. The procedure is straightforward and safe; the adherence and satisfaction were high."