Analgesic Effect and Potential Cumulative Benefit from Caudal Epidural D5W in Consecutive Participants with Chronic Low-Back and Buttock/Leg Pain

Maniquis-Smigel, Liza; Reeves, Kenneth Dean; Rosen, Howard Jeffrey; Lyftogt, John; Graham-Coleman, Cassie; Cheng, An Lin; Rabago, David

doi:10.1089/acm.2018.0085

Cited by 34 publications

(22 citation statements)

References 52 publications

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“…A therapeutic benefit of dextrose based on a neurogenic mechanism was proposed in 2008 36 hydrodissection for carpal tunnel syndrome, 31 peritendinous dextrose injection for Achilles tendinopathy, 37 and epidural dextrose for chronic low back pain. 38,39 Similar effects have been reported in a retrospective analysis of the results from regional hydrodissection using dextrose in patients with various neurogenic pain conditions of the upper body. 40 Several neural mechanisms have been hypothesized.…”

Section: Discussionsupporting

confidence: 65%

Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover

Louw

Reeves²,

Lam

et al. 2019

Mayo Clinic Proceedings

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Objective: To assess the efficacy and longer-term effectiveness of dextrose prolotherapy injections in participants with temporomandibular dysfunction. Patients and Methods: A randomized controlled trial with masked allocation was conducted from January 14, 2013, through December 19, 2015. Forty-two participants (with 54 joints) meeting temporomandibular dysfunction criteria were randomized (1:1) to 3 monthly intra-articular injections (20% dextrose/0.2% lidocaine or 0.2% lidocaine) followed by as-needed dextrose/0.2% lidocaine injections through 1 year. Primary and secondary outcome measures included a 0 to 10 Numerical Rating Scale score for facial pain and jaw dysfunction; maximal interincisal opening (MIO) measured in millimeters, percentage of joints with 50% or more change (improvement) in pain and function, and satisfaction.

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Section: Discussionsupporting

confidence: 65%

Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover

Louw

Reeves²,

Lam

et al. 2019

Mayo Clinic Proceedings

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“…34 In a subsequent open-label study, the pattern and degree of pain relief with dextrose was similar after each injection, with a cumulative pain improvement of 3.4 ± 2.3 points (52%) on the 0-10 NRS scale for pain, and functional improvement 18.2 ± 16.4% (42%) on the 0-100 Oswestry Disability Index at 12 months. 35 The typical injectate volume for research on HD of the median nerve in the carpal tunnel is 10 mL or less. [1][2][3][4]7,8 However, according to the authors' experience, a much larger volume of injectate (typically 20-30 mL) needs to be used to completely release the nerve from the surrounding soft tissues to achieve an oval appearance, as most nerves and plexi are not located in such a confined area as the carpal tunnel.…”

Section: Non-cts-research Observations and Summary Of Research Statusmentioning

confidence: 99%

<p>Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms</p>

Lam¹,

Hung²,

Chiang³

et al. 2020

JPR

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Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves the injection of an anesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue, fascia, or adjacent structures. Animal models suggest the potential for minimal compression to initiate and perpetuate neuropathic pain. Mechanical benefits of HD may relate to release of nervi nervorum or vasa nervorum compression. Pathologic nerves can be identified by examination or ultrasound visualization. The in-plane technique is the predominant and safest method for nerve HD. Five percent dextrose may be favored as the preferred injectate based on preliminary comparative-injectate literature, but additional research is critical. Literature-based hypotheses for a direct ameliorative effect of dextrose HD on neuropathic pain are presented.

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“…There was one level I study, which demonstrated epidural prolotherapy to be efficacious in relieving pain for up to 48 hours, but the results did not differ from placebo at 2 weeks . That same group assessed repeat injections as needed over the course of 1 year in the previous study cohort and found clinically significant improvement in NRS and ODI outcome measures . These studies highlighted the issues with single‐injection prolotherapy and the need to assess the effect of serial prolotherapy epidural injections for long‐term pain relief.…”

Section: Orthobiologics and The Literaturementioning

confidence: 99%

Regenerative Medicine for Axial and Radicular Spine‐Related Pain: A Narrative Review

et al. 2020

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Introduction Regenerative injection‐based therapy has established itself as a therapeutic option for the management of a variety of painful musculoskeletal conditions. The aim of this work was to review the current literature regarding regenerative injection therapy for axial/radicular spine pain. Methods A comprehensive literature review was conducted on the use of regenerative medicine for axial/radicular spine pain. Eligible articles analyzed the therapeutic injection effects of platelet‐rich plasma (PRP), prolotherapy, or mesenchymal signaling cells (MSCs) via intradiscal, facet joint, epidural, or sacroiliac joint delivery. Results Regarding intradiscal PRP, there are level I/IV studies supporting its use. Regarding intradiscal prolotherapy, there are level III to IV studies supporting its use. Regarding intradiscal MSCs, there are level I/IV studies supporting its use with the exception of one level IV study that found no significant improvement at 12 months. Regarding facet joint injections with PRP, there are level I/IV studies supporting its use. Regarding facet joint injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate any statistical significance supporting its use. Regarding epidural injections with PRP, there are level I/IV studies supporting its use. Regarding epidural injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate statistical significance beyond 48 hours. Regarding sacroiliac joint injections with PRP, there are level I/IV studies supporting its use. Regarding sacroiliac joint injections with prolotherapy, there are level I/III studies supporting its use. Conclusions Currently, there are level I studies to support the use of PRP and MSC injections for discogenic pain; facet joint injections with PRP; epidural injections of autologous conditioned serum and epidural prolotherapy; and PRP and prolotherapy for sacroiliac joint pain. One level I study showed that facet joint prolotherapy has no significant benefit. Notably, no intervention has multiple published level I studies.

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Analgesic Effect and Potential Cumulative Benefit from Caudal Epidural D5W in Consecutive Participants with Chronic Low-Back and Buttock/Leg Pain

Cited by 34 publications

References 52 publications

Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover

Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover

<p>Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms</p>

Regenerative Medicine for Axial and Radicular Spine‐Related Pain: A Narrative Review

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