Critical Review of Prolotherapy for Osteoarthritis, Low Back Pain, and other Musculoskeletal Conditions

Kim, Sunny R.; Stitik, Todd P.; Foye, Patrick M.; Greenwald, Brian D.; Campagnolo, Denise I.

doi:10.1097/01.phm.0000124443.31707.74

Cited by 60 publications

(37 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…31 The potential of prolotherapy to stimulate release of growth factors favoring soft tissue healing 11,32 and a positive neural effect 33 have also been suggested. In addition to dextrose-specifi c effects, needle trauma and volume expansion of local tissue may also produce tissue-level effects.…”

Section: Discussionmentioning

confidence: 99%

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

Rabago

Patterson

Mundt

et al. 2013

The Annals of Family Medicine

154

150

View full text Add to dashboard Cite

PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the effi cacy of prolotherapy for knee osteoarthritis. METHODSNinety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or athome exercise. Extra-and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), postprocedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.RESULTS No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises. Ann Fam Med 2013;11:229-237. doi:10.1370/afm.1504. INTRODUCTIONK nee osteoarthritis is a chronic disease resulting in joint pain, stiffness, and decreased function.1 It is common, expensive for patients 2 and society, and age-related 3 ; by age 65 years, most of the population has radiographic evidence of osteoarthritis. 4 Sources of pain include intra-articular and supportive extra-articular structures. 5,6 Standard-of-care is multidisciplinary; however, a recent systematic review reported no clear benefi t of any one therapy. 4 Conservative therapies 7 and oral supplements 8,9 have been evaluated but are without clear effi cacy. The Agency for Healthcare Research and Quality has called for the development of new therapies to prevent and treat knee osteoarthritis. 4 Prolotherapy is an injection therapy for chronic musculoskeletal injury, including knee osteoarthritis. [10][11][12] A core principle is the injection of small volumes of an irritant solution at multiple painful ligament and tendon insertions and in adjacent joint spaces over several treatment sessions. 10Prolotherapy has be...

show abstract

Section: Discussionmentioning

confidence: 99%

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

Rabago

Patterson

Mundt

et al. 2013

The Annals of Family Medicine

154

150

View full text Add to dashboard Cite

show abstract

“…Joint flexibility may decrease with age, affecting normal daily function, older adults could maintain the ability improving autonomy (use of aids), and specific rehabilitation treatment in relation to surgery [54] . The first step is to inform and educate the patient about the nature and consequences of the disease.…”

Section: Flexibility Trainingmentioning

confidence: 99%

Effects of exercise on physical limitations and fatigue in rheumatic diseases

Musumeci

2015

WJO

View full text Add to dashboard Cite

Physical activity covers not just sports but also simple everyday movements such as housework, walking and playing. Regular exercise has a great importance in maintaining good health, indeed inactivity is a risk factor for different chronic diseases. Physical exercise can play a crucial role in the treatment of rheumatic diseases, optimizing both physical and mental health, enhancing energy, decreasing fatigue and improving sleep. An exercise program for patients with rheumatic diseases aims to preserve or restore a range of motion of the affected joints, to increase muscle strength and endurance, and to improve mood and decrease health risks associated with a sedentary lifestyle. In this editorial I describe the benefits of the exercise on physical limitations and fatigue in rheumatic diseases that seem to have a short and long-term effectiveness. A literature review was conducted on PubMed, Scopus and Google Scholar using appropriate keywords based on the present editorial.

show abstract

“…Prolotherapy involves the injection of small amounts of various proliferant solutions (such as hypertonic dextrose, sodium morrhuate, or platelet rich plasma) into ligaments and tendons at the painful enthesis (attachment site to bone), as well as at trigger points and adjacent joint spaces; this procedure induces healing of the injured structures [177].…”

Section: Prolotherapymentioning

confidence: 99%

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Hauser¹

2013

TOREHJ

View full text Add to dashboard Cite

Ligament injuries are among the most common causes of musculoskeletal joint pain and disability encountered in primary practice today. Ligament injures create disruptions in the balance between joint mobility and joint stability, causing abnormal force transmission through the joint, which results in damage to other structures in and around the joint. The long-term consequence of nonhealed ligament injury is osteoarthritis, the most common joint disorder in the world today.Ligaments heal through a distinct sequence of cellular events that take place in three consecutive stages: an acute inflammatory phase, a proliferative or regenerative phase, and a tissue remodeling phase. The process can take months to resolve itself, and despite advances in therapeutics, many ligaments do not regain their normal tensile strength.Various diagnostic procedures have been used to determine and assess ligament injury. Traditionally, MRI and X-rays have been the most utilized techniques; however, because ligaments do not show up clearly with these devices, there have been many false positives and negatives reported due to inconclusive or inaccurate readings. Newer technologies, such as ultrasound and digital motion X-ray, are able to provide a more detailed image of a ligament's structure and function.Numerous strategies have been employed over the years attempting to improve ligament healing after injury or surgery. One of the most important of these is based on the understanding that monitoring early resumption of activity can stimulate repair and restoration of function and that prolonging rest may actually delay recovery and adversely affect the tissue's response to repair. Likewise, there is a shift away from the use of steroid injections and nonsteroidal antiinflammatory medications. Although these compounds have been shown effective in decreasing the inflammation and pain of ligament injuries for up to six to eight weeks, their use has been shown to inhibit the histological, biochemical, and biomechanical properties of ligament healing. For this reason their use is cautioned against in athletes who have ligament injuries. Such products are no longer recommended for chronic soft tissue injuries or for acute ligament injuries, except for the shortest possible time, if at all.Regenerative medicine techniques, such as prolotherapy, have been shown, in both case series and clinical studies, to resolve ligament injuries of the spine and peripheral joints. More research and additional studies are needed to better assess ligament injuries and healing properties.

show abstract

Critical Review of Prolotherapy for Osteoarthritis, Low Back Pain, and other Musculoskeletal Conditions

Cited by 60 publications

References 26 publications

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial

Effects of exercise on physical limitations and fatigue in rheumatic diseases

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Contact Info

Product

Resources

About