David Rabago

University of Wisconsin–Madison | UW · Family Medicine and Community Health

Background Lateral ankle sprain (LAS) is a common injury. Conservative care is not uniformly effective. Chronic ankle instability (CAI) results in up to 70% of patients with LAS in the physically active population. LAS, together with subsequent osteochondral lesions and pain in many patients, leads to the development of post-traumatic osteoarthriti...

Background: Neurocytokines may upregulate or downregulate neuropathic pain. We hypothesized that dextrose (D-glucose) injections for therapeutic purposes (dextrose prolotherapy: DPT) in painful knee osteoarthritis (KOA) would favorably affect synovial-fluid neurocytokine concentrations. Methods: Twenty participants with grade IV symptomatic KOA...

Gulf War Illness (GWI) affects 25–35% of the 1991 Gulf War Veteran (GWV) population. Patients with GWI experience pain, fatigue, cognitive impairments, gastrointestinal dysfunction, skin disorders, and respiratory issues. In longitudinal studies, many patients with GWI have shown little to no improvement in symptoms since diagnosis. The gut microbi...

Despite years of standard treatments, a Marine veteran and former firefighter, disabled due to severe post-traumatic stress disorder (PTSD), worsened over ten weeks while receiving usual care. Bilateral injection of 10 mL of 5% dextrose in water using a 30-gauge needle just under the sternocleidomastoid muscle was performed at weeks 10, 12, 14, 16,...

In the search for biologically active, disease-modifying treatment modalities for chronic pain, three forms of dextrose injection—prolotherapy, perineural injection therapy, and hydrodissection—have emerged as effective for many conditions. Each is discrete but related by the injectant (dextrose) and the clinical tradition from which each is derive...

Gulf War Illness (GWI) affects 25-35% of the 1991 Gulf War Veteran population. Patients with GWI experience pain, fatigue, cognitive impairments, gastrointestinal dysfunction, skin disorders, and respiratory issues. In longitudinal studies, many patients with GWI have shown little to no improvement in symptoms since diagnosis. The gut microbiome an...

Objective To systematic review the effectiveness of hypertonic dextrose prolotherapy (DPT) on pain intensity and physical functioning in patients with lateral elbow tendinosis (LET) compared with other active non-surgical treatments. Data Sources Systematic search of CENTRAL, MEDLINE, EMBASE, Web of Science, PubMed, Dimensions, Global Health, NHS...

This paper provides a brief historical background of saline nasal irrigation (SNI), main modes of SARS-COV-2 transmission and entry, and anti-infective properties of saline. It reviews the protective evidence associated with SNI and gargling against viral upper respiratory tract infection (URTI). SARS-CoV-2 presents as an URTI transmitted mainly vi...

Hypertonic dextrose prolotherapy (DPT) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain. To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) to synthesize evidence on the effectiveness of DPT for TMDs. Eleven electronic databases we...

Aims The aim of the present study was to explore: (1) the feasibility of using color and pain drawing to describe pain; (2) the cultural appropriateness of pain body diagram (PBD); and (3) the cultural meaning of colors used in pain expression within one cultural group—the Hmong residing in the United States. Design A qualitative-descriptive study...

Objective Hypertonic dextrose (HD) injections (prolotherapy) for osteoarthritis are reported to reduce pain. Cartilage regeneration is hypothesized as a mechanism. This in vitro study identifies an HD concentration that stimulates chondrogenic cells to increase metabolic activity and assesses whether this concentration affects collagen deposition a...

Introduction While researchers have studied Hmong patients with limited English proficiency in pain communication, no research has examined primary care providers’ (PCPs’) interpretation of Hmong pain communication. This study examines PCPs’ pain communication experience with Hmong patients. Method A qualitative content analysis was conducted with...

Background: Little is known about the relevance of existing pain scales for patients with limited English proficiency (LEP). Aims: To determine the ranking and perceptions of four pain intensity scales in LEP Hmong. Design: A sequential mixed-method study. Settings: A Midwestern city, USA. Participants/subjects: Eight-four Hmong aged 19 to...

Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Settin...

Objective To assess the efficacy of saline nasal irrigation (S‐NI) and xylitol nasal irrigation (X‐NI) for chronic rhinosinusitis in participants with Gulf War illness (GWI). Methods This 26 week, 3‐arm (1:1:1) randomized controlled trial examined veterans meeting criteria for GWI with moderate‐to‐severe chronic rhinosinusitis and fatigue symptoms...

Purpose: To test the efficacy of intra-articular hypertonic dextrose prolotherapy (DPT) vs normal saline (NS) injection for knee osteoarthritis (KOA). Methods: A single-center, parallel-group, blinded, randomized controlled trial was conducted at a university primary care clinic in Hong Kong. Patients with KOA (n = 76) were randomly allocated (1...

Coccydynia is debilitating pain of the coccyx that substantially impacts quality of life. Although most cases resolve with conservative therapy, pain can become chronic and involve other anatomical areas. Treatment options include physical therapy, manual medicine, injection, and surgery with mixed results. Manual medicine options vary depending on...

Culture and language affect pain reporting, diagnosis, and treatment. Ethnic subgroup populations, such as the Hmong, are understudied in pain research. The study’s purpose is to qualitatively understand older Hmong adults’ pain expression and their pain communication with providers. Sixty-seven participants were recruited from one healthcare syste...

Background: Lateral epicondylalgia (tennis elbow) is a common, debilitating and often treatment-resistant condition. Two treatments thought to address the pathology of lateral epicondylalgia are hypertonic glucose plus lignocaine injections (prolotherapy) and a physiotherapist guided manual therapy/exercise program (physiotherapy). This trial aime...

OBJECTIVE: Pain is challenging to diagnose and manage in primary care, especially when patients have limited English proficiency (LEP). Little is known about whether LEP patients can provide pain information that is consistent with the process and the content that providers expect in a clinical interaction. We explore how LEP Hmong patients communi...

Background Lateral epicondylalgia (tennis elbow) is a common, debilitating and often treatment-resistant condition. Two treatments thought to address the pathology of lateral epicondylalgia are hypertonic glucose plus lignocaine injections (prolotherapy) and a physiotherapist guided manual therapy/exercise program (physiotherapy). This trial aimed...

Background Lateral epicondylalgia (tennis elbow) is a common, debilitating and often treatment-resistant condition. Two treatments thought to address the pathology of lateral epicondylalgia are hypertonic glucose plus lignocaine injections (prolotherapy) and a physiotherapist guided manual therapy/exercise program (physiotherapy). This trial aimed...

Introduction Approximately 25%–35% of the 1991 Gulf War Veteran population report symptoms consistent with Gulf War Illness (GWI), a chronic, multi-symptom illness characterised by fatigue, pain, irritable bowel syndrome and problems with cognitive function. GWI is a disabling problem for Gulf War Veterans, and there remains a critical need to iden...

Chronic musculoskeletal pain and disability dramatically reduce quality and quantity of life worldwide, disproportionately so in low- and middle-income countries. Complementary therapies not typically learned in conventional medical training have much to offer but are under-utilized. Prolotherapy is an injection-based complementary therapy supporte...

Aim: Platelet Rich Plasma (PRP) is an emerging therapy for knee osteoarthritis (KOA). Studies have evaluated the effectiveness of intra-articular PRP, which ignores extra-articular tissue dysfunction and may provide incomplete treatment of KOA. The study aimed to pilot test a leukocyte-rich (mononuclear cells) PRP injection protocol for primary KO...

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 temporom...

Objectives: Knee osteoarthritis (KOA) is a growing health problem with limited nonsurgical treatment options. Prolotherapy is an injection-based technique for chronic KOA pain; health plan coverage is limited, presenting an access barrier. A local health plan recently included coverage for prolotherapy for KOA, but uptake and treatment response in...

Objective To investigate the relationship between tendon structural changes determined by static ultrasound images (US) and sensory changes using quantitative sensory testing (QST), and clinical measures in lateral epicondylalgia. Materials and methods Both elbows of 66 adult participants with a clinical diagnosis of lateral epicondylalgia were in...

Objectives: Chronic low-back pain (CLBP) participants in a prior controlled study reported short-term pain relief after caudal epidural injection of 5% dextrose (D5W). This study assessed whether repeated caudal epidural injections of D5W results in serial short-term diminution of CLBP and progressive long-term decrease in pain and disability. De...

Background: Knee Osteoarthritis (KOA) is a very common condition with prevalence rising with age. It is a major contributor to global disability and has a large socioeconomic burden worldwide. Conservative therapies have marginal effectiveness, and surgery is reserved for severe symptomatic KOA. Dextrose Prolotherapy (DPT) is an evidence-based inj...

Purpose of review: Osteoarthritis and overuse tendinopathy are common chronic conditions of high societal and patient burden. The precise etiology of pain and disability in both conditions is multifactorial and not well understood. Patients are often refractory to conservative therapy. The development of new therapeutic options in both conditions...

Scientific Reports 6 : Article number: 25247 10.1038/srep25247 ; published online: 05 May 2016 ; updated: 07 April 2017 This Article contains errors in Tables 1, 2, 3 and 4 where references 29, 30 and 31 are incorrectly given as references 21, 22 and 30 respectively.

Background Hypertonic dextrose injection (prolotherapy) is reported to reduce pain including non-surgical chronic low back pain (CLBP), and subcutaneous injection of 5% dextrose is reported to reduce neurogenic pain, hyperalgesia and allodynia. The mechanism in both cases is unclear, though a direct effect of dextrose on neurogenic pain has been pr...

Prolotherapy involves the injection of nonbiologic solutions, typically at soft tissue attachments and within joint spaces, to reduce pain and improve function in painful musculoskeletal conditions. A variety of solutions have been used; dextrose prolotherapy is the most rigorously studied and is the focus of this review. Although the mechanism of...

Dextrose prolotherapy (DPT) is a treatment for chronic pain involving the injection of hypertonic dextrose at soft tissue attachments or within joint spaces. The mechanism of action of DPT is likely multifactorial. Controlled animal and human trials have reported proliferation of soft tissue and a potential direct neural effect of dextrose injectio...

Objective: Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, a...

Background: Systematic reviews support nasal saline irrigation for chronic or recurrent sinus symptoms, but trials have been small and few in primary care settings. Steam inhalation has also been proposed, but supporting evidence is lacking. We investigated whether brief pragmatic interventions to encourage use of nasal irrigation or steam inhalat...

Systematic reviews support saline nasal irrigation for chronic/recurrent sinus symptoms but the trials are small, and few in typical primary care settings. Steam inhalation is poorly evidence-based. Our aim was to estimate the impact of brief pragmatic interventions to use steam and nasal irrigation. Methods: Adults with a history of recurrent/chr...

Background: Anecdotal evidence suggests that a vertical small-needle injection method enters the caudal epidural space with comparable efficacy to cephalad-directed methods, with less intravascular injection. Objectives: Assess the success rate of vertical caudal epidural injection using epidurography and the frequency of intravascular injection...

Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 201...

Background: Dextrose injection is reported to improve KOA-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed. Objective: To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful knee osteoarthritis...

Knee osteoarthritis (KOA) is a common chronic disease of high patient and societal impact. The etiology is multifactorial; pain sources include both intra- and extra-articular tissues. A number of alternative therapies have been assessed for KOA. Patients are often refractory to best-practice conservative management, and the development of new ther...

Capsaicin specifically activates, and then gradually exhausts, the transient receptor potential vanilloid type 1 (TRPV-1) receptor, a key receptor in neuropathic pain. Activation of the TRPV-1 receptor is accompanied by burning pain. A natural substance or medication that can reduce the burning pain resultant from capsaicin application may have the...

Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy...

Introduction: Gulf War Illness (GWI) affects 1 in 7 returned Persian Gulf War veterans. Quality-of-life impact is large; there is no cure. Chronic sinus symptoms and fatigue are common. Nasal irrigation with saline (NI-S) or xylitol (NI-X) improve sinus symptoms and fatigue in the general population. This trial will assess the effect of NI-S and N...

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Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient sa...

Objectives: This study determined whether injection with hypertonic dextrose and morrhuate sodium (prolotherapy) using a pragmatic, clinically determined injection schedule for knee osteoarthritis (KOA) results in improved knee pain, function, and stiffness compared to baseline status. Design: This was a prospective three-arm uncontrolled study...

PURPOSE Knee osteoarthritis is a common, debilitating chronic disease. Prolo-therapy 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. METHODS Ninety adults with at le...

To assess the relationship between knee osteoarthritis (KOA)-specific quality-of-life (QoL) and intra-articular cartilage volume (CV) in participants treated with prolotherapy. KOA is characterized by CV loss and multifactorial pain. Prolotherapy is an injection therapy reported to improve KOA-related QoL compared to blinded saline injections and a...

Objective: Chronic lateral epicondylosis is common, debilitating, and often refractory. Prolotherapy (PrT) is an injection therapy for tendinopathy. The efficacy of two PrT solutions for chronic lateral epicondylosis was evaluated. Design: This study is a three-arm randomized controlled trial. Twenty-six adults (32 elbows) with chronic lateral e...

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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 efficacy of prolotherapy for knee osteoarthritis. Methods: Ninety adults with at...

Study design: Single-cohort descriptive and correlational study. Objectives: To investigate the relationships between tendon pathology, biomechanical measures, and self-reported pain and function in individuals with chronic lateral epicondylosis. Background: Lateral epicondylosis has a multifactorial etiology and its pathophysiology is not wel...

Assess platelet rich plasma (PRP) injection for rotator cuff tendinopathy (RCT). Prospective open label study with 1-year follow-up. Participants recruited from an outpatient sports medicine clinic had clinically and magnetic resonance image (MRI)-demonstrated RCT refractory to physical therapy and corticosteroid injection. They received one ultras...

Poster associated with Zgierska A, Obasi C, Brown R, Ewers T, Rabago D, Barrett B. Mindfulness Meditation versus Exercise in the Prevention of Acute Respiratory Infection, possible mechanisms of action: a randomized controlled trial. BMC Complementary and Alternative Medicine, 2012, 12 (Suppl 1):P113

Poster associated with Rabago D, et al. The efficacy of prolotherapy using dextrose-morrhuate for lateral epicondylosis: a pilot randomized controlled trial. BMC Complementary and Alternative Medicine 2012 12(Suppl 1):P79