Prolotherapy injections for chronic low-back pain

Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2007; DOI: 10.1002/14651858.CD004059.pub3
Source: PubMed


Chronic low-back pain is a very common problem for which there is currently no universally effective treatment. Patients with chronic low-back pain have many treatment options and it is important for them to understand the evidence behind each treatment option they may be considering. Prolotherapy injections have been used to treat chronic low-back pain for over 50 years but their use remains controversial. They involve repeatedly injecting ligaments with compounds such as dextrose (sugar) and lidocaine (anaesthetic) to help restart the body's natural healing process by causing controlled acute inflammation (swelling) in the areas injected. Proponents believe this leads to stronger ligaments that can better support the low-back. Prolotherapy injections are often combined with other treatments such as spinal manipulation, exercises, and corticosteroid injections into tender muscles to maximize its effect. This review included five studies that examined the effects of prolotherapy injections on 366 patients with low-back pain that had lasted for longer than three months. Because these studies used different types of prolotherapy injections and different treatment protocols, their results could not be combined. The five studies we examined were therefore divided according to whether they used prolotherapy injections alone or combined prolotherapy injections with spinal manipulation, exercise, and other treatments. Of the five studies we reviewed, three found that prolotherapy injections alone were not an effective treatment for chronic low-back pain and two found that a combination of prolotherapy injections, spinal manipulation, exercises, and other treatments can help chronic low-back pain and disability. Minor side effects such as increased back pain and stiffness were common but short-lived. Based on these five studies, the role of prolotherapy injections for chronic low-back pain is still not clear.

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    • "Study eligibility for both reviews included RCTs and quasi-RCTs on prolotherapy for CLBP, and both reviews assessed study quality using Cochrane Back Review group criteria. The efficacy results of prolotherapy for CLBP reported in the updated review [24] were as follows: prolotherapy protocols vary a great deal and results cannot be combined; there is a possible dose-response relationship with prolotherapy, because negative results were noted in two RCTs with lower doses of the administered drug (eg, 3Â10 ml) compared with three studies with higher doses (eg, 6Â20–30 ml); two RCTs with prolotherapy administered with cointerventions had positive results, whereas three RCTs with prolotherapy administered alone had negative results . Thus, the authors concluded that there is no evidence of efficacy for prolotherapy alone, whereas there is evidence of partial prolonged pain relief for prolotherapy combined with exercise, SMT, and other interventions. "
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    ABSTRACT: The management of chronic low back pain (CLBP) has proven to be very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
    Full-text · Article · Jan 2008 · The Spine Journal
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