What is prolotherapy? |

Overview

Invented in the 1950s by George Hackett, prolotherapy is based on the theory that
chronic pain is often caused by laxness of the ligaments
that are responsible for keeping a joint stable. When ligaments and associated
tendons are loose, the body is said to compensate by using muscles to stabilize
the joint. The net result, according to prolotherapy theory, is muscle spasms and
pain.

Prolotherapy treatment involves injections of chemical irritant solutions into the area around such ligaments. These solutions are believed to cause tissue to proliferate (grow), increasing the strength and thickness of ligaments. In turn, this presumably serves to tighten up the joint and relieve the burden on associated muscles, stopping muscle spasms. In the case of arthritic joints, increased ligament strength would allow the joint to function more efficiently, thus reducing pain.

Prolotherapy has not been widely accepted in conventional medicine. The technique is used by prolotherapy practitioners to treat many conditions, including back pain, osteoarthritis, fibromyalgia, plantar fasciitis, sciatica, sports injuries, temporomandibular joint disorder, tendonitis, and tension headaches. Most studies have focused on its use in back pain and osteoarthritis, but the evidence does not clearly support its effectiveness.

How is prolotherapy performed? Prolotherapy is generally
administered at intervals of four to six weeks, although studies have used a more
frequent schedule. The treatment involves injection of a mixture containing an
irritant and a local anesthetic. A total of four to six treatments is typical.
When treating back pain, prolotherapy practitioners frequently use a form of
manipulation somewhat similar to chiropractic. However, the manipulation
is applied after local anesthetic has been injected, and it is somewhat
intense.

There are several irritant solutions used in prolotherapy. Concentrated dextrose or glucose has become increasingly popular because it is completely nontoxic. Phenol (a potentially toxic substance) and glycerin are also sometimes used. Other, nonirritant substances may be added to the solution, such as vitamin B12, corn extracts, cod liver oil extracts, zinc, and manganese; however, there is no evidence that these substances add any benefit.

Scientific Evidence

Some animal and human studies have found that prolotherapy injections increase the strength and thickness of ligaments. Six double-blind human trials of prolotherapy have been reported: four involving back pain (with mixed results) and the other two involving osteoarthritis (with positive results).

Back pain. Although two studies have suggested prolotherapy may be effective for low back pain, two more recent studies found prolotherapy to be ineffective. In a review of five studies, three found prolotherapy to be no more effective than control treatments for low back pain. The other two studies suggested that prolotherapy was more effective than control treatments when used with therapies such as spinal manipulation and exercise. Another review suggested that prolotherapy may be effective when used with other therapies, but not when used alone.

When used alone, prolotherapy is probably no more effective than a placebo injection for the treatment of low back pain. However, there is some evidence that the technique may be beneficial when combined with other therapies.

Osteoarthritis. A double-blind, placebo-controlled study
evaluated the effects of three prolotherapy injections (using a 10 percent
dextrose solution) at two-month intervals in sixty-eight people with
osteoarthritis of the knee. At the six-month follow-up,
participants who had received prolotherapy showed significant improvements in pain
at rest and while walking. These participants also showed reduced swelling and
fewer episodes of “buckling” than those who had received placebo treatment.

The same research group performed a similar double-blind trial of twenty-seven people with osteoarthritis in the hands. The results at the six-month follow-up showed that range of motion and pain with movement improved significantly in the treated group compared with the placebo group.

Safety Issues

In studies, prolotherapy has not caused any serious, irreversible injury. After each injection there is usually discomfort that lasts for a few minutes to several days, but this discomfort is seldom severe. Of more concern is that severe headaches have been reported in treatment of low back pain in a minority of patients. Also, because phenol is a potentially toxic substance, treatment with a dextrose solution alone is preferable.

Choosing a Practitioner

Prolotherapy is practiced by a medical doctor or a doctor of osteopathy.
Generally, physicians specializing in orthopedics or physical medicine and
rehabilitation are most likely to practice prolotherapy.

Bibliography

Coombes, B. K., L. Bisset, and B. Vicenzino. “Efficacy and Safety of Corticosteroid Injections and Other Injections for Management of Tendinopathy.” The Lancet 376 (2010): 1751-1767.

Dagenais, S., J. Mayer, et al. “Evidence-Informed Management of Chronic Low Back Pain with Prolotherapy.” Spine Journal 8 (2008): 203-212.

Dagenais, S., M. Yelland, et al. “Prolotherapy Injections for Chronic Low-Back Pain.” Cochrane Database of Systematic Reviews (2007): CD004059. Available through EBSCO DynaMed Systematic Literature Surveillance at http://www.ebscohost.com/dynamed.

Hauser, R. A. “Punishing the Pain: Treating Chronic Pain with Prolotherapy.” Rehab Management 12 (1999): 26-30.

Yelland, M. J., et al. “Prolotherapy Injections, Saline Injections, and Exercises for Chronic Low-Back Pain.” Spine 29 (2004): 9-16.