Prolotherapy Research

A Review of the Evidence for Regenerative Injection Therapy (Prolotherapy).

Jonas Skardis DOM, DAAPM, CNAARIP., E J of Age Management Medicine. July 2007.

• “Regenerative Injection Therapy, also known as prolotherapy, is a relatively simple, minimally invasive intervention for the rebuilding of axial and peripheral joint connective tissue. Various substances, most prominently dextrose, can be utilized, via injection, to stimulate regeneration of injured and/or degenerated ligaments, tendons, and cartilage.”

“Injection Therapy for Enthesopathies Causing Axial Spine Pain and “The Failed Back Syndrome:” A Single Blinded, Randomized and Cross-Over Study.

Wilkinson H., Pain Physician, 8: 167-176, 2005

• This singe-blinded, randomized and cross-over study by a neuro-surgeon on the staff of Mass General characterized prolotherapy as a “minimally invasive” therapy aimed at periosteal trigger points at sites of enthesopathy. Success rates were similar to other studies at 80%.

“Randomized Prospective Double-blind Placebo-controlled Study of Dextrose Prolotherapy for Knee Osteoarthritis With or Without ACL Laxity.”

Reeves KD, Hassanein K, Alternative Therapies March 2000, 6(2):68-80

• In concentrations greater than 10%, dextrose has long been utilized as an osmotic shock agent – a thicker substance to burst some cells in a locale and spill inflammatory eicosanoids and other substances. This simple act signals an immune response that results in a 3-5 day inflammatory cascade, followed by 2-4 weeks of fibroblast activity.

• “CONCLUSION: Prolotherapy injection with 10% dextrose resulted in clinically and statistically significant improvements in knee osteoarthritis. Preliminary blinded radiographic readings (1- year films, with 3-year total follow-up period planned) demonstrated improvement in several measures of osteoarthritic severity. ACL laxity, when present in these osteoarthritic patients, improved.”

“Randomized, Prospective, Placebo-controlled Double-Blind Study of Dextrose Prolotherapy for Osteoarthritic Thumb and Finger [DIP, PIP, and trapeziometacarpal] Joints: Evidence of Clinical Efficacy.”

Reeves KD, Hassanein K. Journal of Alternative and Complementary Medicine 2000;6(4):311-320

• Researchers determined that dextrose-based prolotherapy is a safe and effective treatment for mitigating finger joint pain.

“Retrospective Case Series on Patients with Chronic Spinal Pain Treated with Dextrose Prolotherapy.”

Hooper AR, Ding M., J of Alternative and Complementary Medicine 2004; 10(4):670-674

•  “RESULTS: 91% of patients reported reduction in level of pain, 84.8% of patients reported improvements in activities of daily living, and 84.3% reported an improvement in the ability to work.”

“Long Term Effects of DextroseProlotherapy for Anterior Cruciate Ligament Laxity.”

Reeves KD, Hassanein KM., Alternative Therapies May/June 2003; 9(3):58-62

• “Conclusion: In patients with symptomatic anterior cruciate ligament laxity, intermittent dextrose injection resulted in clinically and statistically significant improvement in ACL laxity, pain, swelling, and knee range of motion.”

Note: There are several studies that conclude that prolotherapy is no better than placebo. These are hotly debated in the prolotherapy community due to significant design flaws in the studies.

For instance, there is a study that injected ligaments associated with leg pain that excluded patients with leg pain from the study! Not surprisingly, it was concluded that there was no difference between placebo overall.

Another study that is often referenced to dispute the effectiveness of prolotherapy used a saline injection as a placebo. It is widely known that saline injections will stimulate a healing response. Comparing two therapies that initiate a healing response cannot be used to maintain that one of the therapies doesn’t have an effect compared to no therapy at all. Even with this ineffectual research, several individual markers showed that prolotherapy was up 28% more effective.