Available only at Grace Life Natural Medicine Center
Prolotherapy is the rehabilitation of an incompetent structure as
a ligament and tendon, by the induced proliferation of new cells.
Wong has been in pain management for over ten years and have
personally performed this therapy for over 30,000 people here and
around the world as of June, 2006.
Innovation comes frequently from
extensive experience, Dr. Wong has been researching the
ingredients used for stimulating new growth from around the world,
and using the patient's objective experience as a direct feedback
on the design of each proliferating solution. There are a lot of
choices that can be custom made according to the needs of the
patients. The uniqueness of each clinical problem may demand
special consideration in the strength and amount of the specific
ingredients. Prolotherapy is Pain-Less because of careful
selection and mixture of solutions made of natural compounds,
gaseous components, hormones, nutraceuticals, vitamins and herbs
to attain maximum effect with minimum pain.
Grace Life Medical Center offers
Pain-Less Prolotherapy with Nitrous Oxide conscious sedation,
thus eliminating the need of IV solutions and after effects of
narcotics or valium-like drugs. There is no need for recovery
period after conscious sedation, and patient may leave driving
right afterwards! Patients will feel the onset of the sedation
within 3 minutes and recovery time in another 3 minutes. Nitrous
Oxide is in layman's term- laughing gas, it is particularly
effective for relieving anxiety and pain during the procedure.
Nitrous Oxide Conscious Sedation- as
simple as breathing in Laughing Gas!
most remarkable aspect of prolotherapy is its safety. No one has
ever had a significant reaction to the proliferant solution. The
most basic solution could be as simple as glucose and lidocaine, a
local anesthetic. For those patients with known allergies to
lidocaine, another agent may be used. No one has been allergic to
glucose, it is not possible!
particular usefulness is the treatment of headache, neck pain and
low back pain by prolotherapy. Often, patients present to the
office because they are already out of options and had been told
that they needed a surgery. Typically, they were told that they
have a herniated disc or sciatica, a compressed nerve at the back
with pain radiating from the back to the legs, with cramps and
assured that these are very good candidates for prolotherapy.
Patients will benefit from the expertise of Dr. Wong because of
the possibility of proving what can be done at the first visit by
a diagnostic injection.
local injection given to the back after careful examination by Dr
Wong is the golden test because it is the most accurate way in
telling the real source of the pain. It is far more accurate than
X-ray and MRI scan in telling the source of pain. No one should be
operated before this diagnostic injection is given. Regular
medical doctors do not yet understand the anatomy and essential
structures of the low back, they were not taught many important
structures in their anatomy and residency training classes. This
is because the importance of the connecting ligaments and tendons
of the body have been overlooked. Depending on X-ray and MRI scan
is very misleading because they do not tell where the pain is, and
only actual patients suffering from the pain can tell if the pain
most misleading issue of back surgery is the presence of herniated
discs. One must be careful to check out the scientific information
on the prevalence of herniated discs on normal healthy
volunteers.70% of the population over 30 years old have herniated
discs somewhere along the spine. Thus, if we ask a hundred
volunteers who have absolutely no pain, we could find 70 surgical
candidates!!! Wrong, having a herniated disc does not
automatically mean surgery, because most people that have
herniated discs have no pain at all.
lot of patients present with the diagnosis of sciatica, meaning a
nerve compression. The reason they believe that there is such
nerve compression is that they feel numbness and pain. The problem
is that ligament pain of the neck and low back also refers to the
arm and legs and it frequently cannot be separated clinically.
Ligament referring pain and numbness follows specific pattern. It
is called sclerodermal referral and again, traditional medical
doctors, chiropractors have no knowledge of these anatomical
referral patterns leading to misdiagnosis.
|Prolotherapy Web Sites:
Neural therapy is a feral
meat system for chronic pair and illness. It involves the injection
into autonomic ganglia, peripheral nerves, scars, glands,
trigger points and other tissue.
Hauser's (author of Prolo Your Pain Away ) natural medicine clinic
in Chicago, IL (Caring Medical & Rehabilitation Services)
Thomas Dorman's web site has additional information on prolotherapy.
Dr. Dorman practices in Kent, WA. Dr. Dorman practices the "West-Coast
method" of prolotherapy which is slightly different from Dr. Wheaton.
Dr. Wheaton practices the "Hemwall method" of prolotherapy. Both of
these methods accomplish the same goal, but use slightly different
solutions and frequencies of treatment.
Free clinic for North Thailand
Treating a pastor in Philippines
Busy day treating in China
Midnight service for China
Teaching doctors in Indonesia
Old folks treated in Korea
Buddist Monk in Burma treated
Romanian workers, Israel
Thyroid cartilage, Venezuela
Handicapped pt. Amsterdam
Lima, Peru free clinic
Treating a child in US
Costa Rica Free Pain Clinic
Papimi treatment, US
Injecting veins, US
Severe scoliosis treated in Taiwan
Labor camp, Israel
Indonesia’s muslim patient
Pain clinic, Vietnam
Pastor treated in Panama
Brazil, Sao Paolo, Free clinic
Cambodia free clinic
Tribal people, North Thailand
American Association of Orthopaedic Medicine
Prolotherapy for the Treatment of Back Pain
This pronouncement was written for the American Association of
Orthopaedic Medicine by
Robert G. Klein, M.D., Jeffrey Patterson, D.O., Bjorn Eek, M.D. and
David Zeiger, D.O.
It is the position of
the American Association of Orthopaedic Medicine that prolotherapy is
a safe efficacious therapy for the treatment of selected cases of low
back pain and other chronic myofascial pain syndromes. This is based
upon basic science data showing the effects of prolotherapy in animal
models, clinical studies, a lengthy history of clinical use and
efficacy, and increasingly widespread acceptance within the medical
community. While we recognize that further basic science and
clinical studies need to be done and are currently in process, we
believe that prolotherapy is a safe, cost effective and efficacious
therapy that can provide pain relief and return of function for many
Prolotherapy is an
injection therapy used to treat chronic ligament, joint capsule,
fascial and tendinous injuries of the low back. The goal of this
treatment is to stimulate proliferation of collagen at fibro-osseous
junctions to promote non-surgical soft tissue repair and to relieve
pain.  Animal studies by Liu and others have shown proliferation of
collagen with strengthening of ligaments with prolotherapy. Further
animal research is currently underway at the University of Wisconsin
Medical School. Prolotherapy is commonly used in veterinary
The mechanism of action
of ligament proliferation was supported by a pilot study in human
volunteers that demonstrated an average increase of 65% in
cross-sectional diameter of posterior sacroiliac ligaments 3 months
after treatment. Computerized measurements of range of lumbar motion
before and after treatment have also demonstrated improvements in
motion that are consistent with soft tissue healing. [3,4]
There have now been 5
randomized clinical trials (RCT'S) of prolotherapy [5-9] for chronic
low back pain; their methodology has varied considerably. Two of the
trials [6,7] used similar protocols with well defined injection
sites, using dextrose-glycerine-phenol-xylocaine as the solution
injected, and 6 weekly injection treatments of 20-30mL each. Both
trials used multiple standardized and validated outcome measures to
capture changes in pain, disability, and function over a minimum of 6
months, and both trials reported statistically significant
improvements in pain and disability in the treatment groups.
The 3 other trials
differed considerably. The study by Mathews et al  enrolled only 22
patients (16 treatment and 6 controls) and was unlikely to have the
statistical power needed to detect a reasonable difference between
treatment and placebo. The study by Dechow et al  had only 3 weekly
injection treatments of 10mL each (total volume 30mL vs. 120-180mL in
the two successful trials) of dextrose-glycerine-phenol solution. In
addition, the authors attempted to inject all low back ligaments from
only 2 injection sites rather than lifting and reinserting the needle
at multiple sites as is commonly practiced. This technical difference
may have impacted where the solution was injected. Patient selection
was also an impediment in this trial, and the authors concluded that:
“Many patients were not considered ideal candidates for sclerosing
injections by the operator at the time of the treatment for a variety
of reasons relating to technical difficulties, deconditioning,
patients relying on invalidity benefit, excessive psychological
stress, etc. even though they technically fulfilled the inclusion
criteria. Therefore, the group of patients recruited into our study
was likely to respond poorly to any single intervention in keeping
with the relatively poor prognosis in the group of patients today in
The most recent study by
Yelland from Australia  used a 20% dextrose solution that was
injected at only 20% of the usual sites and did not include facet
joint capsules included in the 2 positive RCT's. Not surprisingly, the
study failed to show an advantage of plain dextrose, which is a weak
prolotherapy solution, compared to a placebo injection of saline.
Despite the shortcomings of this study the results obtained in terms
of pain relief and increased function are quite striking. In both the
group of prolotherapy patients (mean duration of pain was 14.8 years)
and in the saline injection group (mean duration was 13.8 years),
there was a statistically significant decrease in pain and disability
scores at both 12 and 24 months’ follow-up. In fact, just a fraction
less than half of the patients in the prolotherapy group (46%)
achieved a greater than 50% reduction of pain and 42% achieved a
greater than 50% reduction in disability score. The authors stated
that "participants exhibited marked and sustained improvements in
their pain and disability, even with saline injections and normal
activity." It should be appreciated that the bleeding and tissue
disruption associated with needling and saline injections also has a
mild proliferant effect so in fact there was no true placebo
treatment. There may also be neurological effects of prolotherapy in
relieving pain. The authors also admitted that "this trial's success
rates in reducing pain and improving disability are at least as good
as those reported for spinal cord stimulation, surgery or
multidisciplinary treatment for patients with low back pain of shorter
Although there is
disagreement among the studies regarding the use of prolotherapy for
chronic low back pain, this situation is hardly unique to this
specific injection treatment. A recent systematic review of the
literature by Nelemans in Spine  demonstrates how little evidence
there is for the efficacy of a variety of commonly utilized and
reimbursed low back treatments including facet injections, trigger
point injections, and epidural injections. One of the prolotherapy
trials discussed above  was included in this review and ranked
fourth out of twenty-one randomized trials in terms of study design
and is mentioned as the only one with significant follow-up. This
study was one of the few that they cited as showing definite
statistical efficacy when compared to a control treatment using
placebo saline injections.
The literature also
indicates that prolotherapy appears to be very safe. None of the
clinical trials have reported any serious adverse events with this
treatment. In addition, a survey of adverse events related to
prolotherapy reported that a group of almost 100 physicians had
collectively almost 500,000 patients with this treatment approach and
experienced only 66 complications, none of which were
life-threatening. This is supported by the low number of serious or
adverse reactions documented in the Florida review.
studies regarding the use of prolotherapy for chronic low back pain
are necessary to address methodological issues of the previous trials,
the same is true for all other low back treatment approaches, many of
which are commonly utilized and covered by insurers with less
documentation than prolotherapy. The reality is that despite the
enormous impact of low back pain to our society there are no clearly
effective treatments for chronic back pain, at least not in the sense
that they are supported by multiple, high-quality randomized clinical
trials using multiple validated outcome measures and an appropriate
follow-up period. Nevertheless, patients continue to receive care for
their chronic low back pain and insurers routinely pay for such care
despite a lack of convincing efficacy for all chronic low back pain
treatments. In fact, because of multiple pain generators that may
come into play in low back pain, it is quite likely that multiple
therapies will be necessary in any one patient or group of patients.
Prolotherapy should be
considered a valid treatment option in a selected group of chronic low
back pain patients. As such, it should not be held to a higher
standard than other treatments with the same lack of efficacy that are
nevertheless covered by insurers, such as epidural injections, steroid
injections, and IDET, not to mention surgery for cases in which
instability or progressive neurological deficit is absent. The goal of
providing access only to the highest quality of treatments supported
by the scientific literature is laudable. However, if insurers were to
adopt a universal policy of denying payment for chronic low back pain
treatments based on lack of definitive evidence, no one with chronic
back pain would be able to obtain any treatment. Since this is clearly
unacceptable, an alternative is to provide coverage for those
treatments that are biologically plausible, supported in the
literature by a number of cohort and randomized clinical trials, and
have a reasonable safety profile.
Prolotherpy should be
performed by well trained providers utilizing selected solutions and
techniques. A number of different solutions are used in prolotherapy.
The most common ingredients in these solutions are hyperosmolar
dextrose and/or glycerine, combined with local anesthetics such as
lidocaine or marcaine. A more detailed description of prolotherapy is
available in the appended position paper by the Florida Academy of
Pain Management and the review in Musculoskeletal Medicine that is
Vert Mooney, M.D., a
prominent orthopedic surgeon and former chairman of orthopedics at the
University of California, San Diego, wrote a recent editorial in The
Spine Journal concerning prolotherapy . He concluded that "this
fringe treatment (prolotherapy) is no longer at the periphery and
seems to be at the frontier of a justifiable, rational treatment with
a significant potential to avoid destructive procedures."
We therefore urge the
California Technical Assessment Forum to provide coverage for
prolotherapy for chronic low back pain.
1. Banks, A.R., A Rationale for Prolotherapy. Journal of
Orthopaedic Medicine, 1991. 12(3): p. 54-59.
2. Liu, Y.K. and
e. al, An in situ study of the influence of a sclerosing solution
in rabbit medial collateral ligaments and its junction strength.
Connective Tissue Research, 1983. 11: p. 95-102.
3. Klein, R.C.,
T.A. Dorman, and C.E. Johnson, Proliferant injections for low back
pain: histologic changes of injected ligaments and objective
measurements of lumbar spine mobility before and after treatment.
J of Neurol and Ortho Med and Surg, 1989. 10(2): p. 123-126.
4. Klein, R. and
B. Eek, Prolotherapy: an alternative way of managing low back pain.
J of musculoskeletal Med, 1997: p. 45-49.
5. Yelland, M.J.
and e. al., Prolotherapy injections, saline injections, and
exercises for chronic low back pain: a randomized trial. Spine,
2004. 29(1): p. 9-16.
6. Ongley, M.J.,
et al., A new approach to the treatment of chronic low back pain.
The Lancet, 1987: p. 143-146.
7. Klein, R.G.,
et al., A Randomized double-blind trial of dextrose-glycerine-phenol
injections for chronic, low back pain. J. Spinal Disord, 1993.
6(1): p. 23-33.
8. Dechow, E. and
et.al., A randomized, double-blind, placebo-controlled trial of
sclerosing injections in patients with chronic low back pain.
Rheumatology (Oxford), 1999. 38(12): p. 1255-9.
9. Mathews, J.A.
and et.al., Back pain and sciatica: controlled trials of
manipulation, traction, sclerosant and epidural injections. Br J
Rheumatol, 1987. 26(6): p. 416-23.
10. Nelemans, P.
and et.al., Injection therapy for subacute and chronic benign low
back pain. Spine, 2001. 26(5): p. 501-15.
11. Mooney, V.,
Prolotherapy at the fringe of medical care, or is it at the frontier?
Spine, 2003. 3(4): p. 253-4.
Klein, R. and B. Eek,
Prolotherapy: an alternative way of managing low back pain. J of
musculoskeletal Med, 1997: p. 45-49.
Nelemans, P. and et.al.,
Injection therapy for subacute and chronic benign low back pain.
Spine, 2001. 26(5): p. 501-15.
Prolotherapy at the fringe of medical care, or is it at the frontier?
Spine, 2003. 3(4): p. 253-4.
4. The Florida
Academy of Pain Medicine (FAPM), Position Paper on Regenerative
Injection Therapy (RIT): Effectiveness and Appropriate Usage. May,
Originally published in THE LANCET, July 18, 1987, pp. 143 -
A NEW APPROACH TO THE TREATMENT OF
CHRONIC LOW BACK PAIN
Department of Rheumatology, Sansum Medical Clinic, and the Sansum
Medical Research Foundation, Santa Barbara, California 93102, USA
81 patients with chronic low back pain (average duration 10 years)
were randomised to two treatment groups. 40 received an empirically
devised regimen of forceful spinal manipulation and injections of a
dextrose-glycerine-phenol ("proliferant") solution into soft-tissue
structures, as part of a programme to decrease pain and disability.
The other 41 patients received parallel treatment in which the main
differences were less extensive initial local anaesthesia and
manipulation, and substitution of saline for proliferant. Neither
patients nor assessors knew which treatment had been given. When
assessed by disability scores the experimental group had greater
improvement than the control group at one (p<0·001), three (p<0·004),
and six (p<0·001) months from the end of treatment; at six
months an improvement of more than 50% was recorded in 35 of the
experimental group versus 16 of the control group and the numbers free
from disability were 15 and 4, respectively (p<0·003). Visual
analogue pain scores and pain diagrams likewise showed significant
advantages for the experimental regimen.
solution consisted of dextrose 25% (694 mosmol/1), glycerine 25% (2720
mosmol/1), phenol 2.5% (266 mosmol/1), and pyrogen-free water to 100%.
Because this solution may cause a temporary irritation it was diluted
with an equal volume of 0·5% plain lignocaine hydrochloride ('Xylocaine')
to make it comparable with the placebo injection in terms of initial
provocation of post-injection pain. Patients in the placebo group
received sterile 0·9% saline. Each patient received six
injections of approximately 20 ml of the same solution weekly. The
solutions were identical in appearance and were prepared by a
pharmacist using sterile techniques. Phenol has a characteristic odour
that might be detectable if a drop of solution was spilled. This
potential source of bias was eliminated by addition of phenol to the
skin preparation throughout the study.
One month after
treatment both groups had improved in terms of disability and visual
analogue pain scores, but the improvement was significantly greater in
the experimental group at this time and at three and six months (table
III). 35 of 40 patients in the experimental group had greater than 50%
improvement in disability scores, compared with 16 of 41 in the
control group; and the numbers with zero disability scores at six
months were 15 and 4, respectively (p<0·003).
sacroiliac joint has a small range of motion, and when the joint is at
the limit of its range no great force is needed to damage its
Once the ligaments of the low back and pelvis become incompetent,
This permits excessive
external moments to be transmitted to the three-joint complex of
intervertebral disc and zygapophyseal joints,15
and torsional stresses to be placed on the lumbar vertebrae and
sacrum. The former may lead to disc and zygapophyseal joint
degeneration and the latter to a slight displacement of the sacrum
from its normal anatomic position,14
placing traction on pain sensitive structures and producing local as
well as referred pain.
programme tested here has multiple components. We offer the following
speculations as to why it is effective. The dilute lignocaine serves
to interrupt the pain reflex arc and facilitate the manipulation.
Triamcinolone "disinflames" the gluteal muscles, which are subjected
to chronic mechanical strain owing to the incompetence of the lumbar
and sacroiliac ligaments. The manipulation moves the sacroiliac joint
through a full range of motion, rupturing any microadhesions which may
form in response to connective tissue immobilisation,16
and corrects any minor sacral malalignment present. The transient
benefits previously demonstrated with manipulation17 are usually
not sustained unless the supporting ligaments are strengthened. The
proliferant induces an inflammatory response which leads to
fibroblastic hyperplasia and the growth of collagen.1
The exercises encourage synthesis of the extracellular connective
increase ligament junction strength,18
and induce proliferating fibroblasts to line up in parallel to
existing connective tissue.19
worthwhile and desired responses to treatment of chronic low back
Pain Med. 2006 Jan-Feb;7(1):38-45.
School of Medicine, Griffith University and Faculty of Health and
Environmental Sciences, Auckland University of Technology, Australia.
OBJECTIVE: To describe patients' perceptions of minimum worthwhile and
desired reductions in pain and disability upon commencing treatment
for chronic low back pain. DESIGN AND SETTING: Descriptive study
nested within a community-based randomized controlled trial on
prolotherapy injections and exercises. PATIENTS: A total of
110 participants with chronic low back pain. Interventions. Prior to
treatment, participants were asked what minimum percentage reductions
in pain and disability would make treatment worthwhile and what
percentage reductions in pain and disability they desired with
treatment. OUTCOME MEASURES: Minimum worthwhile reductions and desired
reductions in pain and disability. RESULTS: Median (inter-quartile
range) minimum worthwhile reductions were 25% (20%, 50%) for pain and
35% (20%, 50%) for disability. This compared with desired reductions
of 80% (60%, 100%) for pain and 80% (50%, 100%) for disability. The
internal consistency between pain and disability responses was high
(Spearman's coefficient of association of 0.81 and 0.87,
respectively). A significant association existed between minimum
worthwhile reductions and desired reductions, but no association was
found between these two factors and patient age, gender, pain severity
or duration, disability, anxiety, depression, response to treatment,
or treatment satisfaction. CONCLUSIONS: Inquiring directly about
patients' expectations of reductions in pain and in disability is
important in establishing realistic treatment goals and setting
benchmarks for success. There is a wide disparity between the
reductions that they regard as minimum worthwhile and reductions that
they hope to achieve. However, there is a high internal consistency
between reductions in pain and disability that they expect.
Prolotherapy (proliferation therapy) in the treatment of TMD.
Cranio. 2005 Oct;23(4):283-8.
Minnesota Craniofacial Center Midway, 1690 University Avenue West,
Suite 390, Saint Paul, MN 55104, USA. email@example.com
Proliferation therapy, or "prolotherapy," is also known as
regenerative injection therapy (RIT). Since the 1930s, the technique
has been used to stabilize injured joints and to relieve joint pain.
This article reviews the history and scientific literature regarding
prolotherapy and describes the application of the technique to treat
injured or unstable temporomandibular joints (TMJ). Alternative
medicaments and the likely mechanisms of action are discussed. A brief
preliminary summary of a retrospective clinical study of the efficacy
of prolotherapy is included. The study shows that prolotherapy
can be an effective therapeutic modality that reduces TMJ pain and
joint noise in a majority of patients who have reached a
plateau with use of an intraoral appliance, physical therapy, and home
systematic review of prolotherapy for chronic musculoskeletal pain.
Clin J Sport Med. 2005 Sep;15(5):376-80.
University of Wisconsin-Madison, Madison, WI 53715, USA. David.Rabago@fammed.wisc.edu
OBJECTIVE: Prolotherapy, an injection-based treatment of chronic
musculoskeletal pain, has grown in popularity and has received
significant recent attention. The objective of this review is to
determine the effectiveness of prolotherapy for treatment of chronic
musculoskeletal pain. DATA SOURCES: We searched Medline, PreMedline,
Embase, CINAHL, and Allied and Complementary Medicine with search
strategies using all current and historical names for prolotherapy and
injectants. Reference sections of included articles were scanned, and
content area specialists were consulted. STUDY SELECTION: All
published studies involving human subjects and assessing prolotherapy
were included. MAIN RESULTS: Data from 34 case reports and case
series and 2 nonrandomized controlled trials suggest prolotherapy is
efficacious for many musculoskeletal conditions. However,
results from 6 randomized controlled trials (RCTs) are conflicting.
Two RCTs on osteoarthritis reported decreased pain, increased range of
motion, and increased patellofemoral cartilage thickness after
prolotherapy. Two RCTs on low back pain reported significant
improvements in pain and disability compared with control subjects,
whereas 2 did not. All studies had significant methodological
limitations. CONCLUSIONS: There are limited high-quality data
supporting the use of prolotherapy in the treatment of musculoskeletal
pain or sport-related soft tissue injuries. Positive results compared
with controls have been reported in nonrandomized and randomized
controlled trials. Further investigation with high-quality randomized
controlled trials with noninjection control arms in studies specific
to sport-related and musculoskeletal conditions is necessary to
determine the efficacy of prolotherapy.
Intraligamentous injection of sclerosing solutions (prolotherapy) for
spinal pain: a critical review of the literature.
Spine J. 2005 May-Jun;5(3):310-28.
Department of Environmental Health, Science, and Policy, University of
California, Irvine, CA 92697, USA. Simon@CamResearch.com
BACKGROUND CONTEXT: The injection of various solutions aimed at
producing a sclerosing effect has been used to treat soft tissues
injuries (eg, inguinal hernia) for more than 100 years. In the 1930s,
this treatment approach was applied to injured joints in an attempt to
stimulate connective tissue repair. Although several studies have been
published about this method of treatment for various orthopedic and
spinal indications (termed prolotherapy), its use remains
controversial. PURPOSE: To conduct a critical review of the literature
on prolotherapy for spinal pain. STUDY DESIGN/SETTING: Critical review
of the literature. METHODS: Computerized medical literature databases
(Medline, CINAHL, Mantis, Cochrane Central Register of Controlled
Trials) were searched to uncover all published information about the
use of sclerosing injections in humans with spinal pain disorders.
Search results were reviewed for relevance, and information was
abstracted from full-text articles. RESULTS: Our search
uncovered almost 200 reference materials in various media related to
prolotherapy, including 31 clinical studies related to spinal pain.
There were 26 observational cohorts and 5 randomized clinical trials (RCTs). Indications in these studies were low back pain (22), neck pain
(3), cervical headaches (3) and dorsal or thoracic pain (3). A
total of 20 sclerosing solutions were used in these studies; the most
common was a mixture of dextrose 12.5%, glycerin 12.5%, phenol 1.25%
and lidocaine 0.25%. Wide variations were found in treatment
protocols, such as dose, number of treatments and use of adjunct
therapies. Most cohort studies were only of moderate quality and
varied greatly in the substances injected and the use of
co-interventions. Most clinical studies reported positive
results such as decreased pain or disability, although differences
between treatment and control groups did not always reach statistical
significance. Commonly reported adverse reactions to this
treatment include temporary postinjection pain and stiffness. A
handful of more serious adverse events were reported in the 1950s and
1960s with stronger or unknown solutions. CONCLUSION: Prolotherapy
describes a variety of treatment approaches rather than a specific
protocol. Results from clinical studies published to date indicate
that it may be effective at reducing spinal pain. Great variation was
found in the injection and treatment protocols used in these studies
that preclude definite conclusions. Future research should focus on
those solutions and protocols that are most commonly used in clinical
practice and have been used in trials reporting effectiveness to help
determine which patients, if any, are most likely to benefit from this
of dextrose prolotherapy in elite male kicking-sport athletes with
chronic groin pain.
Arch Phys Med Rehabil. 2005 Apr;86(4):697-702.
Physical Medicine and Rehabilitation Service, Jaime Slullitel Rosario
Orthopedic and Trauma Institute, Argentina.
OBJECTIVE: To determine the efficacy of simple dextrose
prolotherapy in elite kicking-sport athletes with chronic groin pain
from osteitis pubis and/or adductor tendinopathy. DESIGN:
Consecutive case series. SETTING: Orthopedic and trauma institute in
Argentina. PARTICIPANTS: Twenty-two rugby and 2 soccer players with
chronic groin pain that prevented full sports participation and who
were nonresponsive both to therapy and to a graded reintroduction into
sports activity. INTERVENTION: Monthly injection of 12.5% dextrose and
0.5% lidocaine into the thigh adductor origins, suprapubic abdominal
insertions, and symphysis pubis, depending on palpation tenderness.
Injections were given until complete resolution of pain or lack of
improvement for 2 consecutive treatments. MAIN OUTCOME MEASURES:
Visual analog scale (VAS) for pain with sports and the Nirschl Pain
Phase Scale (NPPS), a measure of functional impairment from pain.
RESULTS: The final data collection point was 6 to 32 months after
treatment (mean, 17 mo). A mean of 2.8 treatments were given. The mean
reduction in pain during sports, as measured by the VAS, improved from
6.3+/-1.4 to 1.0+/-2.4 ( P <.001), and the mean reduction in NPPS
score improved from 5.3+/-0.7 to 0.8+/-1.9 ( P <.001). Twenty of 24
patients had no pain and 22 of 24 were unrestricted with sports at
final data collection. CONCLUSIONS: Dextrose prolotherapy showed
marked efficacy for chronic groin pain in this group of elite rugby
and soccer athletes.
Retrospective case series on patients with chronic spinal pain treated
with dextrose prolotherapy.
J Altern Complement Med. 2004 Aug;10(4):670-4.
Advanced Spinal Care Centre, Calgary, Alberta, Canada. firstname.lastname@example.org
OBJECTIVES: To determine the clinical benefits of dextrose
prolotherapy in patients with chronic spinal pain. DESIGN:
Retrospective case series. SETTING/LOCATION: During the first 2 years
at an outpatient prolotherapy clinic. SUBJECTS: One hundred and
seventy-seven (177) consecutive patients with a history of chronic
spinal pain completed prolotherapy treatment and were followed for a
period ranging from 2 months to 2.5 years. INTERVENTIONS: Patients
were treated with a proliferant solution containing 20% dextrose and
0.75% xylocaine. One half milliliter (0.5 mL) of proliferant was
injected into the facet capsules of the cervical, thoracic, and lumbar
spine, or combinations of the three areas. The iliolumbar and dorsal
sacroiliac ligaments were also injected in patient with low back pain.
Injections were typically done on a weekly basis for up to 3 weeks. A
set of three injections was repeated in 1 month's time if needed.
OUTCOME MEASURES: Level of pain, and improvement in activities of
daily living were measured on a five-point scale. Improvement in
ability to work was also assessed. RESULTS: Ninety-one percent (91.0%)
of patients reported reduction in level of pain; 84.8% of patients
reported improvement in activities of daily living, and 84.3% reported
an improvement in ability to work. Women required on average, three
more injections than men. Cervical spine response rates were lower
than thoracic or lumbar spine. No complications from treatment were
noted. CONCLUSIONS: Dextrose prolotherapy appears to be a safe and
effective method for treating chronic spinal pain that merits further
investigation. Future studies need to consider differences in gender
Prolotherapy injections for chronic low back pain: a systematic
Spine. 2004 Oct 1;29(19):2126-33.
Del Mar C,
Discipline of General Practice, University of Queensland, Brisbane,
Queensland, Australia. email@example.com
STUDY DESIGN: A systematic review of randomized and quasi-randomized
controlled trials. OBJECTIVES: To determine the efficacy of
prolotherapy injections in adults with chronic low back pain. SUMMARY
OF BACKGROUND DATA: Prolotherapy is an injection-based treatment for
chronic low back pain. Proponents of prolotherapy suggest that some
back pain stems from weakened or damaged ligaments. Repeatedly
injecting them with irritant solutions is thought to strengthen the
ligaments and reduce pain and disability. Prolotherapy protocols
usually include co-interventions to enhance the effectiveness of the
injections. METHODS: The authors searched MEDLINE, EMBASE, CINAHL, and
Science Citation Index up to January 2004, and the Cochrane Controlled
Trials Register 2004, issue 1, and consulted content experts. Both
randomized and quasi-randomized controlled trials comparing
prolotherapy injections to control injections, either alone or in
combination with other treatments, were included. Studies had to
include measures of pain and disability before and after the
intervention. Two reviewers independently selected the trials and
assessed them for methodologic quality. Treatment and control group
protocols varied from study to study, making meta-analysis impossible.
RESULTS: Four studies, all of high quality and with a total of 344
participants, were included. All trials measured pain and disability
levels at 6 months, three measured the proportion of participants
reporting a greater than 50% reduction in pain or disability scores
from baseline to 6 months. Two studies showed significant differences
between the treatment and control groups for those reporting more than
50% reduction in pain or disability. Their results could not be
pooled. In one, co-interventions confounded interpretation of results;
in the other, there was no significant difference in mean pain and
disability scores between the groups. In the third study, there was
little or no difference between groups in the number of individuals
who reported more than 50% improvement in pain and disability. The
fourth study reporting only mean pain and disability scores showed no
differences between groups. CONCLUSIONS: There is conflicting evidence
regarding the efficacy of prolotherapy injections in reducing pain and
disability in patients with chronic low back pain. Conclusions are
confounded by clinical heterogeneity among studies and by the presence
of co-interventions. There was no evidence that prolotherapy
injections alone were more effective than control injections alone.
However, in the presence of co-interventions, prolotherapy injections
were more effective than control injections, more so when both
injections and co-interventions were controlled concurrently.
therapy in osteoarthritis.
Postgrad Med J. 2003 Aug;79(934):449-53.
Department of Internal Medicine, Faculty of Medicine, American
University of Beirut, Beirut, Lebanon. firstname.lastname@example.org
The medical literature was reviewed from 1968-2002 using Medline and
the key words "intra-articular" and "osteoarthritis" to determine the
various intra-articular therapies used in the treatment of
osteoarthritis. Corticosteroids and hyaluronic acid are the most
frequently used intra-articular therapies in osteoarthritis. Other
intra-articular substances such as orgotein, radiation synovectomy,
dextrose prolotherapy, silicone, saline lavage, saline injection
without lavage, analgesic agents, non-steroidal anti-inflammatory
drugs, glucosamine, somatostatin, sodium pentosan polysulfate,
chloroquine, mucopolysaccharide polysulfuric acid ester, lactic acid
solution, and thiotepa cytostatica have been investigated as
potentially therapeutic in the treatment of arthritic joints. Despite
the lack of strong, convincing, and reproducible evidence that any of
the intra-articular therapies significantly alters the progression of
osteoarthritis, corticosteroids and hyaluronic acid are widely used in
patients who have failed other therapeutic modalities for lack of
efficacy or toxicity. As a practical approach for a knee with
effusion, steroid injections should be considered while the presence
of symptomatic "dry" knees may favour the hyaluronic acid approach.
The virtual absence of serious side effects, coupled with the
perceived benefits, make these approaches attractive.
Long-term effects of dextrose prolotherapy for anterior cruciate
Altern Ther Health Med. 2003 May-Jun;9(3):58-62.
Department of Biometry, University of Kansas Medical Center, Kansas
City, Kan., USA.
CONTEXT: Use of dextrose prolotherapy. Prolotherapy is defined as
injection that causes growth of normal cells or tissue. OBJECTIVE:
Determine the 1 and 3 year efficacy of dextrose injection prolotherapy
on anterior cruciate ligament (ACL) laxity. After year 1, determine
patient tolerance of a stronger dextrose concentration (25% versus
10%). DESIGN: Prospective consecutive patient trial. SETTING:
Outpatient physical medicine clinic. PATIENTS OR OTHER PARTICIPANTS:
Eighteen patients with 6 months or more of knee pain plus ACL knee
laxity. This laxity was defined by a KT1000 anterior displacement
difference (ADD) of 2 mm or more. INTERVENTION: Intraarticular
injection of 6-9 cc of 10% dextrose at months 0, 2, 4, 6, and 10.
Injection with 6 cc of 25% dextrose at 12 months. Then, depending on
patient preference, injection of either 10% or 25% dextrose every 2-4
months (based on patient preference) through 36 months. MAIN OUTCOME
MEASURES: Visual analogue scale (VAS) for pain at rest, pain on level
surfaces, pain on stairs, and swelling. Goniometric flexion range of
motion, and KT1000-measured ADD were also measured. All measurements
were obtained at 0, 6, 12 and 36 months. RESULTS: Two patients did not
reach 6 month data collection, 1 of whom was diagnosed with
disseminated cancer. The second was wheelchair-bound and found
long-distance travel to the clinic problematic. Sixteen subjects were
available for data analysis. KT1000 ADD, measurement indicated that 6
knees measured as normal (not loose) after 6 months, 9 measured as
normal after 1 year (6 injections), and 10 measured as normal at 3
years. At the 3 year follow-up, pain at rest, pain with walking, and
pain with stair use had improved by 45%, 43%, and 35% respectively.
Individual paired t tests indicated subjective swelling improved 63%
(P = .017), flexion range of motion improved by 10.5 degrees (P =
.002), and KT1000 ADD improved by 71% (P = .002). Eleven out of 16
patients preferred 10% dextrose injection. 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.
Randomized, prospective, placebo-controlled double-blind study of
dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP,
and trapeziometacarpal) joints: evidence of clinical efficacy.
J Altern Complement Med. 2000 Aug;6(4):311-20.
Rehabilitation Hospital, Gardner, Kansas, USA. email@example.com
OBJECTIVES: To determine the clinical benefit of dextrose prolotherapy
(injection of growth factors or growth factor stimulators) in
osteoarthritic finger joints. DESIGN: Prospective randomized
double-blind placebo-controlled trial. SETTINGS/LOCATION: Outpatient
physical medicine clinic. SUBJECTS: Six months of pain history was
required in each joint studied as well as one of the following: grade
2 or 3 osteophyte, grade 2 or 3 joint narrowing, or grade 1 osteophyte
plus grade 1 joint narrowing. Distal interphalangeal (DIP), proximal
interphalangeal (PIP), and trapeziometacarpal (thumb CMC) joints were
eligible. Thirteen patients (with seventy-four symptomatic
osteoarthitic joints) received active treatment, and fourteen patients
(with seventy-six symptomatic osteoarthritic joints) served as
controls. INTERVENTION: One half milliliter (0.5 mL) of either 10%
dextrose and 0.075% xylocaine in bacteriostatic water (active
solution) or 0.075% xylocaine in bacteriostatic water (control
solution) was injected on medial and lateral aspects of each affected
joint. This was done at 0, 2, and 4 months with assessment at 6 months
after first injection. OUTCOME MEASURES: One-hundred millimeter (100
mm) Visual Analogue Scale (VAS) for pain at rest, pain with joint
movement and pain with grip, and goniometrically-measured joint
flexion. RESULTS: Pain at rest and with grip improved more in the
dextrose group but not significantly. Improvement in pain with
movement of fingers improved significantly more in the dextrose group
(42% versus 15% with a p value of .027). Flexion range of motion
improved more in the dextrose group (p = .003). Side effects were
minimal. CONCLUSION: Dextrose prolotherapy was clinically
effective and safe in the treatment of pain with joint movement and
range limitation in osteoarthritic finger joints.
Randomized prospective double-blind placebo-controlled study of
dextrose prolotherapy for knee osteoarthritis with or without ACL
Altern Ther Health Med. 2000 Mar;6(2):68-74, 77-80.
Bethany Medical Center, Kansas City, Kan., USA.
CONTEXT: Use of prolotherapy (injection of growth factors or growth
factor stimulators). OBJECTIVE: Determine the effects of dextrose
prolotherapy on knee osteoarthritis with or without anterior cruciate
ligament (ACL) laxity. DESIGN: Prospective randomized double-blind
placebo-controlled trial. SETTING: Outpatient physical medicine
clinic. PATIENTS OR OTHER PARTICIPANTS: Six months or more of pain
along with either grade 2 or more joint narrowing or grade 2 or more
osteophytic change in any knee compartment. A total of 38 knees were
completely void of cartilage radiographically in at least 1
compartment. INTERVENTION: Three bimonthly injections of 9 cc of
either 10% dextrose and .075% lidocaine in bacteriostatic water
(active solution) versus an identical control solution absent 10%
dextrose. The dextrose-treated joints then received 3 further
bimonthly injections of 10% dextrose in open-label fashion. MAIN
OUTCOME MEASURES: Visual analogue scale for pain and swelling,
frequency of leg buckling, goniometrically measured flexion,
radiographic measures of joint narrowing and osteophytosis, and
KT1000-measured anterior displacement difference (ADD). RESULTS: All
knees: Hotelling multivariate analysis of paired observations between
0 and 6 months for pain, swelling, buckling episodes, and knee flexion
range revealed significantly more benefit from the dextrose injection
(P = .015). By 12 months (6 injections) the dextrose-treated knees
improved in pain (44% decrease), swelling complaints (63% decrease),
knee buckling frequency (85% decrease), and in flexion range (14
degree increase). Analysis of blinded radiographic readings of 0- and
12-month films revealed stability of all radiographic variables except
for 2 variables which improved with statistical significance. (Lateral
patellofemoral cartilage thickness [P = .019] and distal femur width
in mm [P = .021]. Knees with ACL laxity: 6-month (3 injection) data
revealed no significant improvement. However, Hotelling multivariate
analysis of paired values at 0 and 12 months for pain, swelling, joint
flexion, and joint laxity in the dextrose-treated knees, revealed a
statistically significant improvement (P = .021). Individual paired t
tests indicated that blinded measurement of goniometric knee flexion
range improved by 12.8 degrees (P = .005), and ADD improved by 57% (P
= .025). Eight out of 13 dextrose-treated knees with ACL laxity were
no longer lax at the conclusion of 1 year. 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 osteoarthritis severity. ACL laxity, when present in these
osteoarthritic patients, improved.