Prolotherapy in Primary Care Practice

Primary Care - Clinics in Office Practice

Volumn 37, Issue 1, 2010, Pages 65-80

  Rabago, David ^a   Slattengren, Andrew ^a   Zgierska, Aleksandra ^a  

^a UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH   (United States)

Author keywords

Chronic musculoskeletal pain; Injection therapy; Low back pain; Osteoarthritis; Prolotherapy; Tendinopathy

Indexed keywords

BUPIVACAINE; CHONDROITIN; CORTICOSTEROID; GLUCOSAMINE; GLUCOSE; LIDOCAINE; MORRHUATE SODIUM; NARCOTIC ANALGESIC AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; PARACETAMOL; PHENOL GLYCERIN GLUCOSE; SCLEROSING AGENT; STEROID; UNCLASSIFIED DRUG; ZINC SULFATE;

ALTERNATIVE MEDICINE; BONE PAIN; CHRONIC PAIN; CLINICAL DECISION MAKING; CLINICAL TRIAL; COCCYGODYNIA; DEBRIDEMENT; DISEASE SEVERITY; DRUG FATALITY; DRUG HYPERSENSITIVITY; DRUG MECHANISM; DRUG SAFETY; EVIDENCE BASED MEDICINE; HIP PAIN; HUMAN; INJECTION SITE PAIN; INJECTION SITE PARESTHESIA; KINESIOTHERAPY; KNEE OSTEOARTHRITIS; LEG PAIN; LOW BACK PAIN; MANIPULATIVE MEDICINE; MEDICAL EDUCATION; MUSCULOSKELETAL PAIN; NONHUMAN; OSTEOARTHRITIS; OUTCOME ASSESSMENT; PLANTAR FASCIITIS; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; PROLOTHERAPY; REVIEW; TENDINITIS; TENNIS ELBOW; TREATMENT CONTRAINDICATION; TREATMENT INDICATION; UNITED STATES; VISUAL ANALOG SCALE;

CHRONIC DISEASE; COMPLEMENTARY THERAPIES; HUMANS; INJECTIONS, INTRA-ARTICULAR; INJECTIONS, SPINAL; LOW BACK PAIN; MUSCULAR DISEASES; OSTEOARTHRITIS; PAIN; PRIMARY HEALTH CARE; SCLEROSING SOLUTIONS; TENDINOPATHY; UNITED STATES;

EID: 77149127091     PISSN: 00954543     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.pop.2009.09.013     Document Type: Review

References (78)

1. Hackett G.S., Hemwall G.A., and Montgomery G.A. Ligament and tendon relaxation treated by prolotherapy. 5th edition (1993), Gustav A. Hemwall, Oak Park (IL)
2. Linetsky F.S., FRafael M., and Saberski L. Pain management with regenerative injection therapy (RIT). In: Weiner R.S. (Ed). Pain management (2002), CRC Press, Boca Raton (FL) 381-402
3. Matthews J.H. Nonsurgical treatment of pain in lumbar spinal stenosis. [letter to the editor]. Am Fam Physician 59 2 (1999) 280-284
4. Schnirring L. Are your patients asking about prolotherapy?. Physician Sports Med 28 8 (2000) 15-17
5. Dorman T.A. Prolotherapy: a survey. J Orthopaedic Med 15 2 (1993) 49-50
6. Linetsky F.S., Botwin K., Gorfin L., et al. Regeneration injection therapy (RIT): effectiveness and appropriate usage (2001), Florida Academy of Pain Medicine. http://www.gracermedicalgroup.com/resources/articles/rf_file_0025.pdf Accessed October 15, 2009
7. Maxwell N.J., Ryan M.B., Taunton J.E., et al. Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study. Am J Roentgenol 189 4 (2007) W215-W220
8. Scarpone M., Rabago D., Zgierska A., et al. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med 18 (2008) 248-254
9. Rabago D., Best T.M., Zgierska A., et al. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet rich plasma. Br J Sports Med (2009) 10.1136/bjsm.2008.052761
10. Liu Y.K., Tipton C.M., Matthes R.D., et al. An in-situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res 11 (1983) 95-102
11. Maynard J.A., Pedrini V.A., Pedrini-Mille A., et al. Morphological and biochemical effects of sodium morrhuate on tendons. J Orthop Res 3 (1985) 236-248
12. Banks A. A rationale for prolotherapy. J Orthop Med 13 3 (1991) 54-59
13. Hoksrud A., Ohberg L., Alfredson H., et al. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy. Am J Sports Med 34 (2006) 1738-1746
14. Zeisig E., Fahlström M., Ohberg L., et al. A 2-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow. Br J Sports Med (2008) 10.1136/bjsm.2008.049874
15. Kim S.R., Stitik T.P., and Foye P.M. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil 83 5 (2004) 379-389
16. Reeves K.D., and Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 6 2 (2000) 68-80
17. Jensen K., Rabago D., Best T.M., et al. Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res 26 (2008) 816-823
18. Aneja A., Spero G., Weinhold P., et al. Suture plication, thermal shrinkage and sclerosing agents. Am J Sports Med 33 (2005) 1729-1734
19. Jensen KT. Healing response of knee ligaments to prolotherapy in a rat model [PhD dissertation]. Madison (WI): Biomedical Engineering, University of Wisconsin; 2006.
20. Rabago D., Best T., Beamsly M., et al. A systematic review of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med 15 5 (2005) 376-380
21. Yelland M., Yeo M., and Schluter P. Prolotherapy injections for chronic low back pain: results of a pilot comparative study. Australian Musculoskeletal Medicine 5 2 (2000) 20-30. http://www.musmed.com/ Available at:
22. Ernst E., Pittler M.H., Stevinson C., et al. Randomised clinical trials: pragmatic or fastidious?. Focus on Alternative and Complementary Therapies 63 3 (2001) 179-180. Available at: http://www.pharmpress.com/shop/journals.asp?a=1&cid=27
23. Klein R.G., Eek B.C., DeLong W.B., et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 6 1 (1993) 23-33
24. Dechow E., Davies R.K., Carr A.J., et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology 38 (1999) 1255-1259
25. Yelland M., Glasziou P., Bogduk N., et al. Prolotherapy injections, saline injections, and exercises for chronic low back pain: a randomized trial. Spine 29 1 (2004) 9-16
26. Yelland M.J., Del Mar C., Pirozo S., et al. Prolotherapy injections for chronic low back pain: a systematic review. Spine 29 (2004) 2126-2133
27. Cusi M., Saunders J., Hungerford B., et al. The use of prolotherapy in the sacro-iliac joint. Br J Sports Med (2008) 10.1136/bjsm.2007.042044
28. Khan S.A., Kumar A., Varshney M.K., et al. Dextrose prolotherapy for recalcitrant coccygodynia. J Orthop Surg 16 (2008) 27-29
29. Crawford F., and Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 3 (2003) CD000416
30. Ryan M.B., Wong A.D., Gillies J.H., et al. Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for thetreatment of chronic plantar fasciitis. Br J Sports Med 43 (2009) 303-306 10.1136/bjsm.2008.050021
31. Wheeler A.H. Pathophysiology of chronic back pain. Available at: (2007). http://www.emedicine.com/neuro/topic516.htm
32. Ongley M.J., Klein R.G., Dorman T.A., et al. A new approach to the treatment of chronic low back pain. Lancet 2 (1987) 143-146
33. Bellamy N., Carr A., Dougados M., et al. Towards a definition of "difference" in osteoarthritis. J Rheumatol 28 2 (2001) 427-430
34. Redelmeier D.A., Guyatt G.H., and Goldstein R.S. Assessing the minimal important difference in symptoms: a comparison of two techniques. J Clin Epidemiol 49 (1996) 1215-1219
35. Wells G.A., Tugwell P., Kraag G.R., et al. Minimum important difference between patients with rheumatoid arthritis: the patient's perspective. J Rheumatol 20 (1993) 557-560
36. Loeser J.D. Point of view. Spine 29 1 (2004) 16
37. Reeves K.D., Klein R.G., and DeLong W.B. Letter to the editor. Spine 29 16 (2004) 1839-1840
38. Farrar J.T., Young J.P., LaMoreaux L., et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical rating scale. Pain 94 (2001) 149-158
39. Miller M.R., Mathews R.S., and Reeves K.D. Treatment of painful advanced internal lumbar disc derangement with intradiscal injection of hypertonic dextrose. Pain Physician 9 (2006) 115-121
40. Khan K.M., Cook J.L., Kannus P., et al. Time to abandon the 'tendinitis' myth. BMJ 324 (2002) 626-627
41. Bongers P.M. The cost of shoulder pain at work. Variation in work tasks and good job opportunities are essential for prevention. BMJ 322 (2001) 64-65
42. Wilson J.J., and Best T.M. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician 72 (2005) 811-818
43. Khan K.M., Cook J.L., Bonar F., et al. Histopathology of tendinopathies. Update and implications for clinical management. Sports Med 27 (1999) 393-408
44. Puddu G., Ippolito E., and Postacchini F.A. classification of Achilles tendon disease. Am J Sports Med 4 (1976) 145-150
45. Johnson G.W., Cadwallader K., Scheffel S.B., et al. Treatment of lateral epicondylitis. Am Fam Physician 76 (2007) 843-848 849-50; 853
46. Verhar J. Tennis elbow: anatomical, epidemiological and therapeutic aspects. Int Orthop 18 (1994) 263-267
47. Hamilton P. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract 36 (1986) 464-465
48. Kivi P. The etiology and conservative treatment of lateral epicondylitis. Scand J Rehabil Med 15 (1983) 37-41
49. Gabel G.T. Acute and chronic tendinopathies at the elbow. Curr Opin Rheumatol 11 (1999) 138-148
50. Ono Y., Nakamura R., Shimaoka M., et al. Epicondylitis among cooks in nursery schools. Occup Environ Med 55 (1998) 172-179
51. Ritz B.R. Humeral epicondylitis among gas and waterworks employees. Scand J Work Environ Health 21 (1995) 478-486
52. Buchbinder R., Green S., White M., et al. Shock wave therapy for lateral elbow pain. Cochrane Database Syst Rev 1 (2002) CD003524
53. Smidt N., van der Windt D.A., Assendelft W.J., et al. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet 359 (2002) 657-662
54. Struijs P.A., Smidt N., Arola H., et al. Orthotic devices for the treatment of tennis elbow. Cochrane Database Syst Rev 3 (2005)
55. Kvist M. Achilles tendon injuries in athletes. Sports Med 18 (1994) 173-201
56. Zeisig E., Ohberg L., and Alfredson H. Extensor origin vascularity related to pain in patients with tennis elbow. Knee Surg Sports Traumatol Arthrosc 14 (2006) 659-663
57. Alfredson H., and Ohberg L. Sclerosing injections to areas of neovascularization reduce pain in chronic Achilles tendinopathy: a double-blind randomised trial. Knee Surg Sports Traumatol Arthrosc 13 (2005) 338-344
58. Holmich P., Uhrskou P., and Ulnits L. Effectiveness of active physical training as treatment of long-standing adductor-related groin pain in athletes: a randomized controlled trial. Lancet 353 (1999) 439-443
59. Topol G.A., Reeves K.D., and Hassanein K.M. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with groin pain. Arch Phys Med Rehabil 86 (2005) 697-702
60. Buchbinder R. Plantar fasciitis. N Engl J Med 350 (2004) 2159-2166
61. Taunton J., Ryan M., Clement D., et al. A retrospective case-control analysis of 2002 running injuries. Br J Sports Med 36 (2002) 95-101
62. Reeves K.D., and Hassanein K. 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 6 4 (2000) 311-320
63. Rabago D. The efficacy of prolotherapy in osteoarthritic knee pain. NIH-NCCAM Grant, 1K23 AT001879-01; in press.
64. Reginster J.Y. The prevalence and burden of arthritis. Rheumatology 41 Suppl 1 (2002) 3-6
65. CDC. Prevalence and impact of chronic joint symptoms-seven states, 1996. MMWR Morb Mortal Wkly Rep 47 (1998) 345-351
66. CDC. Prevalence of disabilities and associated health conditions-United States, 1991-1992. MMWR Morb Mortal Wkly Rep 43 (1994) 730-739
67. Felson D.T., and Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 41 8 (1998) 1343-1355
68. Wilson M.G., Michet C.J., Ilstrup D.M., et al. Ideopathic symptomatic osteoarthritis of the hip and knee: a population-based incidence study. Mayo Clin Proc 65 (1990) 1214-1221
69. Oliveria S.A., Felson D.T., Klein R.A., et al. Estrogen replacement therapy and the development of osteoarthritis. Epidemiology 7 (1996) 415-419
70. Levy E., Ferme A., Perocheau D., et al. [Socioeconomic costs of osteoarthritis in France]. Rev Rhum Ed Fr 60 (1993) 63S-67S [in French]
71. Felson D.T., Lawarence R.C., Hochberg M.C., et al. Osteoarthritis: new insights, part 2: treatment approaches. Ann Intern Med 133 (2000) 726-737
72. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 43 (2000) 1905-1915
73. Samson D.J., Grant M.D., Ratko T.A., et al. Treatment of primary and secondary osteoarthritis of the knee. Evid Rep Technol Assess (Full Rep) (2007) 151. http://www.ncbi.hlm.nih.gov/pubmed/18088162 Accessed October 16, 2009
74. Rabago D, Zgierska A, Mundt M, et al. Efficacy of prolotherapy for knee osteoarthritis: results of a prospective case series. Poster presentation at: North American Research Conference on Complementary and Integrative Medicine. May 9, 2009.
75. Schneider R.C., Williams J.J., and Liss L. Fatality after injection of sclerosing agent to precipitate fibro-osseous proliferation. JAMA 170 15 (1959) 1768-1772
76. Keplinger J.E., and Bucy P.C. Paraplegia from treatment with sclerosing agents - report of a case. JAMA 173 12 (1960) 1333-1336
77. Hunt W.E., and Baird W.C. Complications following injection of sclerosing agent to precipitate fibro-osseous proliferation. J Neurosurg 18 (1961) 461-465
78. Dagenais S., Ogunseitan O., Haldeman S., et al. Side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain: a survey of practitioners. Arch Phys Med Rehabil 87 (2006) 909-913