PROLOTHERAPY A NEW TREATMENT MODALITY IN CHRONIC MUSCULOSKELETAL PAIN; SYSTEMATIC REVIEW AND META-ANALYSIS

Main Article Content

Asif Islam
Abdul Munaf Saud
Muhammad Talha Khalil
Samara Siddique
Manusche Ibbad
Abdul Rehman Khan
Aiman Najam
Maheen Hashmi

Keywords

Musculoskeletal distress, Platelet-enriched plasma, Prolotherapy, Corticosteroids

Abstract

Conceptual Background: Picture a therapeutic approach that empowers the restoration of weakened ligaments and tendons, while simultaneously offering a cost-effective and secure remedy to chronic afflictions of the musculoskeletal system. Prolotherapy emerges as such an alluring alternative. However, its triumphs hinge on the accuracy of the injection process, contrast against other treatment options, and the yardsticks applied for appraisal. This scholarly pursuit endeavors to unravel the enduring potency of prolotherapy, employing dextrose, as a combatant against relentless musculoskeletal ailments. The research aims to elucidate the genuine virtues of this treatment in bestowing lasting relief from unyielding musculoskeletal torment.


Investigative Blueprint: A comprehensive scrutiny was conducted, casting a net over a diverse selection of repositories such as Medline, Embase, Cochrane Central, KoreaMed, and KMbase, taking into account studies published until March 2019. The spotlight was cast primarily on randomized controlled trials that contrasted the effects of dextrose prolotherapy against a gamut of alternative interventions including physical exertions, saline, platelet-enriched plasma, and corticosteroid injections. The cornerstone for assessment was the flux in pain indices during quotidian physical engagements.


Insights: The meticulous inquiry aggregated a collection of ten studies, with an adapted aggregate of 600 subjects, retouched from the initial count of 750. Within a span of 6 months to 1 year following dextrose prolotherapy, a noteworthy abatement in pain indices was observed compared to saline injections (standardized mean deviation [SMD] -0.35; 95% probability range [CI] -0.60 to -0.09, P = 0.008) and physical exertions (SMD -0.34; 95% CI -0.61 to -0.06, P = 0.02). Remarkably, the outcomes stemming from prolotherapy stood shoulder to shoulder with platelet-enriched plasma or corticosteroid injections, indicating an absence of consequential disparity in pain indices.


Culmination: Within the realm of alleviating chronic pain, dextrose prolotherapy surfaces as a formidable candidate, transcending the prowess of saline injections or physical exertions, and matching the caliber of platelet-enriched plasma or corticosteroid injections. To cast a more luminous spotlight on the merits of prolotherapy, an imperative exists for additional holistic, uniform, and protracted investigations.

Abstract 179 | pdf Downloads 80

References

1. Reeves KD, Hassanein K. Randomized, prospective, place- bo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometa- carpal) joints: evidence of clinical efficacy. J Altern Comple- ment Med 2000; 6: 311-20.
2. Reeves KD, Hassanein K. Randomized prospective dou- ble-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med 2000 6: 68-74, 77-80.
3. Jahangiri A, Moghaddam FR, Najafi S. Hypertonic dextrose ver- sus corticosteroid local injection for the treatment of osteoar- thritis in the first carpometacarpal joint: a double-blind ran- domized clinical trial. J Orthop Sci 2014; 19: 737-43.
4. Sit RW, Chung VC, Reeves KD, Rabago D, Chan KK, Chan DC, et al. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: a systematic re- view and meta-analysis. Sci Rep 2016; 6: 25247.
5. Paavola M, Kannus P, Järvinen TA, Järvinen TL, Józsa L, Järvin- en M. Treatment of tendon disorders. Is there a role for corti- costeroid injection? Foot Ankle Clin 2002; 7: 501-13.
6. Dean BJ, Lostis E, Oakley T, Rombach I, Morrey ME, Carr AJ. The risks and benefits of glucocorticoid treatment for tendi- nopathy: a systematic review of the effects of local glucocorti- coid on tendon. Semin Arthritis Rheum 2014; 43: 570-6.
7. Tempfer H, Gehwolf R, Lehner C, Wagner A, Mtsariashvili M, Bauer HC, et al. Effects of crystalline glucocorticoid triamcino- lone acetonide on cultered human supraspinatus tendon cells. Acta Orthop 2009; 80: 357-62.
8. Stannard JP, Bucknell AL. Rupture of the triceps tendon associ- ated with steroid injections. Am J Sports Med 1993; 21: 482-5.
9. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylosis: a pilot study. Clin J Sport Med 2008; 18: 248-54.
10. Okuda Y, Adrogue HJ, Nakajima T, Mizutani M, Asano M, Tachi Y, et al. Increased production of PDGF by angiotensin and high glucose in human vascular endothelium. Life Sci 1996; 59: 1455-61.
11. Oh JH, Ha H, Yu MR, Lee HB. Sequential effects of high glucose on mesangial cell transforming growth factor-beta 1 and fi- bronectin synthesis. Kidney Int 1998; 54: 1872-8.
12. Di Paolo S, Gesualdo L, Ranieri E, Grandaliano G, Schena FP. High glucose concentration induces the overexpression of transforming growth factor-beta through the activation of a platelet-derived growth factor loop in human mesangial cells. Am J Pathol 1996; 149: 2095-106.
13. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; (2): CD005328.
14. Aufiero D, Vincent H, Sampson S, Bodor M. Regenerative in- jection treatment in the spine: review and case series with platelet rich plasma. J Stem Cells Res Rev Rep 2015; 2: 1019.
15. Linetsky FS, Manchikanti L. Regenerative injection therapy for axial pain. Tech Reg Anesth Pain Manag 2005; 9: 40-9.
16. Adams E. Bibliography: prolotherapy for musculoskeletal pain. Boston, Veterans. 2008.
17. Goswami A. Prolotherapy. J Pain Palliat Care Pharmacother 2012; 26: 376-8.
18. Nair LS. Prolotherapy for tissue repair. Transl Res 2011; 158: 129-31.
19. Rabago D, Best TM, Beamsley M, Patterson J. A systematic re- view of prolotherapy for chronic musculoskeletal pain. Clin J Sport Med 2005; 15: 376-80.
20. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al.; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assess- ing risk of bias in randomised trials. BMJ 2011; 343: d5928.
21. Uğurlar M, Sönmez MM, Uğurlar ÖY, Adıyeke L, Yıldırım H, Eren OT. Effectiveness of four different treatment modalities in the treatment of chronic plantar fasciitis during a 36-month follow-up period: a randomized controlled trial. J Foot Ankle Surg 2018; 57: 913-8.
22. Seven MM, Ersen O, Akpancar S, Ozkan H, Turkkan S, Yıldız Y, et al. Effectiveness of prolotherapy in the treatment of chronic rotator cuff lesions. Orthop Traumatol Surg Res 2017; 103: 427- 33.
23. Ersen Ö, Koca K, Akpancar S, Seven MM, Akyıldız F, Yıldız Y, et al. A randomized-controlled trial of prolotherapy injections in the treatment of plantar fasciitis. Turk J Phys Med Rehabil 2017; 64: 59-65.
24. Rabago D, Patterson JJ, Mundt M, Kijowski R, Grettie J, Segal NA, et al. Dextrose prolotherapy for knee osteoarthritis: a ran- domized controlled trial. Ann Fam Med 2013; 11: 229-37.
25. Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng AL. Dex- trose prolotherapy versus control injections in painful rotator cuff tendinopathy. Arch Phys Med Rehabil 2016; 97: 17-25.
26. Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM R 2014; 6: 152-8.

Most read articles by the same author(s)