Prolotherapy injections for chronic low-back pain (Review)

Simon Dagenais, Michael J Yelland, Chris B Del Mar, M L Schoene

Research output: Contribution to journalArticleResearchpeer-review

58 Citations (Scopus)

Abstract

Background

Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness.

Objectives

To determine the efficacy of prolotherapy in adults with chronic low-back pain.
Search methods

We searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. Literature search was updated on July 29th, 2009. No new RCTs were identified.

Selection criteria

We included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention.
Data collection and analysis

Two review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible.

Main results

We identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores.

Three randomised controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50% improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity.

Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50% reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling.

Authors' conclusions

There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.
Original languageEnglish
Article numberCD004059.pub3
Pages (from-to)1-28
Number of pages28
JournalCochrane Database of Systematic Reviews
Issue number2
DOIs
Publication statusPublished - 2007

Fingerprint

Low Back Pain
Injections
Pain
Spinal Manipulation
Randomized Controlled Trials
Exercise Therapy
Irritants
Ligaments
MEDLINE
Meta-Analysis
Language
Exercise
Therapeutics

Cite this

Dagenais, Simon ; Yelland, Michael J ; Del Mar, Chris B ; Schoene, M L. / Prolotherapy injections for chronic low-back pain (Review). In: Cochrane Database of Systematic Reviews. 2007 ; No. 2. pp. 1-28.
@article{e51185e1eccd4c949d159325dd1f1986,
title = "Prolotherapy injections for chronic low-back pain (Review)",
abstract = "BackgroundProlotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness.ObjectivesTo determine the efficacy of prolotherapy in adults with chronic low-back pain.Search methodsWe searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. Literature search was updated on July 29th, 2009. No new RCTs were identified.Selection criteriaWe included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention.Data collection and analysisTwo review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible.Main resultsWe identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50{\%} reduction in pain or disability scores.Three randomised controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50{\%} improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity.Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50{\%} reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling.Authors' conclusionsThere is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.",
author = "Simon Dagenais and Yelland, {Michael J} and {Del Mar}, {Chris B} and Schoene, {M L}",
year = "2007",
doi = "10.1002/14651858.CD004059.pub3",
language = "English",
pages = "1--28",
journal = "Cochrane database of systematic reviews (Online)",
issn = "1469-493X",
publisher = "Wiley-Blackwell",
number = "2",

}

Prolotherapy injections for chronic low-back pain (Review). / Dagenais, Simon; Yelland, Michael J; Del Mar, Chris B; Schoene, M L.

In: Cochrane Database of Systematic Reviews, No. 2, CD004059.pub3, 2007, p. 1-28.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Prolotherapy injections for chronic low-back pain (Review)

AU - Dagenais, Simon

AU - Yelland, Michael J

AU - Del Mar, Chris B

AU - Schoene, M L

PY - 2007

Y1 - 2007

N2 - BackgroundProlotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness.ObjectivesTo determine the efficacy of prolotherapy in adults with chronic low-back pain.Search methodsWe searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. Literature search was updated on July 29th, 2009. No new RCTs were identified.Selection criteriaWe included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention.Data collection and analysisTwo review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible.Main resultsWe identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores.Three randomised controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50% improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity.Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50% reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling.Authors' conclusionsThere is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

AB - BackgroundProlotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness.ObjectivesTo determine the efficacy of prolotherapy in adults with chronic low-back pain.Search methodsWe searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. Literature search was updated on July 29th, 2009. No new RCTs were identified.Selection criteriaWe included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention.Data collection and analysisTwo review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible.Main resultsWe identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores.Three randomised controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50% improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity.Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50% reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling.Authors' conclusionsThere is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.

U2 - 10.1002/14651858.CD004059.pub3

DO - 10.1002/14651858.CD004059.pub3

M3 - Article

SP - 1

EP - 28

JO - Cochrane database of systematic reviews (Online)

JF - Cochrane database of systematic reviews (Online)

SN - 1469-493X

IS - 2

M1 - CD004059.pub3

ER -