Anesth Pain Med.  2021 Jan;16(1):81-95. 10.17085/apm.20078.

Prolotherapy for the patients with chronic musculoskeletal pain: systematic review and meta-analysis

• Bae G
• Kim S
• Lee S
• Lee WY
• Lim Y

• KMID: 2512286
• DOI: http://doi.org/10.17085/apm.20078

Abstract

Background
Prolotherapy, which stimulates the healing of loosened ligaments and tendons, is a cost-effective and safe treatment modality for chronic musculoskeletal pain. Its benefits may be affected by injection protocols, comparative regimens, and evaluation scales. The aim of this study was to determine the effectiveness of dextrose prolotherapy as a long-term treatment for chronic musculoskeletal pain.
Methods
Medline, Embase, Cochrane Central, KoreaMed, and KMbase databases were searched for studies published up to March 2019. We included randomized controlled trials which compared the effect of dextrose prolotherapy with that of other therapies such as exercise, saline, platelet-rich plasma, and steroid injection. The primary outcome was pain score change during daily life.
Results
Ten studies involving 750 participants were included in the final analysis. Pain scores from 6 months to 1 year after dextrose prolotherapy were significantly reduced compared to saline injection (standardized mean difference [SMD] –0.44; 95% confidence interval [CI] –0.76 to –0.11, P = 0.008) and exercise (SMD –0.42; 95% CI –0.77 to –0.07, P = 0.02). Prolotherapy yielded results similar to platelet-rich plasma or steroid injection, that it showed no significant difference in pain score.
Conclusions
Dextrose prolotherapy is more effective in the treatment of chronic pain compared to saline injection or exercise. Its effect was comparable to that of platelet-rich plasma or steroid injection. Adequately powered, homogeneous, and longer-term trials are needed to better elucidate the efficacy of prolotherapy.

Keyword

Musculoskeletal pain; Platelet-rich plasma; Prolotherapy; Steroids

Figure

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  Fig. 1. PRISMA flow diagram. Flow diagram of search strategy and study selection. DB: database.

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  Fig. 2. Risk of bias graph. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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  Fig. 3. Risk of bias summary. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.

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  Fig. 4. Forest Plot; (A) saline (B) exercise (C) PRP (D) steroid. Forest plot diagram showing comparisons of VAS for Pain Composite between dextrose prolotherapy and the reference treatments 6 months–1 year. (A) Dextrose vs. Saline on VAS for pain composite 6 months–1 year. (B) Dextrose vs. Exercise on VAS for pain composite 6 months–1 year. (C) Dextrose vs. PRP on VAS for pain composite 6 months–1 year. (D) Dextrose vs. Steroid on VAS for pain composite 6 months–1 year. PRP: platelet-rich plasma, VAS: Visual Analog Scale, Std. Mean difference: standardized mean difference, IV: weighted mean difference, CI: confidence interval, SD: standard deviation.

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