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Prolotherapy injections for chronic low-back pain.

S Dagenais¹, M J Yelland, C Del Mar

¹CHEO Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada, K1H 8L1. sdagenais@cheo.on.ca

The Cochrane Database of Systematic Reviews

|April 20, 2007

Summary

Prolotherapy injections alone do not effectively treat chronic low-back pain. However, when combined with spinal manipulation and exercise, prolotherapy may offer improvements for chronic low-back pain and disability.

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Area of Science:

Regenerative Medicine
Musculoskeletal Disorders
Pain Management

Background:

Prolotherapy involves injecting irritant solutions to strengthen lumbosacral ligaments.
It is used to alleviate certain types of chronic low-back pain.
Spinal manipulation and exercises are often adjuncts to prolotherapy.

Purpose of the Study:

To evaluate the efficacy of prolotherapy in adults experiencing chronic low-back pain.
To synthesize evidence from randomized and quasi-randomized controlled trials.

Main Methods:

Searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, AMED) up to October 2006.
Included RCTs and QRCTs comparing prolotherapy to control injections, with or without co-interventions.
Assessed pain and disability levels before and after treatment; meta-analysis was not possible due to heterogeneity.

Main Results:

Five high-quality studies with 366 participants were identified.
Prolotherapy injections alone showed no significant difference compared to control injections for pain or disability.
Prolotherapy combined with spinal manipulation and exercise demonstrated potential benefits for chronic low-back pain and disability.

Conclusions:

Evidence on prolotherapy for chronic low-back pain is conflicting.
Prolotherapy is not effective as a standalone treatment for chronic low-back pain.
Combined with other therapies, prolotherapy may improve chronic low-back pain, but results are confounded by co-interventions and study heterogeneity.