title: A systematic review of prolotherapy for chronic musculoskeletal pain.
abstract: OBJECTIVE
  Prolotherapy, an injection-based treatment of chronic musculoskeletal pain, has grown in popularity and has received significant recent attention. The objective of this review is to determine the effectiveness of prolotherapy for treatment of chronic musculoskeletal pain.
  
  
  METHODS
  We searched Medline, PreMedline, Embase, CINAHL, and Allied and Complementary Medicine with search strategies using all current and historical names for prolotherapy and injectants. Reference sections of included articles were scanned, and content area specialists were consulted.
  
  
  METHODS
  All published studies involving human subjects and assessing prolotherapy were included.
  
  
  RESULTS
  Data from 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations.
  
  
  CONCLUSIONS
  There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandomized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with noninjection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy.
authors.affiliation: University of Wisconsin-Madison, Madison, WI 53715, USA. David.Rabago@fammed.wisc.edu
authors.forename: David
authors.initials: D
authors.lastname: Rabago
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Best
authors.forename: Mark
authors.initials: M
authors.lastname: Beamsley
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Patterson
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use*; D002908:Chronic Disease; D005947:Glucose / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000627:therapeutic use*; D017116:Low Back Pain / Q000188:drug therapy*; D009140:Musculoskeletal Diseases / Q000188:drug therapy; D010003:Osteoarthritis / Q000188:drug therapy*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D005947:Glucose