A systematic review of prolotherapy for chronic musculoskeletal pain.
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.
Rabago
David
D
University of Wisconsin-Madison, Madison, WI 53715, USA. David.Rabago@fammed.wisc.edu
Best
Thomas M
TM
Beamsley
Mark
M
Patterson
Jeffrey
J
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*
D000779:Anesthetics, Local; D008012:Lidocaine; D005947:Glucose