title: A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain.
abstract: OBJECTIVE
  The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain.
  
  
  METHODS
  Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016.
  
  
  METHODS
  Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected.
  
  
  METHODS
  Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated.
  
  
  RESULTS
  Fourteen RCTs, 1 case-control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood-Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings.
  
  
  CONCLUSIONS
  Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature.
authors.affiliation: Caring Medical Regenerative Medicine Clinics, Oak Park, IL, USA.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Hauser
authors.affiliation: InQuill Medical Communications, Soquel, CA, USA.
authors.forename: Johanna B
authors.initials: JB
authors.lastname: Lackner
authors.affiliation: Caring Medical Regenerative Medicine Clinics, Oak Park, IL, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Steilen-Matias
authors.affiliation: Center for Healing and Regenerative Medicine, Austin, TX, USA.
authors.forename: David K
authors.initials: DK
authors.lastname: Harris
keywords: dextrose; evidence-based medicine; musculoskeletal pain; osteoarthritis chronic pain; prolotherapy; systematic review