By Robert Shmerling, M.D.
Q: What can you tell me about prolotherapy? Have there been published studies on the treatment?
A: Prolotherapy is a pain treatment that includes a series of injections into the region of pain. It is particularly popular as a treatment for back pain and osteoarthritis.
Prolotherapy is based on the theory that pain may be caused by injured soft tissues (such as muscles, tendons and ligaments) and that injecting chemicals into the injured area can stimulate healing. The theory is unproven and this technique is generally not taught in traditional medical schools. It goes by several other names, including proliferative injection therapy, regenerative injection therapy and sclerosant therapy.
Injections are performed every two to three weeks over several months with various irritant agents, often including a type of sugar called dextrose, along with a numbing medication similar to Novocain. Because the injections may temporarily cause pain, ice, codeine-type pain relievers, and acetaminophen (such as Tylenol) may be recommended. Treatments are often combined with physical therapy.
Risks of treatment include more pain, bruising, headache or allergic reactions; rarely, more serious complications occur related to unintentional positioning of the needle near the spinal cord, nerves or lungs.
Unfortunately, there are few studies of the technique. I could find only a few articles in the medical literature that critically evaluate its effectiveness for back pain, arthritis or other painful conditions. Some researchers report benefit with prolotherapy (compared with injections of placebo) but most of these studies evaluated only a small number of patients. They also used methods that made it difficult to know whether prolotherapy was better than more traditional therapies. In addition, other studies found no benefit when comparing prolotherapy to placebo injections.
Recent articles reviewing the world’s published studies of prolotherapy come to this conclusion: So far, studies of prolotherapy are inconclusive.
On the other hand, there is no convincing evidence that it does not work for chronic low back pain, arthritis or other painful conditions. In addition, some studies, though small, have found benefit. And there is no strong suggestion that it is harmful.
More research on prolotherapy will be necessary to determine its usefulness for the treatment of back pain, arthritis or other types of pain.
(Robert H. Shmerling, M.D., is an associate professor at Harvard Medical School and clinical chief of Rheumatology at Beth Israel Deaconess Medical Center in Boston. For additional consumer health information, please visit www.health.harvard.edu.)