Prolotherapy injections for chronic low-back pain

Yelland, M. J., Del Mar, C., Pirozzo, S., Schoene, M. L. and Vercoe, P. (2004) Prolotherapy injections for chronic low-back pain. The Cochrane Database of Systematic Reviews, 2: 1-16. doi:10.1002/14651858.CD004059.pub3


Author Yelland, M. J.
Del Mar, C.
Pirozzo, S.
Schoene, M. L.
Vercoe, P.
Title Prolotherapy injections for chronic low-back pain
Journal name The Cochrane Database of Systematic Reviews
ISSN 1464-780X
Publication date 2004-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004059.pub3
Issue 2
Start page 1
End page 16
Total pages 16
Editor Cochrane Injuries Group
Place of publication Chichester, U.K.
Publisher John Wiley & Sons
Language eng
Subject C1
321017 Orthopaedics
730114 Skeletal system and disorders (incl. arthritis)
11 Medical and Health Sciences
1103 Clinical Sciences
Formatted abstract
Background
Prolotherapy involves repeated injections of irritant solutions to strengthen lumbosacral ligaments and reduce some types of chronic low-back pain; spinal manipulation and exercises are often used to enhance its effectiveness.

Objectives
To determine the efficacy of prolotherapy in adults with chronic low-back pain.

Search strategy
We searched CENTRAL 2006, Issue 3 and MEDLINE, EMBASE, CINAHL, and AMED from their respective beginnings to October 2006, with no restrictions on language, and consulted content experts. Literature search was updated on July 29th, 2009. No new RCTs were identified.

Selection criteria
We included randomised (RCT) and quasi-randomised controlled trials (QRCT) that compared prolotherapy injections to control injections, alone or in combination with other treatments, which measured pain or disability before and after the intervention.

Data collection and analysis
Two review authors independently selected the trials and assessed methodological quality. Intervention protocols varied from study to study, making meta-analysis impossible.

Main results
We identified five high quality studies with a total of 366 participants. All measured pain or disability levels at six months, and four measured the proportion of participants reporting a greater than 50% reduction in pain or disability scores.

Three randomised controlled trials (206 participants) found that prolotherapy injections alone are no more effective than control injection for chronic low-back pain and disability. At six months, there was no difference between groups in mean pain or disability scores (2 RCTs; 184 participants) and no difference in proportions who reported over 50% improvement in pain or disability (3 RCTs; 206 participants). These trials could not be pooled due to clinical heterogeneity.

Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, are more effective than control injections for chronic low-back pain and disability. At six months, one study reported a significant difference between groups in mean pain and disability scores, whereas the other study did not. Both studies reported a significant difference in the proportion of individuals who reported over 50% reduction in disability or pain. Co-interventions confounded interpretation of results and clinical heterogeneity in the trials prevented pooling.

Authors' conclusions
There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability. Conclusions are confounded by clinical heterogeneity amongst studies and by the presence of co-interventions.
Q-Index Code C1
Additional Notes Article CD004059.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 15 Aug 2007, 13:25:03 EST