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Prolotherapy

Radiofrequency Lesioning

Prolotherapy

Prolotherapy remains perhaps one of the most controversial therapies for low back pain despite numerous clinical studies reporting good safety and outcomes from ligament injections. [1] There have been four major randomized controlled trials* on prolotherapy (or ligament sclerosing injections) for low back pain with conflicting results. [2-5] Two of these, comprising 160 patients in all, found prolotherapy injections significantly** better than control injections in terms of pain and disability. [2,3] One other found improvements in both those treated with prolotherapy and with control solutions although the differences were not significant. In this study 20% of patients went onto become painfree two years after treatment. [4]

One difficulty in interpreting the results of studies has been that the injections have been performed on patients with low back pain who have not had a cause for their pain identified (disc, facet, sacroiliac, soft tissue) and because of the use of different injection protocols in terms of how many injections and what substances are injected.

However, in patients with sacroiliac joint instability as the known cause of pain, about 60 in 100 patients can hope for over 50% improvement that lasts for a year or more after a course of three monthly injections. [6] The best results are found in younger women, of whom about three in ten may become pain free. It is not unusual however for repeat injections to be needed (at an average of 12 months but often longer down the line).[7]

In patients with other causes of low back pain, particularly segmental instability, then results may be improved by combining injections with other treatments such as exercise and manipulation although specific data on outcomes for this group are lacking. [1]

* A randomized controlled trial is considered to be the most vigorous scientific method of assessing the effectiveness of treatments. Some patients will get the treatment and a similar set of patients will undergo a similar treatment that is thought to be ineffective. In this context, the term control refers to an injection of a substance not thought to have a treatment effect, such as saline solution. If the trial is blinded then the patient does not know which treatment he/she is receiving and if double-blinded then the treating practitioner is not aware which treatment he/she is giving.

** In controlled trials, the term significant means that there is a less than one in twenty chance that the differences between the two treatment groups occurred by chance. In scientific terms we would therefore imply that there was a real difference between the outcomes of the two interventions.

References

[1] Dagenais et al. Prolotherapy injections for chronic low back pain. Cochrane Database Syst Rev. 2007 (2):CD004059

[2] Klein RG et al. A randomized, double-blind trial of dextrose-glycerine-phenol injections for chronic low back pain. J Spinal Disord. 1993; 6(1):23-33

[3] Ongley M J et al. A new approach to the management of low back pain. Lancet 1987;2(8551):143-6

[4] Yelland et al. Prolotherapy injections, saline injections and exercises for chronic low back pain: a randomized trial. Spine 2004;29:9-16

[5] Dechow E et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology. 1999; 38(12):1255-9

[6] Chakraverty et al. Audit of conservative management of chronic low back pain in a secondary care setting—part 1:facet joint and sacroiliac joint interventions. Acupunct Med. 2004; 22(4):207-13

[7] Chakraverty et al. Analysis of prognostic indicators followinf prolotherapy injections for sacroiliac joint pain. In submission.