Treating Chronic Low Back Pain with ProlotherapyThere are many treatment approaches to chronic low back pain (CLBP). One effective but less commonly used technique is called prolotherapy. Dextrose (a sugar compound) along with a numbing agent (lidocaine) and phenol are injected into the spinal ligaments. The body responds with an inflammatory reaction. Scar tissue is formed and helps stiffen up loose joints.
Prolotherapy is used most often for patients with CLBP from ligament or tendon injury. Trauma or repetitive sprain injuries are the most common cause of these soft tissue injuries. Prolotherapy may help patients with spinal instability from collagen deficiency.
The treatment is usually performed by a medical or osteopathic physician who then performs a spinal manipulation to the injected area. Patients are advised to do exercises flexing and extending the spine for several weeks.
Injections are given on a regular basis over a period of time. This could be weekly, biweekly (twice a month), or once a month. Six to eight treatments are given depending on the patient's response to the treatment.
Studies of prolotherapy are very limited. Positive responses with decreased pain and disability have been reported. There is some debate about the best injection solution to use. Optimal dose size is also uncertain. It appears that prolotherapy may not be effective if too little solution is used. Using higher doses doesn't seem to have any negative effect. The frequency and dose vary from physician to physician.
At least one study showed that results were poor with injection alone without manipulation and exercise afterward. Prolotherapy should be considered when patients have not responded well to other treatments. More study is needed to understand how this treatment works and who can benefit the most by it.
Simon Dagenais, DC, PhD, et al. Evidence-Informed Management of Chronic Low Back Pain with Prolotherapy. In The Spine Journal. February 2008. Vol. 8. No. 1. Pp. 203-212.
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