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Dextrose prolotherapy may have differential effects on pain-related functioning and physical performance for various musculoskeletal pain conditions. Evidence on adverse events was generally lacking and severely limited by methodological concerns. Future research should include larger, rigorous RCTs to better evaluate efficacy and harms, and studies to examine treatment burden and costs.
Musculoskeletal pain conditions are common among US adults. Local injection therapies are often considered as treatment options for those patients who have insufficient improvement in their symptoms from non-pharmacologic and (topical or systemic) pharmacologic therapies. Prolotherapy involves injecting an irritant solution into or around an affected structure to improve musculoskeletal pain and function, and hypertonic dextrose is the most commonly utilized prolotherapy solution. To support development of VA practice recommendations for the use of dextrose prolotherapy to treat acute and chronic musculoskeletal pain, we conducted a systematic review of the benefits and harms of this treatment.
Of 90 eligible studies addressing a variety of musculoskeletal conditions, most were small (total N<100; k=73), half were rated high/serious/critical for risk of bias (k=43), and nearly all were conducted outside of the US (k=83). Studies varied greatly in dextrose concentrations, injection technique, co-interventions, and comparators. Intra-articular dextrose prolotherapy probably had little to no benefit for pain-related functioning or physical performance in knee osteoarthritis, compared with normal saline injections. For shoulder pain due to mixed bursitis and rotator cuff pathology, dextrose prolotherapy probably resulted in worse physical performance outcomes, compared with corticosteroid injections. However, dextrose prolotherapy may improve pain-related functioning for lateral elbow tendinopathy and plantar fasciitis, compared with normal saline injection. The evidence was very uncertain on the benefits of prolotherapy compared with other treatments or for other pain conditions. Across all conditions and comparators, the evidence was very uncertain on the adverse effects of dextrose prolotherapy.
Dextrose Prolotherapy for Musculoskeletal Pain: A Systematic Review (Management Brief)
