A Cochrane review [Abstract] 1 included 5 studies with a total of 366 subjects being trated with prolotherapy for chronic back pain. Prolotherapy means repeatedly injecting ligaments with compounds such as dextrose and lidocaine to help restart the body's natural healing process by causing controlled acute inflammation in the areas injected. All studies were of high quality and 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 randomized controlled trials (206 participants) found that prolotherapy injections alone were no more effective than control injections 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). Two RCTs (160 participants) found that prolotherapy injections, given with spinal manipulation, exercise, and other therapies, were 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.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes) and imprecise data (few patients).
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