Is prolotherapy beneficial?

Posted on October 21, 2012

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Prolotherapy is one of those things I have a vendetta against. Between the clients I’ve known to use it and the brief research I’ve done, my mind has been pretty much made up. However, I’ve never looked at or written about it extensively.

I’m going to start this with a look at the “logic,” assertions, and hypocrisy of prolotherapy. And then I’ll examine some of the literature behind it.

What is prolotherapy / What is it supposed to do

Prolotherapy injections are used to purportedly heal an (absurd, ridiculous, completely full of crap) amount of ailments. How does it do this?

It is thought to do so by re-initiating the inflammatory process that deposits new additional fibers to repair a perceived injury.”

From: Prolotherapy Injections for Chronic Low Back Pain A Systematic Review

Based off prolotherapy attempting to re-initiate / increase inflammation at the ailing site, one can conclude prolotherapy, and it’s proponents, believe the ailments it treats are suffering from a lack of inflammation.

Wait, doesn’t Advil, cortisone and other anti-inflammatories give people pain relief though? Yes, yes they do. So prolotherapy (pro inflammation) and Advil (anti inflammation) both give people pain relief? And as you’ll notice below, anti-inflammatories and prolotherapy are both often recommended for the same condition. Something isn’t right here…

Moving on.

Wikipedia lists one of the possible indications where prolotherapy could be beneficial as Recurrent swelling or fullness involving a joint or muscular region.” Uhh, if there’s already a ton of “proliferation” in the joint (swelling), why are we trying to proliferate (PROlotherapy) more into the joint?

Let the hypocrisy begin.

Random tidbit from prolotherapy.com :

Historical review shows that a version of this technique was first used by Hippocrates on soldiers with dislocated, torn shoulder joints. He would stick a hot poker into the joint, and it would then miraculously heal normally.

Hippocrates…somehow still leading 21st century medicine one idiot at a time.

Next, the list of issues prolotherapy.com declares as benefitted by prolotherapy:

  • Arthritis
  • Arthritis of wrist
  • Back pain
  • Barre-Lieou syndrome
  • Carpal tunnel syndrome
  • Cluster headache
  • Deep aching
  • Degenerative arthritis
  • Degenerative disk disease
  • Disc herniation
  • Fibromyalgia
  • Hand (study two)
  • Headache
  • Heel spurs
  • Hip Degeneration
  • Knee injuries
  • Low back pain
  • Migraine headache
  • Osteoporosis (compression fractures)
  • Post-concussion headache
  • Rotator cuff tears
  • Sacroiliac sprain
  • Sciatica
  • Scoliosis
  • Slipped spine
  • Spinal defects
  • Tennis elbow
  • Tension headache
  • Thumb (study two)
  • TMJ dysfunction
  • Whiplash

Are you insane? One treatment can help ameliorate this many different things? That’s not called prolotherapy; it’s called alcohol. Or pills. Lots of pills.

Some good ones: First, back to the reasoning behind prolotherapy: “It is thought to do so by re-initiating the inflammatory process that deposits new additional fibers to repair a perceived injury.”

ArthrITIS…ITIS = inflammation. Arthritis is an inflammatory condition. Gout, for instance, improves symptoms by “nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, or colchicine. (Wikipedia.) All of these are ANTI-inflammatories.

So let’s get this straight. For an inflammatory condition, the way prolotherapy will help is by putting more inflammation into the area? Right.

Just add some inflammation and you’ll be fiiiiiine.

Heel spurs- Spurs are a result of excessive / malaligned bone growth. Prolotherapy (PROliferation) is supposed to add tissue to the injured site to make it “stronger.” So, for an issue where we already have too much tissue, the solution is a treatment which is supposed to add more tissue?

Just make that sucker bigger and you’ll feel great!

Post-concussion headache– Dear Prolotherapy, a concussion is a BRAIN injury. Injecting some sugar water into the neck is not going to alleviate what is most likely a BRUISE on the brain. And if you’re mumbling to yourself I could inject a needle into my brain; I’m mumbling to myself you’re a moron.

My favorite has got to be scoliosis. I’m dying to know how prolotherapy purports to help morph bone into a different position.

4-6 injections away from that spine morphing into a straight line!

Of course, if you click on the Scoliosis link (on this page: [prolotherapy deleted the page] ) you are led to a page that says, “Signs and symptoms that may be improved (with prolotherapy)”

And then lists scoliosis again.

That’s it.

Their page stating “Select from a list of conditions that can be treated with prolotherapy” leads you to a page stating “Prolotherapy can help these conditions.”

And you wonder why I drink.

Last random note: Prolotherapy has been around for like 20-30 years, at least, and is still not covered or recognized by insurance companies as a viable treatment. And insurance companies would love for it to work. What do you think costs more, a few sugar water injections or a $50,000 reconstructive surgery?

Some of the research

A quick primer before delving in: For any study you’ve found or heard of suggesting a benefit from prolotherapy, look closely at the study and see if there was a control group, whether it was double blind, were there co-interventions, was it homogenous, etc. If you find a study that suggests a benefit, chances are it screwed up one of the above. Here are two examples from studies in 2012: (No control) http://online.liebertpub.com/doi/abs/10.1089/acm.2011.0030 and (not blinded) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373832/ 

There appears to be one big study analyzing prolotherapy: Prolotherapy Injections for Chronic Low Back Pain A Systematic Review

This review only found 4 studies worth examining for something like 20 years worth of potential research. Issues include it being very hard to find two studies that were alike i.e. most of the studies used different injection protocols. Also, a lot of studies used co-interventions, meaning prolotherapy was used in conjunction with another therapy. Therefore, you can’t tell what was actually giving the benefit, if anything.

Notable quotes from the review:

No two studies tested the same component(s) of treatment and had the same number of injection treatments.

“Two studies that compared prolotherapy injections directly against control injections found no evidence that prolotherapy injections are more effective.”

“One study comparing prolotherapy injections with control injections, in the presence of the same co- interventions, found prolotherapy injections to be more effective in achieving more than 50% reduction in pain or disability, but not for mean pain or disability scores. “

Here’s that one study: http://www.sciencedirect.com/science/article/pii/S0140673687923403

Notice in the abstract (bolding mine):

81 patients with chronic low back pain (average duration 10 years) were randomised to two treatment groups. 40 received an empirically devised regimen of forceful spinal manipulation and injections of a dextrose-glycerine-phenol (“proliferant”) solution into soft-tissue structures, as part of a programme to decrease pain and disability. The other 41 patients received parallel treatment in which the main differences were less extensive initial local anaesthesia and manipulation, and substitution of saline for proliferant.

In other words, the control group was not only treated differently in terms of the injections, but also received a different intensity of spinal manipulation. The review quotes this study as having different injection techniques between their groups as well. So, unless I’m misinterpreting this (I can’t find the full text), this study sucks. The authors disqualify their study in the abstract by revealing their control group is in fact, not a control group.

Back to another quote from the aforementioned review:

“The remaining study demonstrated that prolotherapy injections with co-interventions are more effective than control injec- tions with control co-interventions. However, this study failed to define the contribution of the prolotherapy injections to the effectiveness of treatment. “

This study found here: http://www.ncbi.nlm.nih.gov/pubmed/8439713

As the authors of the review mention, there are issues with this study. My issues (again, from what I can tell; can’t find full text):

-Nobody has any idea why the prolotherapy group faired better. Other than pain reduction, everything else was the same between them and the control group. In other words, anything objective was the same; anything subjective differed.

-It’s 20 years old. So, in 20 years not a single other corroborating study has come out.

-One of the authors has 151 publications to his name on pubmed, yet only 5 are concerned with lower back issues. Nearly all other studies deal with childhood psychiatric issues. Two areas of study that are not at all related.

-One of the other authors only has 4 studies to his name, ever.

-A third author has 1 out of 18 studies concerned with the lower back.

If I’m not calling bullshit (I am) then I’m not putting much (any) weight in this one study.

My favorite part from the review:

Prolotherapy injections are not without adverse events, with the majority of participants experiencing a transient increase in pain and stiffness and a few percent with severe headaches suggestive of lumbar puncture.“

This is quite an old technique actually. (I’m sure Hippocrates used this as well.) You know, your foot hurts so you have your friend slap you in the face to take your mind off your foot. So, it’s like maybe my arthritis feels better because you punctured my fucking lumbar and I can’t even think about my arthritis right now.

The review concludes:

“The present studies provide no evidence that prolotherapy injections alone have a beneficial role in the treatment of chronic low back pain.“

I know this is only one condition (lower back pain), but if you still think prolotherapy is worth looking into, just remember you need to examine basically every human ailment that exists, since prolotherapy purports to help them all. Have fun with that. All the above is enough for me.

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Posted in: Pain, Technology