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A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain

PainSci » bibliography » Hauser et al 2016

Two articles on PainSci cite Hauser 2016: 1. The Complete Guide to Low Back Pain2. The Complete Guide to Patellofemoral Pain Syndrome

PainSci notes on Hauser 2016:

This is a typical “garbage in, garbage out” review of a small number of diverse and generally low quality studies (despite the authors’ opinions to the contrary).

They included eighteen case-series studies, which is basically just a bunch of formal anecdotes. Reviews rarely include these, because no one considers them valuable data — they have their role, but it’s not for establishing the efficacy of an intervention, that’s for sure.

Their conclusions are sunny, the data much less so. I trust the review even less than I trust some of the individual trials.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

OBJECTIVE: The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain.

DATA SOURCES: Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016.

STUDY SELECTION: Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected.

DATA EXTRACTION: Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated.

DATA SYNTHESIS: Fourteen RCTs, 1 case-control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood-Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings.

CONCLUSION: Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature.

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