PROLOTHERAPY (For Low Back Pain)
Studies Favorable: Total 2
Level IV:  2 Studies

http://www.ncbi.nlm.nih.gov/pubmed/16850071?ordinalpos=19&itool=EntrezSvstem2.
PEntrez.Pubmed.Pubme dResultsPaneLPubmedDefaultReportPanel.PubmedRVDocSum

2. Hooper RA, Ding M. Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy. J Altern Complement Med. 2004 Aug;10(4):670-4. Retrospective case series. One hundred and sev­enty-seven (177) consecutive patients with a history of chronic spinal pain completed prolotherapy treatment and were followed for a period ranging from 2 months to 2.5 years. Patients were treated with a proliferant solution con­taining 20% dextrose and 0.75% xylocaine. Ninety-one percent (91.0%) of patients reported reduction in level of pain; 84.8% of patients reported improvement in activities of daily living, and 84.3% reported an improvement in ability to work. Dextrose prolotherapy appears to be a safe and effective method for treating chronic spinal pain that merits further investigation.
Level IV: FAVORABLE for low back pain.

http://www.ncbi.nlm.nih.gov/pubmed/15 353024?ordinalpos=32&itool=EntrezSvstem2.
PEntrez.Pubmed.PubmedResultsPaneLPubmedDefaultReportPanel.PubmedRVDocSum

PROLOTHERAPY (For Low Back Pain)
Studies Unfavorable: Total 3
Level 1:  3 Studies

1. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical Interventional Therapies for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline. Spine. 2009 Apr 9. [Epub ahead of print]. Literature review including five 5 star randomized placebo controlled trials on the efficacy of prolotherapy as a nonsurgical interventional therapy for low back pain. Few nonsurgical interventional therapies, including prolo therapy, for low back pain have been shown to be effective in randomized, placebo-controlled trials.
Level I: UNFAVORABLE for low back pain

http://www.ncbi.nlm.nih.gov/pubmed/19363456?ordinalpos=l&itool=
EnlrezSvstem2.PEntrez.Pubmed.PubmedResultsPaneLPubmedDefaultReportPanel.PubmedRVDocSum

2. Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004059. Review. Literature review of randomised controlled trials (5 star) and quasi-randomised controlled trials (QRCT; using, for example, birth date to assign participants to groups) that compared prolotherapy injections to control injections or other therapies. Inncluded were trials with co-interventions of chiropractic care, etc.. There is conflicting evidence regarding the efficacy of prolotherapy injections for patients with chronic low-back pain. When used alone, prolotherapy is not an effective treatment for chronic low-back pain. When combined with spinal manipulation, exercise, and other co-interventions, prolotherapy may improve chronic low-back pain and disability.
Level I: UNFAVORABLE for Low Back pain.

http://www.ncbi.nlm.nih.gov/pubmed/17443537?ordinalpos=17&itool=EntrezSvstem2.
PEntrez.Pubmed.PubmedResultsPaneLPubmedDefaultReportPanel.Pubmed RVDocSum

3. Yelland MJ, Glasziou PP, BogdukN, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2004 Jan 1;29(1):9-16; discussion 16. Randomized controlled trial with two-by-two factorial design, triple-blinded for injection status, and single-blinded for exercise status. One hundred ten participants with nonspecific low-back pain of average 14 years duration were randomized to have repeated prolotherapy (20% glucose/0.2% lignocaine) or normal saline injections into tender lumbo-pelvic ligaments and randomized to perform either flexion/extension exercises or normal activity over 6 months. In chronic nonspecific low-back pain, significant and sustained reductions in pain and disability occur with ligament injections, irrespective of the solution injected or the concurrent use of exercises.
Level I: UNFAVORABLE for low back pain.

PROLOTHERAPY (For Low Back Pain)
Studies Neutral: Total 5
Level I: Studies

1. Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature. Spine J. 2005 May-Jun;5(3):310-28. Review. Literature review on 26 observational cohorts and 5 randomized clinical trials (RCTs). Indications in these studies were low back pain (22), neck pain (3), cervical headaches (3) and dorsal or thoracic pain (3). Prolotherapy describes a variety of treat­ment approaches rather than a specific protocol. Results from clinical studies published to date indicate that it may be effective at reducing spinal pain. Great variation was found in the injection and treatment protocols used in these studies that preclude definite conclusions.
Level I: NEUTRAL for low back and neck pain.

http://www.ncbi.nlm.nih.gov/pubmed/15863087?ordinalpos=27&itool=EntrezSvstem2.PEntrez.Pu
bmed_PubmedResultsPaneLPubmedDefaultReportPanel.PubmedRVDocSum

Yelland MJ, Del Mar C, Pirozzo S, Schoene ML Prolotherapy injections for chronic low back pain: a system­atic review. Spine. 2004 Oct 1 ;29(19) :2126-33. Review. Literature review on randomized and quasi-randomized controlled trials comparing prolotherapy injections to control injections, either alone or in combination with other treatments, were included. Four studies, all of high quality and with a total of 344 participants, were included. There is conflicting evidence regarding the efficacy of prolotherapy injections in reducing pain and disability in patients with chronic low back pain. Conclusions are confounded by clinical heterogeneity among studies and by the presence of co-interventions. There was no evidence that prolotherapy injections alone were more effective than control injec­tions alone. However, in the presence of co-interventions, prolotherapy injections were more effective than control injections, more so when both injections and co-interventions were controlled concurrently.
Level I: NEUTRAL for low back pain.

http://www.ncbi.nlm.nih.gov/pubmed/15454703?ordinalpos=31&itool=EntrezSvstem2.
PEntrez.Pubmed.Pubmed_ResultsPanel.PubmedDefaultReportPanel.Pubmed_RVDocSum

Level II: Studies

1. Kim SR, Stitik TP, Foye PM, Greenwald BD, Campagnolo DI. Critical review of prolotherapy for osteoarthri­tis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil. 2004 May;83(5):379-89. Review. Three randomized, controlled studies were found studying the use of dextrose/ glycerine/phenol prolotherapy for chronic low back pain; however, they were inconclusive due to the lack of ade­quate controls, heterogeneity inpatient diagnoses, and variations in solutions injected. Two randomized, controlled studies were found that provide some evidence supporting the use of 10% dextrose prolotherapy for osteoarthritis. The sample size of the study (n = 13) involving osteoarthritic thumbs and fingers may have been too small to be strongly conclusive; however, it provides preliminary data to support future studies. Two studies involving os­teoarthritic knees report an improvement in anterior cruciate ligament laxity; however, they did not have control groups for comparison. Only case reports were found supporting the pursuit of controlled clinical studies of prolotherapy for chronic neck pain. On the basis of the scarce body of literature critically reviewed to date, the clini­cal efficacy of prolotherapy in treating osteoarthritis, low back pain, and other musculoskeletal conditions remains inconclusive.
Level II: NEUTRAL for low back and joint pain.

http://www.ncbi.nlm.nih.gov/pubmed/15100629?ordinalpos=37&itool=
EntrezSvstem2.PEntrez.Pubmed.Pubmed ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

Level II: Studies
1. Rabago D, Best TM, Beamsley M, Patterson J. A systematic review of prolotherapy for chronic musculoskele­tal pain. Clin J Sport Med. 2005 Sep;15(5):376-80. Review. Literature review of 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations and are graded 4 Star due to deficiencies from 5 star ratings.. There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandom­ized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with non-injection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy. Results thus far are contradictory
Level II: NEUTRAL for back and joint pain.

http://www.ncbi.nlm.nih.gov/pubmed/16162983?ordinalpos=26&itool=EntrezSvstem2.
PEntrez.Pubmed.Pubmed ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

Level IV: Studies
6. Cusi M, Saunders J, Hungerford B, Wisbey-Roth T, Lucas P, Wilson S. The use of prolotherapy in the sacro­iliac joint. Br J Sports Med. 2008 Apr 9. [Epub ahead of print]. Prospective case series study to determine whether prolotherapy is effective in the treatment of deficient load transfer of the sacroiliac joint. This descriptive study of prolotherapy in private practice has shown positive clinical outcomes for the 76% of patients who attended the 3 months and 12 months' follow up visits and for the 32% of patients who attended follow up visits at 24 months.
Level IV: NEUTRAL for low back pain from sacroilietis

http://www.ncbi.nlm.nih.gov/pubmed/18400878?ordinalpos=9&itool=EntrezSystem2.
PEntrez.Pubmed.Pubmed_ResultsPanelPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Neck Pain)
Studies Favorable: Total 3
Level IV:  2 Studies

1. Hooper RA, Frizzell JB, Faris P. Case series on chronic whiplash related neck pain treated with intraarticu­lar zygapophysial joint regeneration injection therapy. Pain Physician. 2007 Mar;10(2):313-8. Retrospective case series. Eighteen consecutive patients were treated with intraarticular prolotherapy. Intraarticular RIT improved pain and function in this case series. The procedure appears safe, more effective than periarticular RIT, and lasted as long, or longer, than those patients with previous radiofrequency neurotomy.
Level IV: FAVORABLE for neck pain

http://www.ncbi.nlm.nih.gov/pubmed/17387354?ordinalpos=18&itool=EntrezSystem2.PEntrez.
Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

2. Centeno CJ, Elliott J, Elkins WL, Freeman M. Fluoroscopically guided cervical prolotherapy for instability with blinded pre and post radiographic reading. Pain Physician. 2005 Jan;8(l):67-72. Prospective case series study (n = 6) was to determine if proliferant injections have an effect on cervical translation as measured by a blinded reader. The results of this study demonstrate statistically significant correlations between proliferant injections, a reduction of both cervical flexion and extension translation, as well as a reduction in pain VAS score.
Level IV: FAVORABLE for neck pain

http://www.ncbi.nlm.nih.gov/pubmed/16850045?ordinalpos=20&itool=EntrezSvstem2.PEntrez.
Pubmed.Pubmed_ResultsPanelPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Neck Pain)
Studies Unfavorable: Total 0

PROLOTHERAPY (For Neck Pain)
Studies Neutral: Total 1
Level I: 1 Study

1. Dagenais S, Haldeman S, Wooley JR. Intraligamentous injection of sclerosing solutions (prolotherapy) for spinal pain: a critical review of the literature. Spine J. 2005 May-Jun;5(3):310-28. Review. Literature review on 26 observational cohorts and 5 randomized clinical trials (RCTs). Indications in these studies were low back pain (22), neck pain (3), cervical headaches (3) and dorsal or thoracic pain (3). Prolotherapy describes a variety of treat­ment approaches rather than a specific protocol. Results from clinical studies published to date indicate that it may be effective at reducing spinal pain. Great variation was found in the injection and treatment protocols used in these studies that preclude definite conclusions.
Level I: NEUTRAL for low back and neck pain.

http://www.ncbi.nlm.nih.gov/pubmed/15863087?ordinalpos=27&itool=EntrezSvstem2.PEnlrez.
Pubmed.Pubmed_ResultsPanelPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Elbow Pain)
Studies Favorable: Total 2
Level I: Studies

1. Scarpone M, Rabago DP, Zgierska A, Arbogast G, Snell E. The efficacy of prolotherapy for lateral epicondylo-sis: a pilot study. Clin J Sport Med. 2008 May;18(3):248-54. Double-blind randomized controlled trial to assess whether prolotherapy, an injection-based therapy, improves elbow pain, grip strength, and extension strength in pa­tients with lateral epicondylosis. Prolotherapy with dextrose and sodium morrhuate was well tolerated, effectively decreased elbow pain, and improved strength testing in subjects with refractory lateral epicondylosis compared to Control group injections.
Level I: FAVORABLE for epicondylitis.

http://www.ncbi.nlm.nih.gov/pubmed/18469566?ordinalpos=7&itool=EntrezSvstem2.PEntrez.
Pubmed.PubmedResultsPanelPubmedDefaultReportPanel.Pubmed_RVDocSum

Level III: Studies

1. Rabago D, Best TM, Zgierska A, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet rich plasma. Br J Sports Med. 2009 Jan 21. [Epub ahead of print]. Literature review including two case control - 3 star - and one 2 star prospec­tive case series. Sample size - pilot study - was small. Evidence supporting the use of prolotherapy injections in the treatment of lateral epicondylosis only.
Level IE: FAVORABLE for epicondyitis

http://www.ncbi.nlm.nih.gov/pubmed/19028733?ordinalpos=3&itool=EntrezSvstem2.PEntrez.
Pubmed.Pubmed ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Elbow Pain)
Studies Neutral: Total 0

PROLOTHERAPY (For Joint Pain )
Studies Favorable: Total 3)
Level I: Studies

1. Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clini- cal efficacy. J Altern Complement Med. 2000 Aug;6(4):311-20. Prospective randomized double-blind placebo- controlled trial. Thirteen patients (with seventy-four symptomatic osteoarthitic joints) received active treatment, and fourteen patients (with seventy-six symptomatic osteoarthritic joints) served as controls. Dextrose prolotherapy was clinically effective and safe in the treatment of pain with joint movement and range limitation in osteoarthritic finger joints.
Level I: FAVORABLE for finger arthritis.

http://www.ncbi.nlm.nih.gov/pubmed/10976977?ordinalpos=44&itool=EntrezSvstem2.
PEntrez.Pubmed.Pubmed ResultsPanelPubmed_DefaultReportPanel.Pubmed_RVDocSum

2. Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000 Mar;6(2):68-74, 77-80. Prospective randomized double-blind placebo-controlled trial. Six months or more of pain along with either grade 2 or more joint narrowing or grade 2 or more osteophytic change in any knee compartment. A total of 38 knees were completely void of cartilage radiographically in at least 1 compartment. Prolotherapy injection with 10% dex- trose resulted in clinically and statistically significant improvements in knee osteoarthritis.
Level I: FAVORABLE for knee arthritis.

http://www.ncbi.nlm.nih.gov/pubmed/10710805 ?ordinalpos=46&itool=EntrezSvstem2.PEntrez.
Pubmed.Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

Level IV: Studies
1. Reeves KD, Hassanein KM. Long-term effects of dextrose prolotherapy for anterior cruciate ligament laxity. Altern Ther Health Med. 2003 May-Jun;9(3):58-62. Case series to determine the 1 and 3 year efficacy of dextrose injection prolotherapy on anterior cruciate ligament (ACL) laxity. Eighteen patients with 6 months or more of knee pain plus ACL knee laxity. In patients with symptomatic anterior cruciate ligament laxity, intermittent dextrose injec­tion resulted in clinically and statistically significant improvement in ACL laxity, pain, swelling, and knee range of motion.
Level IV: FAVORABLE for ACL laxity

http://www.ncbi.nlm.nih.gov/pubmed/12776476?ordinalpos=42&itool=EntrezSvstem2.PEntrez.
Pubmed.Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Joint Pain)
Studies Unfavorable: Total 0

PROLOTHERAPY (For Joint Pain)
Studies Neutral: Total 2
Level II: Studies

1. Rabago D, Best TM, Beamsley M, Patterson J. A systematic review of prolotherapy for chronic musculoskele­tal pain. Clin J Sport Med. 2005 Sep;15(5):376-80. Review. Literature review of 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations and are graded 4 Star due to deficiencies from 5 star ratings.. There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandom­ized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with non-injection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy. Results thus far are contradictory
Level II: NEUTRAL for back and joint pain.

http://www.ncbi.nlm.nih.gov/pubmed/16162983?ordinalpos=26&itool=EntrezSvstem2.
PEntrez.Pubmed.Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

2. Kim SR, Stitik TP, Foye PM, Greenwald BD, Campagnolo DI. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil. 2004 May;83(5):379-89. Review. Three randomized, controlled studies were found studying the use of dextrose/ glycerine/phenol prolotherapy for chronic low back pain; however, they were inconclusive due to the lack of adequate controls, heterogeneity inpatient diagnoses, and variations in solutions injected. Two randomized, controlled studies were found that provide some evidence supporting the use of 10% dextrose prolotherapy for osteoarthritis. The sample size of the study (n = 13) involving osteoarthritic thumbs and fingers may have been too small to be strongly conclusive; however, it provides preliminary data to support future studies. Two studies involving osteoarthritic knees report an improvement in anterior cruciate ligament laxity; however, they did not have control groups for comparison. Only case reports were found supporting the pursuit of controlled clinical studies of prolotherapy for chronic neck pain. On the basis of the scarce body of literature critically reviewed to date, the clinical efficacy of prolotherapy in treating osteoarthritis, low back pain, and other musculoskeletal conditions remains inconclusive.
Level II: NEUTRAL for low back and joint pain.

http://www.ncbi.nlm.nih.gov/pubmed/15100629?ordinalpos=37&itool=EntrezSvstem2
.PEntrez.Pubmed_Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Miscellaneous)
Studies Favorable: Total 1
Level IV: Studies

1. Khan SA, Kumar A, Varshney MK, Trikha V, Yadav CS. Dextrose prolotherapy for recalcitrant coccy-godynia. J Orthop Surg (Hong Kong). 2008 Apr; 16(1): 27-9. Prospective case series present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia. Dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy.
Level IV: FAVORABLE for coccydynia.

http://www.ncbi.nlm.nih.gov/pubmed/18453654?ordinalpos=8&itool=EntrezSvstem2.
PEntrez.Pubmed.Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

2. Topol GA, Reeves KD, Hassanein KM. Efficacy of dextrose prolotherapy in elite male kicking-sport athletes with chronic groin pain. Arch Phys Med Rehabil. 2005 Apr;86(4):697-702. Consecutive case series. Twenty-two rugby and 2 soccer players with chronic groin pain that prevented full sports participation and who were nonrespon-sive both to therapy and to a graded reintroduction into sports activity. Dextrose prolotherapy showed marked efficacy for chronic groin pain in this group of elite rugby and soccer athletes. Level IV: FAVORABLE for hamstring strains

http://www.ncbi.nlm.nih.gov/pubmed/15827920?ordinalpos=28&itool=EntrezSvstem2.PEntrez.Pubmed
.Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum

PROLOTHERAPY (For Miscellaneous)
Studies Unfavorable: Total 1
Level: Studies

PROLOTHERAPY (For Miscellaneous)
Studies Neutral: Total 1
Level IV: Studies

1. Choi H, McCartney M, Best TM. Treatment of Osteitis Pubis and Osteomyelitis of the Pubic Symphysis in Athletes: A Systematic Review. Br J Sports Med. 2008 Sep 30. [Epub ahead of print]. Literature review including one 2 star case series. Described the use of dextrose prolotherapy as a treatment modality for osteitis pubis.
Level IV: NEUTRAL. For osteitis pubis

http://www.ncbi.nlm.nih.gov/pubmed/18812419?ordinalpos=4&itool=EntrezSvstem2.PEntrez.
Pubmed.Pubmed_ResultsPaneLPubmed_DefaultReportPanel.Pubmed_RVDocSum