The Pharmaceutical Journal
Vol 272 No 7296 p498
24 April 2004

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Prolotherapy technique is ineffective for treating low back pain

POEM series

Clinical question Is prolotherapy effective in non-specific low back pain?

Bottom line In this trial, patients with chronic low back pain improved over time. Prolotherapy did not appear to be significantly more effective than saline injections.

Synopsis Prolotherapy consists of ligament injections, exercises, and supplements of vitamins and minerals. The injections variably contain ablative agents like phenol, glycerine or hypertonic glucose combined with a local anaesthetic. In this study, 110 patients with chronic back pain were randomly assigned, by masked allocation in a factorial design, to receive active prolotherapy (4ml 50 per cent glucose, 1ml 2 per cent lidocaine, and 5ml water) or saline and put on an active exercise regimen or asked to take their usual exercise. The treating clinician administered the injections every two weeks until six injections were given. All participants were supplied with a daily supplement of 30mg zinc, 22.5mg manganese, 3mg beta-carotene, 15mg pyridoxine, and 1,000mg vitamin C for six months. The main outcomes — pain on a visual analogue scale and a measure of disability — were evaluated by intention to treat. Researchers were blinded to treatment group. They had complete follow-up on 96 per cent of patients at the end of the first year, but only 80 per cent after two years. Although more patients receiving prolotherapy reported greater than 50 per cent reduction in pain, the mean reductions in pain or disability scores were not significantly different between treatment groups.

Level of evidence 2b (Individual cohort study or low-quality randomised controlled trial, eg, with less than 80 per cent follow-up).

Reference Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 2004;29:9–16

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