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PROLOTHERAPY RESEARCH
Pain physician
Wilkinson HA. Injection therapy for enthesopathies causing axial
spine pain and the "failed back syndrome": a single blinded, randomized
and cross-over study. Pain Physician. 2005 Apr;8(2):167-73.
BACKGROUND: Enthesopathies are a common cause of axial
pain that is amenable to "minimally invasive" therapy.
OBJECTIVE: To evaluate the effectiveness of injection
therapy for enthesopathies.
DESIGN: Single blinded, randomized, and cross-over study.
METHODS: Thirty-five patients diagnosed as having painful
enthesopathies as a major pain generator were studied. Of the patients
studied, 86% of patients had undergone prior lumbar spine surgery and
all were referred for neurosurgical evaluation for possible surgery.
Patients were injected either with anesthetics alone or with anesthetics
combined with phenol-glycerol proliferant prolotherapy. Outcomes were
analyzed both clinically at the time of regular follow-ups, and by a
series of multipart questionnaires.
RESULTS: Patients received a total of 86
Prolotherapy injections, 39
with local anesthetics, and 47 with prolotherapy. By clinical assessment
patients obtained excellent to good relief of pain and tenderness after
80% of prolotherapy injections, but only 47% after anesthetics alone. By
questionnaire, 66% reported excellent to good relief after prolotherapy
vs. 34% after anesthetics alone. Patients reported improvement in work
capacity and social functioning following both types of injections, but
a greater reduction in focal pain intensity following prolotherapy
injections. The mean and median durations of persistent relief were 2.4
and 1.75 months with prolotherapy vs. 1.8 and 0.75 months with
anesthetics alone. Roughly 10% obtained greater than six months of
relief from either injection. In the crossover portion of the study,
patients reported that prolotherapy injections following initial
anesthetic-only injections provided much better relief than that
achieved after their anesthetic-only injections, and that
anesthetic-only injections following initial prolotherapy injections
failed to provide relief as good as that achieved after their
prolotherapy. Subsequent to this study, only four of 35 patients
required additional spine surgery, but 29 of the 35 patients requested
additional injections.
CONCLUSIONS: Injection therapy of painful enthesopathies
can provide significant relief of axial pain and tenderness combined
with functional improvement, even in "failed back syndrome" patients.
Phenol-glycerol prolotherapy provides better and longer lasting relief
than injection with anesthetics alone. Prolotherapy provides over six
months of relief for some patients but generally provides relief for
only a few months. However, most patients described good to excellent
relief, felt that the injections had been beneficial, and requested
additional injections for recurrent or residual focal pain.
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