Prolotherapy interview on Medscape

[Doctodd]

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http://www.medscape.com/viewarticle/707539?src=mp&spon=8&uac=4272HZ

 

[ampaphb]

http://www.medscape.com/viewarticle/707539?src=mp&spon=8&uac=4272HZ

Now that is funny. The article refers to the Chochrane study (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;34:1078-1093.)

Specifically, it says:

Medscape: A 2009 Cochrane review of nonsurgical interventional therapies for low back pain reported that prolotherapy was not effective for chronic low back pain. Could you comment on this?

Dr. Goodley: Their commentary states that they correlated 3 unnamed studies of patients with chronic low back pain [CLBP] as the only criteria.

​

Well, if you go look at the Cochrane study, what it says is:

Five randomized, placebo-controlled trials evaluated prolotherapy. All were included in a higher quality Cochrane review. We rated 4 trials higher quality. For chronic nonspecific low back pain, 3 trials (2 higher quality) found no difference between prolotherapy and either saline or local anesthetic control injections for short- or long-term (up to 24 months) pain or disability. One higher quality trial found prolotherapy associated with increased likelihood of short-term improvement in pain or disability versus control injection (RR 1.47, 95% CI: 1.04–2.06), but both treatment groups received a number of cointerventions including spinal manipulation, local injections, exercises, and walking. In the fifth trial, effects of prolotherapy could not be determined because the prolotherapy group received strong manipulation and the control injection group only light manipulation. A higher quality Cochrane review rated all 5 placebo-controlled trials of higher quality, and also found prolotherapy to be ineffective when used alone for chronic low back pain. Nearly all patients in most trials experience the expected temporary increase in back pain and stiffness following prolotherapy injections. Postinjection headaches suggestive of lumbar puncture occurred in 2% to 4% of patients in 2 trials.​

The cited articles are:

Dechow E, Davies R, Carr A, et al. A randomized, double-blind, placebocontrolled trial of sclerosing injections in patients with chronic low back pain. Rheumatology 1999;38:1255–9.

Klein R, Eek B, DeLong W, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 1993;6:23–33.

Mathews J, Mills S, Jenkins V, et al. Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injection. Br J Rheumatol 1987;26:416–23.

Ongley M, Klein R, Dorman T, et al. A new approach to the treatment of chronic low back pain. Lancet 1987;2:143–6.

Yelland M, Glasziou P, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine 2004;29:9–16.
​

Makes you wonder how they can be "unnamed", and yet referenced at the end of the very same Cochrane review article. 😉

 

[Mister Mxyzptlk]

"Postinjection headaches suggestive of lumbar puncture occurred in 2% to 4% of patients in 2 trials."

😱 😱 😱

Those prolo mixtures could be very nasty when injected IT.