Evidence-based use of proloterapy in treating musculoskeletal pain

Prolotherapy is a regenerative therapy method involving the injection of an irritant solution into the painful ligament and tendon insertions and adjacent joint spaces in the treatment of chronic musculoskeletal pain. Hypertonic dextrose is commonly used solution. The goal is reducing pain and promoting tissue repair and growth. Current hypotheses suggest that prolotherapy stimulates local healing of chronically injured extra-and intra-articular tissue. As a procedure, prolotherapy is safe with few adverse effects or contraindications. It has long history and widespread use as a complementary medical treatment. Although the most frequently published indication is the treatment of chronic low back pain, recent studies have investigated its use in the treatment of refractory tendinopathies as well as osteoarthritis. There is growing evidence to recommend using prolotherapy in the treatment of refractory tendinopathies, specifically lateral epicondylosis and Achilles tendinopathy and osteoarthritis, specifically knee and hand osteoarthritis. There is also an evidence to recommend the use of prolotherapy in the treatment of chronic low back pain in combination with adjunctive therapies as spinal manipulation or exercises. Prolotherapy remains a promising option for the treatment of musculoskeletal pain when other standard treatments have proven to be ineffective. However, further large-scale and well designed clinical studies are needed to obtain more objective evidences