Low Back Pain and Sciatica and Prolotherapy

Prolotherapy is based on the theory that chronic pain is often caused by laxness of the ligaments that are responsible for keeping a joint stable. When ligaments and associated tendons are loose, the body is said to compensate by using muscles to stabilize the joint. The net result, according to prolotherapy theory, is muscle spasms and pain.

Prolotherapy treatment involves injections of chemical irritant solutions into the area around such ligaments. These solutions are believed to cause tissue to proliferate (grow), increasing the strength and thickness of ligaments. In turn, this presumably serves to tighten up the joint and relieve the burden on associated muscles, stopping muscle spasms. In the case of arthritic joints, increased ligament strength would allow the joint to function more efficiently, thus reducing pain. Naturally, low back pain and sciatica might benefit from prolotherapy.

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Although two studies have suggested prolotherapy may be effective for low back pain, 4 two more recent studies found prolotherapy to be ineffective.⁵

In a review of five studies, three found prolotherapy to be no more effective than control treatments for low back pain . The other two studies suggested that prolotherapy was more effective than control treatments when used with therapies such as spinal manipulation and exercise.⁶ Another review suggested prolotherapy may be effective when used with other therapies, but not when used alone.⁷ What can one make of this contradictory evidence? When used alone prolotherapy is probably no more effective than a placebo injection for the treatment of low back pain. However, there is some evidence that the technique may be beneficial when combined with other therapies.

Prolotherapy and Osteoarthritis

Since osteoarthritis can often cause low back pain, treatments for osteoarthritis can sometimes be used to and as beneficial treatment for low back pain and/or sciatica. For that reason, the following studies are on the effectiveness of prolotherapy on osteoarthritis specifically.

A double-blind, placebo-controlled study evaluated the effects of 3 prolotherapy injections (using a 10% dextrose solution) at 2-month intervals in 68 people with osteoarthritis of the knee. 8 At the 6-month follow-up, participants who had received prolotherapy showed significant improvements in pain at rest and while walking, reduction in swelling, episodes of "buckling," and range of flexion, as compared to those who had received placebo treatment.

The same research group performed a similar double-blind trial of 27 people with osteoarthritis in the hands. 9 The results at the 6-month follow-up showed that range of motion and pain with movement improved significantly in the treated group as compared to the placebo group.

Safety Issues

In studies, prolotherapy has not caused any serious, irreversible injury. There is usually discomfort after each injection that lasts for a few minutes to several days, but this discomfort is seldom severe. ¹ Of more concern, severe headaches have been reported in treatment of low back pain in a minority of patients. Because phenol is a potentially toxic substance, treatment with a dextrose solution alone is preferable.