A Randomized Controlled Trial of Intra-Articular Prolotherapy Versus Steroid Injection for Sacroiliac Joint Pain

Kim, Woong Mo; Lee, Hyung Gon; Jeong, Chaehwan; Kim, Chang Mo; Yoon, Myung Ha

doi:10.1089/acm.2010.0031

Cited by 115 publications

(84 citation statements)

References 20 publications

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“…It is hypothesized to work by initiating an inflammatory process that results in enhanced blood flow and accelerated tissue repair. In the only randomized study evaluating prolotherapy for injectionconfirmed SIJ pain, Kim et al compared up to 4 bi-weekly IA dextrose 25% injections to steroids [71]. Although no differences in short-term outcomes were noted with both the groups significantly improving at 2 weeks, at 15 months post-treatment, 58.7% of patients who received prolotherapy continued to experience a positive outcome versus 10.2% in the IA steroid group.…”

Section: Prolotherapymentioning

confidence: 99%

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Cohen

Chen

Neufeld

2013

Expert Review of Neurotherapeutics

327

236

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Sacroiliac joint (SIJ) pain is an underappreciated source of mechanical low back pain, affecting between 15 and 30% of individuals with chronic, nonradicular pain. Predisposing factors for SIJ pain include true and apparent leg length discrepancy, older age, inflammatory arthritis, previous spine surgery, pregnancy and trauma. Compared with facet-mediated and discogenic low back pain, individuals with SIJ pain are more likely to report a specific inciting event, and experience unilateral pain below L5. Owing in part to its size and heterogeneity, the pain referral patterns of the SIJ are extremely variable. Although no single physical examination or historical feature can reliably identify a painful SIJ, studies suggest that a battery of three or more provocation tests can predict response to diagnostic blocks. Evidence supports both intra- and extra-articular causes for SIJ pain, with clinical studies demonstrating intermediate-term benefit for both intra- and extra-articular steroid injections. In those who fail to experience sustained relief from SIJ injections, radiofrequency denervation may provide significant relief lasting up to 1 year. This review covers all aspects of SIJ pain, with the treatment section being primarily focused on procedural interventions.

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Section: Prolotherapymentioning

confidence: 99%

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Cohen

Chen

Neufeld

2013

Expert Review of Neurotherapeutics

327

236

View full text Add to dashboard Cite

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“…5,6 Recent MRI and ultrasound reports are also consistent with a description of OSD as "a tendinopathy/ apophysosis of the patellar tendon/tibial tubercle." [7][8][9][10][11][12] Safety and level A-C evidence of efficacy (per US Preventive Services Task Force criteria) of injection of 10% to 25% dextrose in areas of damaged ligament, tendon, and cartilage in adults has been demonstrated in randomized controlled trials in Achilles tendinosis, 13 finger osteoarthritis, 14 knee osteoarthritis, 15 lateral epicondylosis, 16 sacroiliac joint pain, 17 and in case series collections of patients with Achilles degeneration, 18,19 anterior cruciate ligament laxity, 20 coccygodynia, 21 hip adductor and abdominal tendinosis, 22 and plantar fasciosis. 23 There are no previous reports of application of dextrose injection in a strictly pediatric population, nor are there reports of injection about an apophysis where, as described, the source of pain and pathomechanism are not yet clear.…”

mentioning

confidence: 99%

Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease

Topol¹,

Podestá

Reeves

et al. 2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Osgood-Schlatter disease symptoms may wax and wane until maturity and affect sport confidence and participation periodically. Chronic sequelae may include anterior knee pain, kneeling discomfort, or sports limitation. Symptom reduction parallels resolution of patellar tendinopathy by MRI/ultrasound, although ossicles may persist radiographically. WHAT THIS STUDY ADDS:Small-needle injection of the patellar tendon enthesis/tibial apophysis with 12.5% dextrose was safe and well tolerated in adolescents with recalcitrant OsgoodSchlatter disease. Dextrose injection resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than did usual care. abstract OBJECTIVE: To examine the potential of dextrose injection versus lidocaine injection versus supervised usual care to reduce sport alteration and sport-related symptoms in adolescent athletes with OsgoodSchlatter disease. PATIENTS AND METHODS: Girls aged 9 to 15 and boys aged 10 to 17 were randomly assigned to either therapist-supervised usual care or double-blind injection of 1% lidocaine solution with or without 12.5% dextrose. Injections were administered monthly for 3 months. All subjects were then offered dextrose injections monthly as needed. Unaltered sport (Nirschl Pain Phase Scale Ͻ 4) and asymptomatic sport (Nirschl Pain Phase Scale ϭ 0) were the threshold goals. RESULTS: Sixty-five knees in 54 athletes were treated. Compared with usual care at 3 months, unaltered sport was more common in both dextrose-treated (21 of 21 vs 13 of 22; P ϭ .001) and lidocaine-treated (20 of 22 vs 13 of 22; P ϭ .034) knees, and asymptomatic sport was more frequent in dextrose-treated knees than either lidocaine-treated (14 of 21 vs 5 of 22; P ϭ .006) or usual-care-treated (14 of 21 vs 3 of 22; P Ͻ .001) knees. At 1 year, asymptomatic sport was more common in dextrose-treated knees than knees treated with only lidocaine (32 of 38 vs 6 of 13; P ϭ .024) or only usual care (32 of 38 vs 2 of 14; P Ͻ .0001). CONCLUSIONS: Our results suggest superior symptom-reduction efficacy of injection therapy over usual care in the treatment of OsgoodSchlatter disease in adolescents. A significant component of the effect seems to be associated with the dextrose component of a dextrose/ lidocaine solution. Dextrose injection over the apophysis and patellar tendon origin was safe and well tolerated and resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than usual care. Pediatrics 2011;128:e1121-e1128

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“…A similar study compared the effects of hyperosmolar dextrose versus triamcinolone acetonide fluoroscopically guided intraarticular injections into painful sacroiliac joints. Results demonstrated improvements in pain and disability scores from baseline in both groups; however, the effects of the dextrose group lasted longer than the steroid group [125]. In another study, intraarticular dextrose prolotherapy to the sacroiliac joint gave significant improvements in the numeric rating scale and Oswestry Disability Index compared to baseline (p<0.01) [126].…”

Section: Effective Applications Of Prolotherapy In the Treatment Of Cmentioning

confidence: 93%

Structural Basis of Joint Instability as Cause for Chronic Musculoskeletal Pain and Its Successful Treatment with Regenerative Injection Therapy (Prolotherapy)

Hauser¹,

Blakemore²,

Wang³

et al. 2014

TOPAINJ

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Joint dysfunctions and associated musculoskeletal pain are among the most common medical complaints presented to clinicians. Ligaments are collagenous fibrous structures that are primarily responsible for maintaining smooth joint motion, restraining excessive joint displacement, and providing stability across the joint. Ligaments also act as sensory organs for the joints and have significant input to pain sensation. When ligaments are subjected to forces beyond their normal range of motion, injury and failure occur, resulting in joint laxity (looseness or instability), and subsequent disruptions in the balance between joint mobility and joint stability. These dysfunctions can result in joint pain and the development of osteoarthritis. Several strategies have been employed over the years in attempts to improve joint instability from ligament injury; however, some of the standard therapeutic approaches (drugs, corticosteroid injections, and surgery) employed to address these problems have not been very effective because they often do not address the underlying cause of the problems, and in fact can inhibit ligament healing and restoration. For these reasons, there is current and growing interest among patients and clinicians in prolotherapy, an alternative therapeutic modality that can reduce or eliminate pain by stimulating the natural regenerative processes in and around the joint to facilitate the restoration of degenerated ligaments and tendons to a healthy state, improving joint support, function and reducing pain. This review presents current evidence from clinical studies demonstrating that prolotherapy is a significant and effective alternative treatment modality for people with ligament-related injuries and resultant joint instability.

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A Randomized Controlled Trial of Intra-Articular Prolotherapy Versus Steroid Injection for Sacroiliac Joint Pain

Abstract: Intra-articular prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies are needed to confirm the safety of the procedure and to validate an appropriate injection protocol.

Cited by 115 publications

References 20 publications

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Sacroiliac joint pain: a comprehensive review of epidemiology, diagnosis and treatment

Hyperosmolar Dextrose Injection for Recalcitrant Osgood-Schlatter Disease

Structural Basis of Joint Instability as Cause for Chronic Musculoskeletal Pain and Its Successful Treatment with Regenerative Injection Therapy (Prolotherapy)

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