Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

Abstract

BackgroundIncreasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales.MethodsPubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and five randomized controlled trials were included, comprising 326 participants. We estimated the effect sizes of pain reduction before and after serial dextrose injections and compared the values between dextrose prolotherapy, comparative regimens, and exercise 6 months after the initial injection.ResultsRegarding the treatment arm using dextrose prolotherapy, the effect sizes compared with baseline were 0.65 (95% confidence interval [CI], 0.14–1.17), 0.84 (95% CI, 0.40–1.27), 0.85 (95% CI, 0.60–1.10), and 0.87 (95% CI, 0.53–1.21) after the first, second, third, and fourth or more injections, respectively. The overall effect of dextrose was better than control injections (effect size, 0.36; 95% CI, 0.10–0.63). Dextrose prolotherapy had a superior effect compared with local anesthesia (effect size, 0.38; 95% CI, 0.07–0.70) and exercise (effect size, 0.71; 95% CI, 0.30–1.11). There was an insignificant advantage of dextrose over corticosteroids (effect size, 0.31; 95% CI, –0.18 to 0.80) which was only estimated from one study.ConclusionDextrose injections decreased pain in osteoarthritis patients but did not exhibit a positive dose–response relationship following serial injections. Dextrose prolotherapy was found to provide a better therapeutic effect than exercise, local anesthetics, and probably corticosteroids when patients were retested 6 months following the initial injection.

Effectiveness of Glenohumeral Joint Dilatation for Treatment of Frozen Shoulder: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…We performed a literature search primarily in PubMed from the earliest record to February 2017. Scopus, Embase and Google Scholar were used as secondary database sources for the purpose of retrieving relevant studies not indexed in PubMed 9 , 10 . A systematic review and meta-analysis of associated topics, the Cochrane Collaboration Central Register of Controlled Clinical Trials and Cochrane Systematic Reviews, was also examined to confirm that all pertinent trials were enrolled.…”

Association between Loss of Skeletal Muscle Mass and Mortality and Tumor Recurrence in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

“…Two authors independently extracted the data from the included studies and assessed their quality by using the Newcastle-Ottawa Scale [10][11][12]. The following details were presented in this review: first author's name, year of publication, patients' characteristics, enrolled numbers, sex ratio, muscle mass measurement, definition of skeletal muscle mass loss, subsequent treatment for hepatic malignancy, outcome variables, and adjusted major confounders.…”

Features and Clinical Effectiveness of the Regenerative Injection Treatments: Prolotherapy and Platelet-Rich Plasma for Musculoskeletal Pain Management

“…A systematic review and meta-analysis compare the effect of dextrose PrT against control injections and exercise in the treatment of osteoarthritis. Dextrose PrT is superior to exercise, local anesthetics, and corticosteroids in 6 month follow-up [26]. Similar to this, a 3-arm, blinded, RCT compared dextrose PrT, saline, and at-home exercise, and PrT is better clinical enhance of pain, function, and stiffness than saline injections and at-home exercises [27].…”