Comparative study between the effect of neural versus intra-articular dextrose prolotherapy on pain and disability in patients with knee osteoarthritis

Subcutaneous injections of dextrose in musculoskeletal pain, a potential therapeutic intervention: scoping review

BACKGROUND

The aims of this review were to identify and to analyze the clinical studies that used subcutaneous injections of dextrose for treating musculoskeletal pain, in order to establish an overview.

METHODS

A systematic search was carried out in scientific databases including Web of Science, Cochrane Central Register of Controlled Trials, PUBMED and other sources, up until March 2024. We included clinical studies that used subcutaneous injections of dextrose in the treatment of individuals with musculoskeletal pain associated with tendinopathies, enthesopathy, osteoarthritis, ligament sprains, muscle strains or bursitis of various locations.

RESULTS

Twenty studies that met the criteria were included in this review; of those, 13 were randomized clinical trials, one non-randomized comparative study and six were case series studies, comprising a total of 1226 patients. In all included studies, efficacy in pain reduction was reported in the groups treated with dextrose when comparing evaluations at baseline, short term and medium term.

CONCLUSIONS

Subcutaneous injections of dextrose could be a beneficial treatment for reducing musculoskeletal pain; however, factors such as the high heterogeneity in the treatment schemes, uncertainty in the mechanisms of action and the level of evidence found, indicate that this technique is still under development.

Chronic Low Back Pain Forced Me to Search for and Find Pain Solutions: An Autobiographical Case Report

Lifelong, pregnancy-induced low back pain forced me to search for solutions to the problem of pain. Currently, low back pain is often diagnosed as “nonspecific” and, as a result, a multitude of tests and poorly effective, at times side effect-laden or habit-forming treatments are recommended. My quest for relief took me to first diagnose my pain as coming from the sacroiliac joints, then to prolotherapy, the first treatment which brought me prolonged relief. I then learned how to perform prolotherapy. In 2009, when I undertook a randomized controlled study of dextrose prolotherapy for rotator cuff tendinopathy, I restricted my practice to treating pain.

As low back pain was a large part of my practice, I sought new ways to examine the sacroiliac joints. I conducted a consecutive patient data collection which suggested that over three-quarters of those with low back pain suffer from displaced sacroiliac joints. In a further randomized controlled study, I found that the two-minute corrective exercise I derived from this test provided immediate relief to 90% of those using it.

With Dr. John Clark Lyftogt I discovered the safety and effectiveness of 5% dextrose perineural injections to provide immediate pain relief to any area supplied by a nerve I could reach with my needle. As I was treating many diabetics with peripheral neuropathy, I shifted my perineural injection material to 5% mannitol, which may be as effective, with less exposure to dextrose as a potential benefit for diabetics.

As most people dislike injections, a pharmacist and I developed a mannitol-containing topical cream for pain relief. We compared a base cream to the same cream with mannitol on lips pretreated with capsaicin cream which made them burn. By 10 minutes the probability the two creams were as effective in relieving the burn was less than 0.001 in favor of mannitol. When given to 235 patients with a total of 289 different painful conditions, we found that it provided 53% relief in an average of 16 minutes with a median of four hours duration.

Now retired, after 55 years of medical practice, I love to relieve the pain of friends and fellow hikers using exercise and cream. Searching for and finding solutions to chronic pain has enriched my life and that of many others.