Discussion

Post-study data revealed an average reported drop in pain of 2.9 points on a 10-point scale. This data showed an even greater average drop in pain of 3.9 for those patients who were told prior to Prolotherapy that nothing more could be done for their pain, or surgery was their only option. More than 80% of the study population reported improvements in mobility (walking and daily activities), exercise ability, anxiety, depression, overall disability, and the large majority (75%) were able to discontinue use of pain medication. When subjects were asked at one year follow-up whether their lower back pain improved following Prolotherapy, 98% answered yes.

Though practitioners and patients of the procedure have long touted Prolotherapy’s benefits, placebo-controlled studies have been lacking, and few insurance companies provide coverage. As a result, Prolotherapy is still considered by many to be experimental. In double-blinded human studies, the evidence on the effectiveness of Prolotherapy for low back pain has been promising but mixed.^39-42 Factors that could have contributed to suboptimal results in some of the studies are a limited number of sites were treated and/or a limited amount of proliferant was used. In one study on chronic low back pain, tissue biopsies performed three months after completion of Prolotherapy showed statistically significant increases in collagen fiber and ligament diameter (60%), suggesting clinical evidence of the procedure’s effectiveness.⁴³

Animal studies on Prolotherapy offer more definitive results, and also show that the procedure induced the production of new collagen.^44,45 In one double-blinded animal study, ligament mass increased by 44%, ligament thickness by 27%, and the ligament-bone junction strength by 28% over a six-week period.⁴⁶ Improvements in ligament and tendon diameter and strength have also been documented.^47,48

Former U.S. Surgeon General C. Everett Koop began advocating for insurance coverage of Prolotherapy in 1978 after it alleviated his chronic leg and back pain, but few inroads have been made. Most physicians are not familiar with the procedure, do not practice it, and therefore cannot attest to its benefits. Awareness of the procedure rose in 2005 when Dr. Robert Sheeler, medical editor of the Mayo Clinic Health Letter, lent his qualified support to its effectiveness for various types of joint pain, including that arising from the sacroiliac.⁴⁹ Though several Mayo Clinic physicians now offer Prolotherapy as a treatment option, widespread understanding and acceptance of the procedure in the medical community is still in its infancy, and further research studies are needed to determine the extent of its benefits.

Comparison of pre- and post-study data showed significant improvements across all indicators. The results of this retrospective pilot study therefore suggest that Hackett-Hemwall dextrose Prolotherapy can play a role in decreasing pain, improving mobility and range of motion, reducing medication use, and improve many quality of life parameters in patients with unresolved low back pain. (See Table 2.)