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A Systematic Review of Prolotherapy for Chronic Musculoskeletal Pain

Rabago, David MD; Best, Thomas M MD, PhD; Beamsley, Mark MD; Patterson, Jeffrey DO

Clinical Journal of Sport Medicine: September 2005 - Volume 15 - Issue 5 - p E376
doi: 10.1097/01.jsm.0000173268.05318.a4
Critical Review

Objective: Prolotherapy, an injection-based treatment of chronic musculoskeletal pain, has grown in popularity and has received significant recent attention. The objective of this review is to determine the effectiveness of prolotherapy for treatment of chronic musculoskeletal pain.

Data Sources: We searched Medline, PreMedline, Embase, CINAHL, and Allied and Complementary Medicine with search strategies using all current and historical names for prolotherapy and injectants. Reference sections of included articles were scanned, and content area specialists were consulted.

Study Selection: All published studies involving human subjects and assessing prolotherapy were included.

Main Results: Data from 34 case reports and case series and 2 nonrandomized controlled trials suggest prolotherapy is efficacious for many musculoskeletal conditions. However, results from 6 randomized controlled trials (RCTs) are conflicting. Two RCTs on osteoarthritis reported decreased pain, increased range of motion, and increased patellofemoral cartilage thickness after prolotherapy. Two RCTs on low back pain reported significant improvements in pain and disability compared with control subjects, whereas 2 did not. All studies had significant methodological limitations.

Conclusions: There are limited high-quality data supporting the use of prolotherapy in the treatment of musculoskeletal pain or sport-related soft tissue injuries. Positive results compared with controls have been reported in nonrandomized and randomized controlled trials. Further investigation with high-quality randomized controlled trials with noninjection control arms in studies specific to sport-related and musculoskeletal conditions is necessary to determine the efficacy of prolotherapy.

From the University of Wisconsin-Madison, Madison, WI.

Received for publication August 2004; accepted May 2005.

*Tables 1 to 4 cited within the text are available via the Article Plus feature at Please go to the September/October issue and click on the Article Plus link posted with the article in the Table of Contents.

This research was supported by the University of Wisconsin Medical School, the University of Wisconsin, Department of Family Medicine, and the US National Institutes of Health: National Center for Complementary and Alternative Medicine.

Reprints: David Rabago, MD, UW Dept. of Family Medicine, 777 S. Mills St., Madison, WI 53715 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.