Prolotherapy Injections Research Articles

Semi-invasive therapies for pain in knee osteoarthritis: A systematic review and network meta-analysis.

The increasing number of semi-invasive pain therapies in knee osteoarthritis poses challenges in decision-making. This review aimed to simultaneously compare established intra-articular therapies with newer peri-articular therapies and explore effect modifiers. Randomized controlled trials were searched from five electronic databases without date or language restrictions. Study selection and data extraction of reports, retrieved up to May 2024, were performed independently by paired assessors. The primary outcome was 6-month pain score. Nine treatments were included. The effect size (ES) for each treatment, relative to placebo, was estimated using standardized means difference and expressed with 95% confidence intervals (CI). The rigor of results was evaluated with subgroup/sensitivity analyses. A total of 111 studies (14,695 participants) were included, with intra-articular hyaluronic acid having the greatest number of participants. Neuroablation demonstrated the greatest ES (1.08, 95% CI: 0.07, 2.10). While platelet-rich plasma (PRP) ranked second (ES: 0.75, 95% CI: 0.28, 1.22), it was the only intervention demonstrating statistically significant effect at 3, 6, and 12 months. However, this statistical significance was lost in some sensitivity analyses. Larger estimates for biologics and PRP compared with prolotherapy, steroid, and hyaluronic acid injections were consistently observed across different timepoints and in multiple sensitivity analyses. Generally, no statistically significant difference was found between the nine types of therapies. Although there is robust evidence suggesting greater efficacy of PRP, potentially including biologics, over other interventions, future research is needed to identify the phenotype or patient subgroup that would benefit most from PRP.

The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study

Letter to the editor, Scientific Comment on of the article titled: "The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study"

The efficacy of ultrasound and fluoroscopy-guided caudal epidural prolotherapy versus steroids for chronic pain management in failed back surgery syndrome

ABSTRACT Background Caudal epidural prolotherapy injection has emerged as a successful treatment for managing chronic pain. This study is a prospective randomized, double-blinded clinical trial. It assesses and compares the effectiveness of prolotherapy versus steroid injection for pain relief in cases of failed back surgery syndrome (FBSS). It involved randomly assigning 90 patients with FBSS to one of two equal groups: steroids or prolotherapy. The VAS was used to measure pain as the primary outcome, while disability was measured by the Oswestry disability index (ODI). McGill Pain Questionnaire (MPQ) and complications were recorded as secondary outcomes. Results The VAS improved significantly from the baseline in both groups at all follow-up periods (p < 0.001). Nonetheless, after 2, 4, and 6 weeks post-injection, there was no statistically significant difference between the two groups, while at 8 weeks, 3, and 6 months, the VAS was statistically significantly lower in the steroids group than in the prolotherapy group (p < 0.001). The ODI and MPQ improved significantly from the baseline in both groups at all follow-up periods (p < 0.001). However, after 2 and 4 weeks post-injection, there was no statistically significant difference between the two groups; but, at 6 and 8 weeks, 3, and 6 months, the ODI and MPQ were statistically significantly lower in the steroid group compared to the prolotherapy group (p < 0.001). Only one patient in the steroid group suffered from pain and swelling at the injection site without a statistically significant difference between the two groups. Conclusion Caudal epidural prolotherapy injection has good efficacy in managing pain that can be similar to steroid injection but shorter in duration in cases of FBSS with comparable safety profile.

Comparison between the effect of Steroid Injection, Prolotherapy Local Injection and Extracorporal Shock Wave Therapy in Treatment of Symptomatic Calcaneal Spur

Abstract Background Calcaneal spurs are common cause of heel pain occurring anywhere along the calcaneal tuberosity and most frequently found at the insertion of the plantar fascia. They are usually asymptomatic, but when they are painful, the condition is generally the result of inflammation of the insertional fibers of the plantar fascia at the medial tuberosity. Symptomatic calcaneal spurs are often found in association with plantar fasciitis. Like plantar fasciitis, calcaneal spurs can occur alone or may be part of a systemic inflammatory condition such as rheumatoid arthritis or gout. In some patients, the cause seems to be entirely mechanical, and such patients often exhibit an abnormal gait with excessive heel strike. Objective To compare the effectiveness of dextrose prolotherapy injection, corticosteroid injection and extracorporal shockwave in symptomatic calcaneal spur, based on clinical and functional outcome measures. Patients and Methods This study was conducted on forty-five patients diagnosed with symptomatic calcaneal spur (plantar fasciitis) for more than 6 months. The patients were recruited from Physical Medicine, Rheumatology and Rehabilitation department at Ain Shams University Hospitals. Diagnosis was based on detailed history taking, full clinical examination, pain and functional assessments of the foot using visual analogue scale (VAS score) and foot function index (FFI). Results Eight weeks after treatment, the pain score by VAS was significantly improved at ESWT group mostly, less extent at prolotherapy group and least at corticosteroid group. Also the percentage of improvement in ESWT group was found higher than the other groups indicating the long term analgesic effect of ESWT. Eight weeks after treatment, the FFI subscales (pain, disability and activity limitation)and total FFI score significantly improved mostly at ESWT group, less extent at prolotherapy group and least at corticosteroid group indicating the long term beneficial effect of ESWT on the function in patients with chronic PF. Conclusion Although ESWT, dextrose prolotherapy injection, and local corticosteroid injection were all effective in the treatment of symptomatic calcaneal spur during 8weeks of follow-up but, ESWT was superior to all other modalities in its effect on pain intensity and function during daily life activities at long term follow up.

The Impact of Prolotherapy and Steroid Injection on De Quervain's Tenosynovitis: A Retrospective Outcome Study

Aim: Patients with De Quervain's stenosing tenosynovitis (DQT) experience problems in daily living activities due to the chronic inflammatory process and tenderness around the wrist. This study aimed to compare the effects of prolotherapy and steroid injection on short-term functional outcomes in DQT patients. Methods: In this retrospective study between January 2022 and 2023, a cohort of 34 patients with complete demographic data and elbow pain and functional scores, which were recorded at pre-treatment, two weeks, and six weeks post-treatment, was divided into the steroid injection (n=17) and prolotherapy (n=17) groups. Demographic and clinical data of all patients were recorded. The outcomes of the Visual Analogue Scale (VAS) score for wrist pain, Quick Disability Assessment of Arm, Shoulder, and Hand Problems (QuickDASH), and the Health Assessment Questionnaire (HAQ) for wrist functions were examined. Results: Initial assessments did not reveal any differences between groups in terms of VAS (p=0.756), QuickDASH (p=0.168), and HAQ (p=0.615). In the second week post-treatment, there was a significant reduction in VAS, QuickDASH, and HAQ in steroid injection compared to the prolotherapy (p=0.001). This difference continued at sixth-week post-treatment; VAS (p=0.007), QuickDASH (p=0.003), and HAQ (p=0.011) were found to be significantly lower in steroid injection than in the prolotherapy. Conclusion:Our findings underscore the superior effectiveness of steroid injection compared to prolotherapy in reducing wrist pain and improving functional outcomes in patients with DQT. These findings benefit orthopedic settings in choosing treatment options logically, though further research is needed to understand long-term effects and mechanisms.

EFFECTIVENESS OF ULTRASOUND GUIDED DEXTROSE PROLOTHERAPY INJECTION IN COMPARISON WITH EXTRACORPOREAL SHOCK WAVE THERAPY ON IMPROVING PAIN AND FUNCTION AMONG ATHLETES WITH ACHILLES TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Achilles tendinosis is a chronic, degenerative condition affecting both sedentary individuals and athletes of all abilities, with prevalence in running-based sports particularly high. Pain is considered to be the primary symptom of Achilles tendinosis, to the extent that it is suggested that a patients symptoms can reflect the severity of the condition. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. Objectives: To determine the effectiveness of ultrasound guided Dextrose prolotherapy injection in comparison with extracorporeal wave therapy on improving pain and function among athletes with Achilles tendinopathy Study Design: A Randomized controlled trial Methods: Fifty eight athletes with achilles tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: dextrose prolotherapy injection under ultrasound guidance (prolotherapy group n = 29), and 3 sessions of focused extracorporeal shock wave therapy (ESWT group n = 29). The outcome measures were Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire and pain visual analog scale (VAS). Both the groups underwent rehabilitation programs. For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by students t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the groups comparison was analysed using students t-test. A p-value &lt; 0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection (p &gt; 0.05). Within the group comparison showed significant improvement in outcome measures in both the groups at all follow ups (p = 0.00). Between the groups analysis found improvement in the VAS and VISA-A scores at all follow ups but the improvement was significantly more in the Prolotherapy group in comparison with the ESWT group (p = 0.00). Conclusion: Ultrasound guided injection of dextrose prolotherapy in combination with eccentric strengthening exercises lead to significant improvement in pain and function over the long term in comparison with focused ESWT among athletes with Achilles tendinosis and thereby enabling faster return to sports.

A Review of Lateral Epicondylitis Injection: Drugs Used, Injection Techniques and Guidance Method

Abstract This article aimed to study the most suitable drug for injection, injection techniques and guidance method for treating tennis elbow. The words ‘injection technique’, ‘lateral epicondylitis’ and ‘tennis elbow’ were keyed into PubMed search base, and 145 full-text English language articles were obtained, from which 22 articles were deemed suitable for review based on content and relevance. One article was added from the author’s collection. The eligibility was (a) patients with tennis elbow or lateral epicondylitis, (b) patients who had undergone injection therapy and (c) studies that had done a comparison between two or more agents or two techniques or used comparison between using or not using imaging guidance for injection. It was found that corticosteroid injections in tennis elbow produce a short-term improvement in symptoms, while prolotherapy, autologous blood and platelet-rich plasma (PRP) injections may show more efficacy in the long term. In terms of technique, peppering seems to be a better alternative to tender point injections. The use of ultrasound guidance does not seem to have any effect on the overall efficacy of the injection treatment. The evidence in this study shows that it is better to use corticosteroids for short-term improvement, whereas bioactive agents like PRP injections may work better in the long term.

The Effect of Intra-articular Hypertonic Dextrose Prolotherapy on Pain, Quality of Life, and Functional Outcomes Scores in Patients With Knee Osteoarthritis.

Introduction Knee osteoarthritis is a common chronic condition leading to pain and debility. Prolotherapy is a safe and cost-effective treatment option. Our team conducted a case series to examine the effect of prolotherapy on functional measures and quality of life in patients with knee osteoarthritis. Methods Our case series included 15 total patients consisting of male and female patients aged 50-85 years old with a prior diagnosis of knee osteoarthritis and moderate pain. The patients completed baseline Western Ontario and McMaster Universities Arthritis Index (WOMAC) and EuroQol-5 Dimension (EQ5D) surveys and received an ultrasound-guided intra-articular prolotherapy injection. The patients were then followed up by Telehealth at one-, two-, and three-monthpost-procedure. Results Data points for 15 patients were recorded over the duration of the three months. Results revealed significantly improved functional scores from the baseline period (M = 0.60) to the one-month (M = 0.43), two-month (M = 0.48), and three-month (M = 0.46), observed power = 0.99. Participants reported significantly lower pain scores between the baseline period (M = 0.60) compared to the one-month (M = 0.34), two-month (M = 0.35) and three-month (M = 0.39) periods. There was no statistical significance across time in participants' EQ5D scores. The repeated-measures analysis of variance (ANOVA) revealed no statistically significant differences in participants scores between the baseline (M = 64.4), one-month (M = 68.93), two-month (M = 68.47), or three-month (M = 68.33), observed power = 0.31. There were no statistically significant differences in participants WOMAC stiffness scores between the baseline (M = 0.67), one-month (M = 0.46), two-month (M = 0.57), or three-month (M = 0.56) periods, observed power = 0.73. The results revealed no significant change in participants' EQ5D and WOMAC stiffness scores. The results support a statistically significant improvement in patients' self-reported functioning and pain scores between the baseline and one-month, two-month, and three-month periods. Discussion The significant improvement in function occurred between the baseline and one-month time periods and the pain reduction was sustained throughout the two-month and three-month periods. Our study supports prolotherapy as an effective treatment option to improve pain and function in knee osteoarthritis. The study could be repeated with a large sample size to further investigate the effects of prolotherapy on quality-of-life measures.

Effectiveness of Dextrose Prolotherapy in Chronic Plantar Fasciitis: A Cross-Sectional Study

&#x0D; Introduction: Plantar fasciitis is a very common musculoskeletal condition encountered in the outpatient department of orthopedics. It's the most common cause of heel pain. Patients have pain on weight-bearing, which limits their activities. Usually, plantar fasciitis is diagnosed on the basis of history and clinical examination; however, X-ray and USG can be helpful in atypical presentations. Mostly, plantar fasciitis is managed conservatively, which includes stretching exercises, footwear modification, ultrasonics, and injections. Prolotherapy is a very cost-effective, and OPD-based procedure that has shown promising results in many tendinopathies. There are no other risks involved in this procedure, and patients can start light activities immediately after the injection.&#x0D; Objective: To evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis (PF).&#x0D; Methodology: This prospective, cross-sectional study, was conducted from July 2021 to December 2021 at Birat Medical College and Teaching Hospital after taking permission from the Institutional Review Committee (IRC). Patient selection was done using inclusion and exclusion criteria. A total of 66 patients were included in the study, who received two prolotherapy injections in a gap of two weeks and were followed up after 12 weeks. Patient’s clinical (Visual Analogue Score for pain at rest and activities), functional (Foot Function Index), and ultrasonograhic (plantar fascia thickness) findings were noted pre- and post-test and were evaluated.&#x0D; Results: There were 66 adult patients included in the study, out of which 39 patients (59.1%) were female and 27 patients (40.1%) were male. Their age ranged from 26 to 68 years, with a mean age of 43.91 and a standard deviation (SD) of 10.225. The mean BMI was 25.758 with an SD 2.69 (range: 19.6-33.2). The clinical score (VAS-R and VAS-A), functional score (FFI), and ultrasonographic findings (PF thickness) yielded significant outcomes following prolotherapy.&#x0D; Conclusion: Prolotherapy is a safe, economical, and effective treatment module for plantar fasciitis that has shown significant improvement in pain, functional outcomes, and patient satisfaction.

Prolotherapy Versus Phonophoresis and Corticosteroid Injections for the Treatment of Plantar Fasciitis: A Randomized, Double-Blind Clinical Trial

The aim of this study was to compare the effectiveness of prolotherapy with phonophoresis and steroid injection in patients with plantar fasciitis (PF). One hundred forty-six patients with PF were randomly divided into prolotherapy, phonophoresis, and injection groups. The treatment method to be applied to them was determined by drawing lots of equal numbers of papers with "Prolotherapy," "Corticosteroid," and "Phonophoress" written on it among those who accepted to be treated. Patients were evaluated using heel sensitivity index (HSI), visual analog scale (VAS), foot function index (FFI), and Short Form (SF)-36 at baseline, first and third months after the therapy. Plantar fascia thickness (PFT) was measured by ultrasonography (USG) at baseline, first and third months after the therapy. Statistically significant improvements were found in all parameters at 1 and 3 months after treatment in all groups (p < .05). There was no significant difference between VAS and FFI scores between the 3 groups (p > .05). Improvement in the HSI (p=.021) and SF-36 general health (GH) subscales at the third month after treatment in the prolotherapy group was significantly better at the first and third months compared to the other groups (p=.033 and p < .01). No complications were observed in any of the patients. Our study results suggest that prolotherapy, phonophoresis, and steroid injection are beneficial as safe treatment modalities in the early period of PF treatment. The improvement of HSI and SF-36 GH subscale lasts longer with prolotherapy, but ultrasonographic findings do not change in the third month of these treatment applications.

The effect of hypertonic dextrose prolotherapy on knee osteoarthritis outpatients in Dr. Ramelan Navy Hospital Surabaya: case series

Background: The high use and pressure on the knee cause osteoarthritis to occur frequently. Prolotherapy is a non-surgical injection therapy used to treat chronic pain in musculoskeletal conditions, including knee OA. This solution can create local irritation, inflammation, and tissue regeneration, thereby increasing the strength of damaged ligaments, tendons, and intra-articular structures. Therefore, the aim of this research is to assess the changes in VAS and WOMAC scores, as well as plain radiographs of knee OA patients after hypertonic dextrose prolotherapy. Methods: This experimental case series was done at the Physical Medicine and Rehabilitation Polyclinic of dr. Ramelan Navy Hospital Surabaya from December 2021 to April 2022, by giving hypertonic dextrose prolotherapy injection intraarticularly to 3 knee OA subjects using a 22G or 23G needle. This procedure was performed 3 times on each subject, with an interval of 4 weeks each. The assessments were carried out with VAS and WOMAC scores, as well as plain radiographs of the knees before the procedure and 1 month after the third injection for evaluation. Results: In all 3 subjects, the knee joint spaces were slightly widened on plain radiographs, as well as decreased VAS and WOMAC scores after injection. Conclusion: Hypertonic dextrose prolotherapy here had minimal side effects, affordable prices, and a fast process. It also causes a reduction in pain and joint stiffness and causes functional improvement. Prolotherapy may be considered a therapy for knee OA patients.

Comparison of Dextrose Prolotherapy and Triamcinolone Intraarticular Injection on Pain and Function in Patients with Knee Osteoarthritis - A Randomized Clinical Trial.

The present study was performed to assess the therapeutic effects of combined intra and extraarticular dextrose prolotherapy on knee osteoarthritis and its comparison with intra- articular triamcinolone injection. In this study, 50 patients suffering from knee osteoarthritis were allocated into two groups as a double-blind randomized clinical trial. The first group received one session of dextrose prolotherapy as one intra-articular injection of 10cc dextrose 16% and periarticular intradermal injections of dextrose 12% at 4 points around the knee (2.5 cc at each point). The second group underwent therapy with one intra-articular injection of triamcinolone (40 mg). Compared to pretreatment, both interventions caused significant improvement in pain (evaluated by VAS) and WOMAC (all its components) in 1 and 3 months postintervention (all with P-value < 0.005). In the first month, pain reduction was significantly better in corticosteroid group (P-Value 0.002 and 0.048 respectively). In third month post intervention, improvements in VAS and WOMAC components were significantly greater in prolotherapy group. Both methods of corticosteroid and dextrose prolotherapy (combined intra and extraarticular technique) are effective on pain and function of patients with knee osteoarthritis. Compared to corticosteroid, prolotherapy method was associated with less pain reduction in short- term, but its effects were more persistent and in midterm examinations (3 months), it was more effective than corticosteroid.

Comparative Study of Methylprednisolone, Platelet-Rich Plasma and Prolotherapy Injections In Management of Shoulder Rotator Cuff Tendinopathies

Comparative Study of Methylprednisolone, Platelet-Rich Plasma and Prolotherapy Injections In Management of Shoulder Rotator Cuff Tendinopathies

Comparison Clinical Effects of Hypertonic Dextrose and Steroid Injections on Chronic Subacromial Bursitis: A Double-Blind Randomized Controlled Trial.

To determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy (DPT) for chronic subacromial bursitis patients. 54 patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder pain and disability index (SPADI) and visual analog scale (VAS) were the primary outcomes. The steroid group (n = 26) exhibited significant VAS score improvements comparing to baseline at weeks 2, 6, and 12; the DPT group (n = 28) exhibited VAS score improvements at weeks 6, and 12. The steroid group displayed significant SPADI score improvements compared to baseline at weeks 2, 6, and 12, the DPT group exhibited significant score decreases at weeks 2, and 6. Compared with the DPT group, the steroid group demonstrated significantly greater decreases in VAS scores at weeks 2, and 6; the steroid group showed significantly greater decreases in SPADI scores at weeks 2, 6, and 12. Both hypertonic DPT and steroid injections can provide short-term improvements of pain and disability among chronic subacromial bursitis patients. Moreover, steroid injections showed better effectiveness than hypertonic DPT in ameliorating pain and improving function.

Prolotherapy Injection with Hyperosmolar Dextrose Solution in the Treatment of Achilles Tendinopathy: A Pilot Study

Prolotherapy Injection with Hyperosmolar Dextrose Solution in the Treatment of Achilles Tendinopathy: A Pilot Study

Prolotherapy: A Narrative Review of Mechanisms, Techniques, and Protocols, and Evidence for Common Musculoskeletal Conditions.

Prolotherapy is a nonsurgical regenerative technique that allows small amounts of irritant solution to be injected into the site of painful tendon and ligament insertions to promote the growth of healthy cells and tissues. The goal of prolotherapy is to stimulate growth factors that may strengthen attachments and reduce pain. Prolotherapy injection technique is centered around a focused physical examination and strong anatomic knowledge for maximized results. Prolotherapy is beneficial in a variety of different musculoskeletal conditions, including, but not limited to, lateral epicondylosis, rotator cuff tendinopathy, plantar fasciitis, Achilles tendinopathy, osteoarthritis, low back pain, sacroiliac joint pain, and TMJ laxity.

Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial

Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12months following the injections. The secondary outcome variable was recorded only 8-12months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64years) in the BTX-A group and 14 (10 females, 4 males; 32.37years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P<.01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P>.05). Patient satisfaction showed no significant difference between the groups (P>.05). These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.

Prolotherapy and Platelet Rich Plasma Injections for the Treatment of Sacroiliac Joint Dysfunction: A Descriptive Review

Prolotherapy and Platelet Rich Plasma Injections for the Treatment of Sacroiliac Joint Dysfunction: A Descriptive Review

Corticosteroid Versus Dextrose Ultrasound-Guided Injection in the Treatment of Sacroiliac Joint Dysfunction: A Randomized Double-Blinded Clinical Trial

Background: Sacroiliac Joint (SIJ) dysfunction, a common etiology of Low Back Pain (LBP), is a challenging diagnosis. There is controversy over the efficacy of prolotherapy and corticosteroid injections in relieving SIJ dysfunction. Inconsistent success rates reported in previous studies can be due to heterogeneity in selecting the patients and procedures between studies. This study was conducted to compare the efficacy of local injection of dextrose prolotherapy and corticosteroid in treating the SIJ dysfunction.&#x0D; Methods: This 36-week, double-blind, Randomized Controlled Trial (RCT) included 40 patients with SIJ dysfunction. The clinical impression was confirmed by the use of a diagnostic injection of local anesthetic inside SIJ. Participants received a single injection of either hypertonic dextrose solution or triamcinolone under Ultrasound (US) guidance. The primary outcome measurement tools, including the Visual Analog Scale (VAS) for pain and the Dallas Pain Questionnaire (DPQ), were evaluated initially and after 2, 8, and 36 weeks.&#x0D; Results: In both prolotherapy and corticosteroid groups, VAS significantly declined within 36-weeks of follow-up. However, there was no remarkable difference between the two groups at any follow-up timepoints. Similarly, DPQ revealed a remarkable improvement in the corticosteroid group while it did not show any meaningful change in the prolotherapy group.&#x0D; Conclusion: Both local injections of dextrose and corticosteroids can successfully reduce pain in patients with SIJ dysfunction without significant superiority between the two treatments. However, corticosteroid injection was slightly more effective in terms of improvement of functional status. Further investigations are required to extend these results to SIJ dysfunction treatment more reliably.

Neural Prolotherapy in Persistent Post-Surgery Pain: A Case Report

Introduction: Persistent postoperative pain is a clinical condition of discomfort (pain) and lasts more than 2 months after surgery without other causes, such as chronic infection or pain due to chronic conditions that occurred before surgery. This study aims to describe PPSP management and its outcomes.&#x0D; Case presentation: A woman, 54 years old, a housewife, came to the hospital with complaints of persistent pain from a surgical scar in the abdominal area. The pain has gotten worse in the last 3 months and sometimes feels like it's spreading to the area around the surgical wound. The pain is felt sharp and hot, spreads to the area around it, and is felt when resting, aggravated by activity experienced 5 months ago since the operation to remove the uterus. The patient was diagnosed with persistent post-surgical pain. Neural prolotherapy is performed on patients with PPSP indications. The drugs used are 5% dextrose solution and 2% lidocaine. Injection of 0.5-1 ml of dextrose was carried out in the area along the surgical scar and its surroundings. After the injection, the patient felt that the pain was reduced (numeric rating scale 1/10).&#x0D; Conclusion: Neural prolotherapy can be used in the management of patients with PPSP complaints. Treatment with neural prolotherapy injection using a mixture of D5% solution and lidocaine has a good prognosis for symptom improvement and relatively minimal complications.