Is Prolotherapy Worthwhile for Sciatica Pain?

I am considering prolotherapy for relief of sciatica pain. Can you give me an update on studies regarding its efficacy? A recent meeting I attended indicated it as a very promising treatment.

– June 10, 2011

I last wrote about prolotherapy on this website in 2003 in response to a question about whether it was an acceptable alternative to a hip replacement. Prolotherapy, which is sometimes used for sciatica pain, involves injections – usually of dextrose and saline – into painful ligaments, tendons and joint spaces. The theory is that these injections trigger growth of new, healthy tissue to stabilize bones and joints, thus relieving musculoskeletal pain and stiffness.

Since then, only a handful of additional studies have looked at prolotherapy and few have been randomized clinical trials comparing prolotherapy with another treatment. Results remain inconclusive. Even so, prolotherapy appears to be gathering medical adherents, although many physicians remain skeptical. Because prolotherapy hasn’t been proved effective, few insurance companies cover it. According to an October 19, 2010 Wall Street Journal report, prices can vary, from $200 to $1,000 per treatment (and you may need up to six treatments before you know for sure whether or not the injections are helping).

In 2009, investigators at the Cochrane Collaboration updated their review of five published studies of prolotherapy for low back pain that lasted longer than three months. The studies included a total of 366 patients. The reviewers were unable to completely combine the results of the five studies because of variations in the types of injections and the treatment protocols. (Some of the studies tested prolotherapy alone and some combined the injections with spinal manipulation, exercise and other treatments.) The review showed that prolotherapy alone was not effective for low back pain, but that positive results were seen in the two studies in which the injections were combined with spinal manipulation, exercises and other treatments. Unfortunately, studies of this type make it impossible to say which component was responsible for the improvement. The investigators concluded that the role of prolotherapy for treating chronic low back pain remains unclear.

Although prolotherapy is promoted as safe, there are risks, including localized inflammation, pain, swelling, redness, soreness, temporary stiffness and bruising. Temporary numbness, tingling or itching at the injection site can also occur, and the injections can worsen the pain you hoped to relieve. More serious side effects include infection and bleeding.

For now, I do not recommend prolotherapy for treatment of musculoskeletal discomfort such as sciatica pain. Instead, for pain I suggest considering therapeutic yoga and acupuncture.

Andrew Weil, M.D.

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