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K. Dean Reeves, M.D. Clinical Associate Professor Physical Medicine and Rehabilitation
Emphasis on Research in Use of Prolotherapy (Also called Regenerative Injection Therapy) ReevesOffice @ gmail.com Office Email DeanReevesMD @ gmail.com Personal email
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PDG: Klein et al 1993 Near significant (P = .056) evidence for superior effect of the inflammatory proliferant solution anesthetic needling (Klein et al) in chronic low back pain. Klein RG, Bjorn CE, DeLong B, et al: A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic low back pain. J Spinal Disord 6:23, 1993. PDG: Ongley et al 1987 Significant (P < .001) evidence for superior effect of the inflammatory proliferant solution over saline needling in chronic low back pain. Ongley MJ, Klein RG, Dorman TA, et al: A new approach to the treatment of chronic low back pain. Lancet 2:143, 1987.
Despite better-than-placebo improvement in the control group, the first two blinded studies of chronic low back pain (using phenol/dextrose/glycerin as active solution) demonstrated significant (P < .001) Ongley MJ, Klein RG, Dorman TA, et al: A new approach to the treatment of chronic low back pain. Lancet 2:143, 1987. and near significant (P = .056) Klein RG, Bjorn CE, DeLong B, et al: A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic low back pain. J Spinal Disord 6:23, 1993. evidence for superior effect of the inflammatory proliferant solution over saline needling (Ongley et al) and anesthetic needling (Klein et al). These two studies were weakened somewhat by multiple simultaneous treatments, although the injection solution was the only significant difference between the two groups. PDG: (Phenol Dextrose Glycerine) Dechow et al 1999 Incorrect injection sites along with failure to examine lead to worse rather than better outcomes. Dechow E, Davies RK, Carr AJ, et al: A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology 39:1255, 1999. The third study was led by a chief investigator (rheumatologist) who had a mandate to "prove or disprove prolotherapy", was armed with a complete lack of knowledge of prolotherapy technique or referral patterns for ligament or tendon, and brilliantly, but probably unwittingly, designed the study to fail. Dechow E, Davies RK, Carr AJ, et al: A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatolgy 39:1255, 1999. Failure was insured by: 1. Accepting patients with axial (back) pain only and excluding patients with leg pain referral. 2. Finding a physician who was conversant with prolotherapy but preventing him from examining the patients for areas to inject. Rather the physician was forced to inject only specified areas. 3. Allowing treatment only on ligaments that would cause leg pain and not any ligaments that would treat axial (back) pain, and . 4. Injecting inflammatory (phenol-based) proliferant in these incorrect areas. . As a consequence of injecting inflammatory solution in completely wrong areas, this study is recorded as a prolotherapy study in which the active group did worse than the control. This study is worthy of inclusion in a discussion of back pain studies because of what it says about study design in musculoskeletal medicine. IE: It trumpets the importance of knowing anatomy, and referral patterns in connective tissue, and of hands-on examination.
DEX: Yelland et al 2004 Injection alone, even without proliferant, is effective long term for chronic intractable back pain. Yelland MJ, Glasziou PP, Bogduk N, et al: Prolotherapy injections, saline injections, and exercises for chronic low-back pain: A randomized trial. Spine 29(1):9, 2004. A fourth study was reported in 2004 and designed by an experienced physician in Brisbane. Yelland MJ, Glasziou PP, Bogduk N, et al: Prolotherapy injections, saline injections, and exercises for chronic low-back pain: A randomized trial. Spine 29(1):9, 2004. This study, like the previous studies, compared repetitive needle contact with bone, with and without proliferant. A gentler proliferant (dextrose) was utilized. Substantial and sustainable important improvements in pain and function were demonstrated by both injection groups, despite incomplete injection which minimized areas that several key areas. Highlighted by this study is the importance of the beneficial effect of needling alone and that needling is not a placebo intervention. The hope is that future studies on low back pain will include a near-placebo arm that avoids connective tissue contact or blood effects and that standard injection methods will be used. In the treatment of low back pain, standard treatment methods are now taught in cadaver courses offered by the American Academy of Orthopedic Medicine. An example of such a near-placebo would be needle insertion through skin without contacting bone or ligament. Meanwhile consecutive patient studies with complete technique continue to support a high percentage of response to proliferant injection in chronic back pain patients. Hooper RA, Ding M: Retrospective case series on patients with chronic spinal pain treated with dextrose prolotherapy. J Altern Complement Med 10(4):670, 2004.
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To contact us: General questions --> reevesoffice@gmail.com
Billing related questions --> reevesbilling@gmail.com
Research related questions --> DeanReevesMD@gmail.com
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C. Randomized Clinical Trials in Low Back Pain: 
In
the treatment of low back pain there are four treatment comparison studies.
The control group in all back studies involved needle contact with attachments
of ligaments and tendons. By injecting ligaments and tendons, there is needle
contact with cell membranes of connective tissue cells. Disrupting cell
membranes releases lipids, which in turn cause signaling of fibroblasts.
In
addition, microbleeding from needle contact is expected, and Edwards and
colleagues have demonstrated the potential healing effect of whole blood
injection in patients with recalcitrant tennis elbow. Edwards
SG, Calandruccio JH: Autologous blood injections for refractory lateral
epicondylitis J Hand Surg [Am] 28(2):272, 2003.