Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

Abstract

Background: Increasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales.

Methods: PubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and five randomized controlled trials were included, comprising 326 participants. We estimated the effect sizes of pain reduction before and after serial dextrose injections and compared the values between dextrose prolotherapy, comparative regimens, and exercise 6 months after the initial injection.

Results: Regarding the treatment arm using dextrose prolotherapy, the effect sizes compared with baseline were 0.65 (95% confidence interval [CI], 0.14-1.17), 0.84 (95% CI, 0.40-1.27), 0.85 (95% CI, 0.60-1.10), and 0.87 (95% CI, 0.53-1.21) after the first, second, third, and fourth or more injections, respectively. The overall effect of dextrose was better than control injections (effect size, 0.36; 95% CI, 0.10-0.63). Dextrose prolotherapy had a superior effect compared with local anesthesia (effect size, 0.38; 95% CI, 0.07-0.70) and exercise (effect size, 0.71; 95% CI, 0.30-1.11). There was an insignificant advantage of dextrose over corticosteroids (effect size, 0.31; 95% CI, -0.18 to 0.80) which was only estimated from one study.

Conclusion: Dextrose injections decreased pain in osteoarthritis patients but did not exhibit a positive dose-response relationship following serial injections. Dextrose prolotherapy was found to provide a better therapeutic effect than exercise, local anesthetics, and probably corticosteroids when patients were retested 6 months following the initial injection.

Keywords: dextrose; hand; knee; osteoarthritis; prolotherapy.

Figure 1

Flow diagram of the evaluation process for the inclusion or exclusion of studies. Adapted from Moher et al. Abbreviation: RCT, randomized controlled trial.

Figure 2

Forest plot of the effect of pain reduction from baseline after the first, second, third, and fourth or more injections. Abbreviations: ES, effect size; CI, confidence interval.

Figure 3

Forest plot of comparisons of the effect size between dextrose prolotherapy and the reference treatments: (A) the pooled result from four randomized controlled trials comparing dextrose with other injections; (B) the pooled result comparing dextrose and exercise; and (C) the subgroup analysis based on different comparative injectates and (D) the affected joints. Abbreviations: ES, effect size; CI, confidence interval; OA, osteoarthritis.