Prolotherapy treatment is sometimes referred to as ‘alternative’ treatment. This term generally describes a treatment for which there is not good scientific evidence. This is NOT the case for Prolotherapy. There is far more ‘scientific support’ for Prolotherapy than there is for Cortisone injections, for example, in terms of effectiveness. And there are several ‘head to head’ studies matching Prolotherapy with cortisone treatment. In all of these, Prolotherapy and cortisone both give symptom relief during the first six months. But when these studies are carried out to a year, Prolotherapy results continue, while cortisone results disappear. Even more importantly, when studies are carried out further, and where there is an ‘untreated’ group for comparison, cortisone-treated people begins to have MORE symptoms and WORSE symptoms than they would have had if NOTHING had been done. In other words, there is very good scientific evidence that cortisone makes you worse, long term, than you otherwise would have been. So, who is basing their treatment on ‘science’?
The main problem with Prolotherapy research is a somewhat technical question, but let me try to clearly describe it in brief: There have been hundreds of scientific papers documenting the beneficial effects and safety of Prolotherapy, but these have been ‘retrospective studies’ (my 1000 or 2000 patient experience), without a ‘control group’ of untreated patients, or patients treated with ‘placebo’ for comparison. Currently, such studies are not deemed ‘valid’, though most of our current medical techniques were developed based on precisely this kind of data. Until 2013, there were only five ‘controlled’ (with a ‘placebo’ group for comparison) Prolotherapy studies looking at large numbers of patients. The problem with these studies is that the ‘placebo’ was not actually ‘inactive’. In all of them, the ‘control’ group was actually given a treatment known to produce some level of healing (injecting ANY substance into a ligament or tendon will trigger healing to some degree, even ‘dry needling’ will do so, when nothing is injected. All you have to do is trigger bleeding in the structure with a needle.) So, while in each of these studies there was a ‘significant difference’ between the results of the Dextrose treatment that was being studied and symptoms in ‘untreated’ patients, AND ALSO a significant difference between the ‘placebo’ treated group and ‘untreated patients’, (since these were actually ‘effective’ treatments as well), but in each study NOT QUITE a significant difference between the results of the study drug (Dextrose) and the ‘placebo’, then the ‘conclusion’ of each study was that ‘Prolotherapy is no better than a placebo’. This is the only line in these studies read by the insurance companies and Medicare. But do you see the problem with this ‘conclusion’?
Currently, there are a number of small studies, and in 2014 a good study by Patterson and Rabago showing clear benefit of Prolotherapy in a good sized study of knee treatments that DID have a ‘control group’. While the scientific evidence continues to mount to support this treatment, I would not hold your breath on the insurance and medicare questions. There are a lot of forces that want to maintain the ‘status quo’, and there are no ‘monied interests’ that want to promote Prolotherapy treatment, or to fund research on this treatment.