Higher concentration of dextrose more than 5% induced cell apoptosis. comparing different concentrations and combinations of dextrose solutions in prolotherapy. Notable progress made was via an i n vitro study done by Woo et el. The ideal dextrose concentration in prolotherapy injections is still under investigation. 6 However, recent research in animal models has suggested that dextrose also stimulates proliferation via non-inflammatory mechanisms, as described later in this section. It is also called regenerative injection therapy or proliferative therapy and involves the injection of dextrose into a joint, muscle, tendon, or other soft tissue area where it classically has been described as acting as an irritant to induce a local inflammatory response that triggers the natural healing cascade (proliferative phase of tissue repair). Prolotherapy has been used in clinical practice since the 1950s and is supported by the strongest body of clinical evidence. The focus in this article is discussion of the evolving evidence base underpinning the therapeutic injection of dextrose. Prolotherapy, PIT, and hydrodissection are supported for specific indications by a growing body of literature. Acquisition of these procedural skills is sometimes through formal medical training, but more often in continuing medical education contexts. 4Įach modality is in use as outpatient therapy in the U.S. Hydrodissection: Dextrose is injected adjacent to peripheral nerves with continuous ultrasound guidance to release peripheral nerves from their encasing fascia in order to provide a decompressive effect.5 The purported mechanism is associated with a sensorineural effect. Perineural injection treatment (PIT): The injection of dextrose adjacent to peripheral nerves to reduce neuropathic pain.3 The purported mechanism focuses on proliferative repair. Prolotherapy: Injection of hypertonic dextrose to treat chronic musculoskeletal pain.3,4Ĭlinical trials have assessed three distinct therapeutic dextrose-related modalities and reported positive clinical effects compared with blinded injection controls. Hypothesized mechanisms and clinical trials suggest injection with dextrose has the potential to 1) slow, halt or even reverse degenerative changes in ligaments, tendons, and joints, 2) simultaneously localize and treat primary nociceptive sources by precise diagnostic injection, 3) reduce peripheral sensitization in neuropathic pain, and 4) directly release nerve entrapment and reduce neurogenic inflammation without risk of anesthetic toxicity. Therapeutic injections with dextrose are increasingly used for this purpose.īasic science and clinical research suggest several ways in which dextrose can reduce pain, improve overall function, and restore connective tissue function. National organizations have therefore called for new treatments of chronic pain and musculoskeletal conditions, including therapy that addresses the underlying pain pathology. Musculoskeletal conditions can significantly limit function and are the leading cause of disability. 2 In addition the World Health Organization reports 1.71 billion people with musculoskeletal conditions worldwide. The prevalence of chronic pain among adults in the US is 20.4%, 1 a concomitant opioid epidemic and subsequent opioid-related deaths have created a national emergency.
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