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October 15, 2012
8:00:00 AM - 11:00:00 AM
Room Hall C-Area A
Efficacy of Prolotherapy Versus Corticosteroid for Patients With Myofascial Pain Syndrome: A Retrospective Comparative Study
Billy K. Huh, M.D.,Ph.D., Hsiang H. Kung, M.D., Lance Roy, M.D.
Duke University Medical Center, Durham, North Carolina, United States
Background: Prolotherapy involves injection of an irritant, usually a dextrose based compound, into painful soft tissues. In theory the injection begins a controlled inflammatory response. This in turn causes connective tissue growth and collagen tissue formation resulting in a more stable, less painful joint or strengthened tendons or ligaments. However the therapy remained somewhat controversial and efficacy remains elusive since most studies used wide variety of compounds and also in the presence of co-interventions which also demonstrated efficacy. In this retrospective study we have compared the efficacy of prolotherapy versus steroid injection for patients with myofascial pain syndrome (MPS).

Methods: Eighty-eight consecutive patients (59 steroid injections, 29 prolotherapy) with diagnosis of MPS who received trigger point injection (TPI) from Duke pain clinic between January 2005 to February 2012 were reviewed. Exclusion criteria include patients with unmanaged coexisting non-myofascial pain. Patients were treated with either a proliferant solution containing a mixture of 3:1 ratio of 20% Dextrose and 1% lidocaine or mixture of 20 mg methylprednisolone in 4ml 1% lidocaine. The prolotherapy group received biweekly injection as needed. Steroid group received up to 2 injections. Outcome measure included pain severity (PS) from brief pain inventory (BPI). The change in PS before and after treatment was evaluated for significant decrease within each treatment group using paired t-tests and compared between groups using a two-group t-test. All tests were 2-tailed. Failure to decrease PS after two injections was considered non-responder.

Results: The response rate of treatment was 66.7% for prolotherapy and 74.1% for steroid group (p=0.98). In prolotherapy group, PS decrease from 6.59±1.88 to 4.06±2.13 in 4 weeks (p=0.027). The steroid group, PS decreased from 6.86±2.13 to 4.41±3.10 (p=0.001) in 4 -8 weeks. The decrease in pain score was significant within each group (p < 0.001).

Conclusion: Both groups provided significant pain relief for patients suffering from MPS. Dextrose prolotherapy appears to be a safe and effective method for treating MPS. Patients with contraindication for steroid injection may be treated with prolotherapy. Small sample size precludes determining whether one therapy is superior to the other. Prospective, randomized studies with a larger sample size are warranted.
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