Original Title: Efficacité et innocuité de la prolothérapie dans le traitement de la douleur musculosquelettique chronique

Authors' objectives: duction Musculoskeletal system disorders may be the source of chronic pain. These conditions and the resulting pain represent a major public health issue as they have considerable consequences on different aspects of the lives of those affected. The problem is also on the increase as the population ages. Considered a modality of regenerative medicine, prolotherapy is a non-surgical treatment aimed at alleviating certain types of chronic or persistent musculoskeletal pain in people who are refractory to conventional treatments. Prolotherapy involves injecting an irritant solution - often dextrose - into joints or fibrous tissue. Although not covered by Quebec's public insurance plan, this intervention has gained in popularity over the past 10 years, and the Collège des médecins du Québec (CMQ) asked the Institut national d'excellence en santé et en services sociaux (INESSS) to evaluate prolotherapy's efficacy and safety in the treatment of chronic musculoskeletal pain. The present work is intended as an update of the literature since the publication of a 2013 report concluding that, overall, the evidence from the selected randomized clinical trials did not support the use of prolotherapy for the musculoskeletal conditions examined.

Authors' results and conclusions: RESULTS (#1 NO CLINICAL PRACTICE OF PROLOTHERAPY TO RELIEVE CHRONIC MUSCULOSKELETAL PAIN IS RECOGNIZED BY SCIENTIFIC ORGANIZATIONS OR LEARNED SOCIETIES): None of the eight selected documents (guidelines or position statements) mentioning prolotherapy as an intervention to treat chronic musculoskeletal pain aims to specifically frame the use of prolotherapy. (#2 EVIDENCE ON THE EFFECTIVENESS OF PROLOTHERAPY AND ITS POSITIVE IMPACT ON QUALITY OF LIFE IS INSUFFICIENT TO DRAW CLEAR CONCLUSIONS): Analysis of the 50 comparative primary studies shows considerable heterogeneity in prolotherapy practice and methodology, and consequently in pain and functional outcomes. • Reliable, objective data on the impact of prolotherapy on the quality of life are rarely reported. • Some authors highlighted significant benefits of prolotherapy in some comparative analyses, particularly when compared to saline injections and interventions associated with physical exercises, but these effects are not reproducible between studies, and a placebo effect cannot be excluded.(#3 PROLOTHERAPY'S SAFETY CANNOT BE EVALUATED, AS IT HAS NOT BEEN SYSTEMATICALLY AND RIGOROUSLY STUDIED): Very few studies were designed to examine safety or presented detailed data on the adverse effects of prolotherapy. • The most commonly reported adverse effect is transient pain at the injection site and, as such, prolotherapy is considered a safe intervention by some authors of randomized clinical trials. • However, there is a risk of under-reporting of adverse events, since no rigorous methodology for collecting data and presenting safety results is described in the studies selected. CONCLUSION: The literature review shows that no clinical practice of prolotherapy to relieve chronic musculoskeletal pain related to the various disorders examined, which is supported by a high level of evidence, is recognized by scientific bodies or learned societies. Overall, the majority of studies reviewed lack clarity and important methodological details, and the available evidence on the effectiveness of prolotherapy is based on a diversity of protocols, comparators, and evaluation methods, and such evidence is not reproducible between studies. The various results examined do not allow us to conclude that prolotherapy is clinically effective in relieving pain or improving people's functional level. Moreover, few reliable and objective data are available to support the impact of prolotherapy on quality of life. Furthermore, prolotherapy's safety cannot be established in the absence of rigorous studies on the subject, although the main adverse effects reported generally appear to be minor. Further high-quality studies will be required to determine the efficacy and safety of this therapeutic modality for the management of chronic musculoskeletal pain.

Authors' methods: A rapid review2 of systematic reviews, randomized clinical trials, before-and-after comparative studies and non-comparative studies was conducted to document the study parameters, namely the efficacy, impact on quality of life, and safety of prolotherapy for relieving chronic musculoskeletal pain. A narrative review of the scientific and grey literature was also conducted to identify practice guides, guidelines, and other framework documents that make recommendations or propose positions relating to prolotherapy. Scientific and grey literature were identified in several databases. Documents were selected according to predefined inclusion and exclusion criteria (PICOS model). The extracted data were analyzed and presented as narrative synthesis and tables of results for each of the evaluation questions. Findings were formulated considering the evaluation of the methodological quality of the studies, the consistency of the results derived from these studies, and the biases raised by the authors.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/efficacite-et-innocuite-de-la-prolotherapie-dans-le-traitement-de-la-douleur-musculosquelettique-chronique.html

Year Published: 2024

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/efficacite-et-innocuite-de-la-prolotherapie-dans-le-traitement-de-la-douleur-musculosquelettique-chronique.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)