Effectiveness and safety of dextrose prolotherapy for chronic spinal pain: A systematic review

Chronic spinal pain markedly impairs function and quality of life. Dextrose prolotherapy is a potential treatment thought to induce a controlled inflammatory response, promote connective-tissue repair, enhance spinal stability, and modulate nociceptive signaling. This systematic review synthesised current evidence on its effectiveness and safety. A systematic search was performed in PubMed, ScienceDirect, SpringerLink, and the Cochrane Library up to June 2025. Eligible studies included randomized controlled trials (RCTs), prospective cohort studies, and prospective case series (≥10 patients) reporting outcomes on pain, physical function, quality of life, or adverse events. Risk of bias was assessed using Joanna Briggs Institute tools for nonrandomized studies and the Cochrane Risk of Bias 2 tool for RCTs. Twelve studies were included (six case series, two cohort studies, one quasi-experimental study, and three RCTs), involving chronic low back pain, sacroiliac joint pain, discogenic pain, coccydynia, failed back surgery syndrome, and lumbar disc herniation. Most studies reported pain reduction; intra-articular injections of 25%-50% dextrose were associated with analgesia lasting 6-24 months, whereas 5% epidural dextrose provided rapid relief in radicular pain. Improvements in physical function and quality of life were also reported, with no major complications. Overall, dextrose prolotherapy appears safe and potentially effective for chronic spinal pain, particularly in refractory cases, although outcomes may depend on patient selection, dextrose concentration, and injection technique.