Dextrose Prolotherapy หรือ DPT (การฉีดสารละลายกลูโคส) Ep. 3

Glucose Prolotherapy Part 3

Back pain is a common condition, particularly among the elderly. It can originate from muscles, tendons, nerves, joints, intervertebral discs, or it might not have a clearly identifiable cause. The pain is often chronic, lasting for months or years, significantly impacting daily functioning and quality of life.

Currently, glucose solution is used in the treatment of back pain caused by nerve issues through a technique known as Perineural Injection Therapy.

In 2016, a study by Liza et al1. examined 32 patients with moderate to severe chronic back pain with non-surgical indications. The participants were divided into two groups: Group 1 received glucose caudal epidural injection, while Group 2 received saline caudal epidural injection. Pain levels were monitored, and results showed that the glucose group experienced a significant reduction in pain, from an initial pain score of 6 to 1.7 four hours after injection. This difference was statistically significant (p < 0.001) compared to the saline group. Additionally, 16 out of 19 patients (84%) in the glucose group reported more than 50% pain reduction four hours post-injection.

 

In 2018, Liza and colleagues2 conducted a follow-up study where glucose solution was injected into epidural space every two weeks for a total of four sessions. It was observed that each injection progressively reduced pain, with the initial pain score of 6.5 decreasing to about 3 after one year. Moreover, 21 out of 32 patients (66%) in this study experienced more than 50% pain reduction.

  
Currently, ultrasound technology is used to improve the accuracy of needle placement during the caudal epidural injection, reducing the risk of misplaced injections and minimizing exposure to X-rays for patients. This advancement enhances the effectiveness and safety of the procedure. However, risks such as infection and bleeding may still occur, so it is essential to perform the procedure with sterile equipment and proper technique to minimize potential complications.

Therefore, glucose caudal epidural injection with ultrasound guidance is an intriguing option for patients with chronic back pain who have failed conventional physical therapy.

                                                                    The image shows a caudal epidural injection performed under ultrasound guidance.

 

Reference

1.    Maniquis-Smigel L, Dean Reeves K, Jeffrey Rosen H, Lyftogt J, Graham-Coleman C, Cheng AL, Rabago D. Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial. Anesth Pain Med. 2016 Dec 6;7(1):e42550. doi: 10.5812/aapm.42550. PMID: 28920043; PMCID: PMC5554430.

2.    Maniquis-Smigel L, Reeves KD, Rosen HJ, Lyftogt J, Graham-Coleman C, Cheng AL, Rabago D. Analgesic Effect and Potential Cumulative Benefit from Caudal Epidural D5W in Consecutive Participants with Chronic Low-Back and Buttock/Leg Pain. J Altern Complement Med. 2018 Dec;24(12):1189-1196. doi: 10.1089/acm.2018.0085. Epub 2018 Jun 8. PMID: 29883193; PMCID: PMC6308281.