What is the comparison between prolotherapy and ozone therapy for intra-articular (within a joint) injections?

From the Guidelines

Prolotherapy is conditionally recommended against in patients with knee and/or hip OA, according to the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1.

Key Considerations

• The choice between prolotherapy and ozone therapy should be based on the specific joint condition, availability of experienced practitioners, and patient preference.
• Prolotherapy is generally more established in Western medicine and involves injecting an irritant solution into the joint or surrounding ligaments to stimulate a healing response.
• Ozone therapy, meanwhile, involves injecting a mixture of oxygen and ozone gas into joints, which is thought to reduce inflammation, improve oxygenation, and have antimicrobial properties.
• A typical prolotherapy protocol involves injections every 2-4 weeks for 3-6 sessions, while ozone therapy usually requires 3-5 weekly sessions.
• Both treatments may cause temporary pain and swelling at injection sites.

Evidence-Based Recommendations

• The 2019 American College of Rheumatology/Arthritis Foundation guideline conditionally recommends against prolotherapy in patients with knee and/or hip OA due to limited evidence of benefit and variability in injection schedules, sites, and comparators 1.
• The guideline also strongly recommends against hyaluronic acid injections in hip OA and conditionally recommends against them in patients with knee and/or first CMC joint OA 1.
• The European League Against Rheumatism (EULAR) recommendations for intra-articular therapies emphasize the importance of patient-centered outcomes, effective communication, and consideration of contextual factors in the decision-making process 1.

From the Research

Prolotherapy for Intra-Articulation Joints

• Prolotherapy is a technique that involves the injection of an irritant, usually a hyperosmolar dextrose solution, to treat chronic painful musculoskeletal conditions, including intra-articulation joints 2.
• The goal of prolotherapy is to stimulate growth factors that may strengthen attachments and reduce pain in conditions such as osteoarthritis, low back pain, and tendinopathies 3.
• Prolotherapy has been shown to be effective in treating various musculoskeletal conditions, including lateral epicondylosis, rotator cuff tendinopathy, plantar fasciitis, Achilles tendinopathy, and sacroiliac joint pain 3.

Comparison with Ozone Therapy

• There is limited direct comparison between prolotherapy and ozone therapy for intra-articulation joints in the provided studies.
• However, prolotherapy has been compared to other treatments, such as lidocaine injection, and has shown significant improvement in pain and dysfunction in conditions like temporomandibular dysfunction 4.

Efficacy of Prolotherapy

• Moderate evidence suggests that prolotherapy is safe and can help achieve significant symptomatic control in individuals with osteoarthritis, with significant improvement in scores for pain, function, and range of motion 5.
• Prolotherapy has been shown to be beneficial in a variety of different musculoskeletal conditions, with high patient satisfaction and minimal adverse events 4.
• Further research is needed to standardize treatment protocols and provide basic science evidence for the use of prolotherapy in treating intra-articulation joints 5.