{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T17:16:33Z","timestamp":1777742193862,"version":"3.51.4"},"reference-count":62,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Chronic low back pain with associated leg pain (CLBP\u2010L) (whether referred or radiating) is a common, debilitating, and expensive condition. Epidural steroid injections (ESI) are commonly used, although effectiveness is often limited. Dextrose prolotherapy injections (DPT) are a potential alternative treatment to address the biomechanical and neurological causes of CLBP\u2010L.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the effectiveness of DPT compared with ESI for CLBP\u2010L.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Pragmatic unblinded, randomized controlled trial.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Outpatient pain clinic; ESIs were performed in an operating room, DPT in a clinic procedure room.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n Adults aged between 18 and 90 years with at least 12\u2009weeks of CLBP\u2010L, and at least 6 on a 0\u201310 point leg pain severity numerical rating scale (NRS).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Up to three monthly injections for ESI participants; up to five monthly treatments for DPT participants.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Least square mean (LSM) analysis of NRS 0\u201310 point pain scale (primary) and Oswestry Disability Index (secondary) at 1, 3, 6, and 12\u2009months after treatment completion, using intention to treat analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n One hundred twelve participants were enrolled; eight withdrew from the study before receiving therapy; 104 participants (53% female; 58 15\u2009years old; body mass index 28\u2009\u00b1\u20095\u2009kg\/m\n 2<\/jats:sup>\n , with 19 23\u2009months CLBP\u2010L) were randomized (55 DPT, 49 ESI) and analyzed. No baseline differences existed between groups. DPT outperformed ESI in LSM pain scores at 6 (5.1\u2009\u00b1\u20090.7 vs. 7.2\u2009\u00b1\u20090.75 points;\n p<\/jats:italic>\n \u2009<\u2009.001) and 12 m(5.2\u2009\u00b1\u20090.7 vs. 6.9\u2009\u00b1\u20090.7 points;\n p<\/jats:italic>\n \u2009=\u2009.001) months. Function score LSMs also favored the DPT group at 6 (33\u2009\u00b1\u20095 vs. 45\u2009\u00b1\u20094.5 points;\n p<\/jats:italic>\n \u2009<\u2009.001) and 12\u2009 (34\u2009\u00b1\u20094.5 vs. 42\u2009\u00b1\u20095 points;\n p<\/jats:italic>\n \u2009=\u2009.012) months. There were no adverse events.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n For participants with CLBP\u2010L, DPT resulted in statistically significant and clinically meaningful improvement of pain and function compared with ESI at 1\u2009year after treatment completion. DPT may be an appropriate alternative for patients with CLBP\u2010L.<\/jats:p>\n <\/jats:sec>\n \n Clinical Trials<\/jats:title>\n NCT01934868, registered on August 30, 2013.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/pmrj.70136","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T11:31:33Z","timestamp":1777462293000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prolotherapy versus epidural steroid injections for lumbar pain with associated leg pain: A pragmatic randomized controlled trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1384-2130","authenticated-orcid":false,"given":"Osnat","family":"Wende","sequence":"first","affiliation":[{"name":"Department of Anesthesia (Specialist in Pain Relief Medicine) Hadassah Hebrew University Medical Center Jerusalem 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Rabago","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine Penn State College of Medicine Hershey Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1186\/s12891-016-1110-z","article-title":"Implementation interventions to improve the management of non\u2010specific low back pain: a systematic review","volume":"17","author":"Mesner SA","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"e_1_2_12_3_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.pain.2009.08.020","article-title":"On the definitions and physiology of back pain, referred pain, and radicular pain","volume":"147","author":"Bogduk 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