Authors (including presenting author) :
Law MS (1), Carmen Chan (1), Chan OL (1), Chan CW (1)
Affiliation :
(1) Pain Management Unit, Department of Anaesthesiology & Operating Services, Kwong Wah Hospital
Introduction :
OA knee joint pain is the second most common musculoskeletal pain. Among those age > 65 every 2 out of 5 experienced chronic knee pain. There was a long waiting list before TKR could be offered in HK. At the same time adults with joint pain is known to have difficulty with basic activities, such as movement and sensory, emotional, and mental functioning, or have limitations in complex activities that include full participation in social, occupational, and household functioning.
Prolotherapy has been used in clinical practice for more than 80 years to treat various chronic musculoskeletal conditions. Dextrose solution is one of the commonest agent for prolotherapy. It is readily available and affordable public system. Systemic review show strong Level 1 evidence that patients with OA knee, results in significant sustained improvement, including reduction of pain and function.
The mechanism of action behind however is not completely understood. Yet experimental studies have shown the positive effect of hypertonic dextrose in promoting direct intracellular expression of growth factors in tenocytes and fibroblasts. And therefore Dextrose prolotherapy may benefit those with OA knee through the stabilization of interarticular ligaments, promoting articular cartilage recovery and improvement in range of motion.
Reference:
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016 Jul 7;9:139-59
Objectives :
To provide a local audit data on the effectiveness of Dextrose prolotherapy on patient with chronic OA knee pain.
Methodology :
All patient with Chronic OA knee pain consented to have Dextrose prolotherapy were recruited for outcome measure before intervention up to 6 months post intervention.
Outcome data:
1.Pain Severity in Brief Pain Inventory (BPI),
2.Pain interverence in Brief Pain Inventory (BPT),
3.Pain Self Efficacy Questionnaire (PSEQ);
were measured from pre-intervention and post-intervention at 1,2,3,4,5,6 months
Result & Outcome :
Demographic data:
1. 13 cases has completed the 6 months follow up between the period 1/3/2024 to 31/12/2024
2. Female 12, Male 1
3. Age: 44 – 85 yrs old, average 67.2 years old
Result
1. The BPI pain severity score reduced at 1 month post intervention from 5.3 to 4 (P= 0.006).
2. There was no significant change in pain severity on subsequent follow up beyond the first month up to 6 months post intervention.
3. There was no significant change in PSEQ, Pain interference on the all the follow up time points up to 6 months post intervention.
4. There was a trend of deterioration in Pain Severity/ Pain interference/ PSEQ but not up to statistical significant
5. The BPI on work was worsen on post intervention 5 and 6 months.
6. The response rate was about 50% i.e. the patient reported to have >30% pain reduction post-intervention
