CLINICAL RESEARCH POSTER PRESENTATION ABSTRACTS
Please note: All posters will be displayed in
Salons 10-12.
FRIDAY, 10:15-11:00 AM
Glick R, Day R, Stone D, Cortazzo M.
Prolotherapy for the treatment of lateral epicondylitis.
University of Pittsburgh School of Medicine.
Center for Integrative Medicine at UPMC Shadyside
glickrm@upmc.edu
Lateral epicondylitis or tennis elbow can be a chronic
and disabling condition for athletes and workers and often defies conservative
medical approaches. Prolotherapy is an injection technique that can
be quite effective in treating ligament and tendon dysfunction, although
controlled clinical trials investigating this technique are few and
yield mixed results. The present pilot study seeks to determine the
feasibility and tolerability of prolotherapy in the treatment of lateral
epicondylitis, to determine if there is a trend towards efficacy, and
to determine treatment effect size for future power calculations.
Eight adult subjects with chronic lateral epicondylitis
were randomized to receive 3 injections over a 7 week period, with each
injection using 5 cc's of either a saline solution or 15% dextrose solution,
combined with 1% lidocaine, into the 3 most tender areas around the
enthesis at the lateral epicondyle area. Additionally, all subjects
were instructed on a stretching and strengthening program. Baseline
and outcome measures included: Pain severity rating from the McGill
Pain Questionnaire-Short Form (MPQ) consisting of 15 items rated 0-3
in intensity for a total possible score of 45; Physical Composite (PC)
and Mental Health Composite (MHC) scores on the SF-36 v.2; Physical
measures including dolorimetry and grip and wrist extension strength.
A physician, blind to the treatment assignment, performed the diagnostic
exam, instructed the subjects on the exercise program, and performed
the physical measures at baseline and end of treatment.
The primary outcome measure—MPQ scores, were
reduced from a mean of 11.75 at baseline to 4.0 at end of intervention
in the active group and from 6.5 to 5.75 in the control group. Given
the small sample size and moderate standard error, this resulted in
a p value of 0.086. The secondary measure of the PC score on the SF-36
also showed a trend towards treatment response with a p value of 0.051.
The MHC and physical measures including dolorimetry, grip strength,
and wrist extension strength did not show consistent trends. If one
looks at treatment response as a discrete outcome, as measured by a
50% or greater decrease in their pain score on the MPQ, 3 of 4 subjects
in the active group and 1 of 4 in the control group were considered
treatment responders. While this is well below significance on the Fisher's
Exact Test, this trend can be used for power calculations for conducting
a more definitive study.
This small pilot study shows a moderate trend suggesting
efficacy of prolotherapy in the treatment of lateral epicondylitis;
given the prevalence and associated impairment in vocational and avocational
activities, further research should be conducted into this potentially
useful and overlooked treatment modality.
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