The effect of dextrose prolotherapy on pain and functional outcomes in chronic shoulder pain: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Shoulder pain is a common musculoskeletal condition that substantially affects daily activities and work and imposes a considerable socioeconomic burden. Dextrose prolotherapy has been proposed as a regenerative intervention for musculoskeletal disorders, but previous reviews have primarily focused on specific shoulder conditions rather than chronic shoulder pain across different etiologies. This study evaluated the effects of dextrose prolotherapy on pain and functional outcomes in adults with chronic shoulder pain compared with control interventions. Methods: PubMed, ScienceDirect, and the Cochrane Library were searched on January 20, 2025. Three reviewers independently screened studies according to predefined eligibility criteria. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and pooled effects were estimated using standardized mean differences (SMDs). Results: Among 585 identified records, 12 randomized controlled trials were included in the systematic review, and seven were eligible for each quantitative synthesis. The overall pooled effect on pain was not statistically significant (SMD -0.19; 95% confidence interval [CI], -0.84 to 0.46). The pooled effect on functional outcomes was also not statistically significant (SMD -0.72; 95% CI, -1.85 to 0.41). Exploratory subgroup analysis suggested lower pain scores after repeated injections (at least three sessions; SMD -0.80; 95% CI, -1.26 to -0.35), whereas a single injection was associated with higher pain scores than control (SMD 0.60; 95% CI, 0.04 to 1.16). These subgroup findings were accompanied by substantial heterogeneity and were not derived from direct head-to-head comparisons. Conclusion: Current evidence does not demonstrate a statistically significant overall benefit of dextrose prolotherapy for pain or functional outcomes in chronic shoulder pain. Repeated injections may be associated with greater pain reduction than a single injection, but this exploratory finding requires confirmation in adequately powered, diagnosis-specific randomized trials using standardized injection protocols.

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