Joint Injections for Osteoarthritic Knee Pain - Full Text View

Purpose

The purpose of this study is to determine whether prolotherapy (PrT), a therapy based on injection of a sugar solution in and around the knee, can decrease pain and disability from knee osteoarthritis (OA).

Condition	Intervention	Phase
Osteoarthritis	Procedure: Dextrose Prolotherapy Procedure: Saline Prolotherapy Other: At-home physical therapy exercise group	Phase I Phase II

MedlinePlus related topics:

Exercise and Physical Fitness Osteoarthritis

ChemIDplus related topics:

Sodium chloride Dextrose Lidocaine

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Placebo Control, Parallel Assignment, Efficacy Study

Official Title:	The Efficacy of Prolotherapy in Osteoarthritic Knee Pain

Further study details as provided by National Center for Complementary and Alternative Medicine (NCCAM):

Primary Outcome Measures:

Quality of life, pain scores and disability at wks 0, 5, 9, 12, 24, 52 [ Time Frame: Participants will be followed for one year. ] [ Designated as safety issue: No ]

Secondary Outcome Measures:

Secondary outcomes include disease and general quality of life indicators. [ Time Frame: Participants will be monitored for one year. ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	111
Study Start Date:	July 2004
Estimated Study Completion Date:	August 2009
Estimated Primary Completion Date:	August 2009 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental Subjects in Group 1 receive PrT with 15% and 25% dextrose solution, as it is generally practiced in the US today.	Procedure: Dextrose Prolotherapy Injection procedure: 50% dextrose is diluted with .9% 'normal' saline and 1% lidocaine to achieve 15% dextrose for ligament injections and 25% dextrose for intra-articular injection.
2: Placebo Comparator Subjects in Group 2 will receive the same treatment as Group 1, except that a 0.9% 'normal' saline solution with no known benefit will be used instead of dextrose.	Procedure: Saline Prolotherapy 7 mL 9% 'normal' saline and 3mL 1% lidocaine
3 At-home physical therapy exercises as a non-injection control	Other: At-home physical therapy exercise group Subjects in the at-home physical therapy exercise group will receive a patient information pamphlet about knee osteoarthritis and conservative care instructions for standard at-home physical therapy exercises

Detailed Description:

OA is a common, debilitating condition for which there is no cure and no known cause. Prolotherapy (PrT) is an injection-based therapy for chronic musculoskeletal pain in which an irritant solution is injected at painful ligaments and tendons to produce stronger connective tissue and decrease pain. Although limited studies suggest PrT is effective may be effective for low back pain, its use has not been rigorously studied in human clinical trials for osteoarthritis.

Participants in this study will be randomly assigned to receive one of three treatments: standard PrT, injections with a saline placebo, or a pamphlet with recommendations for home knee physical therapy. Injections will be given at Weeks 1, 5, and 9; injection group subjects will have the option to receive an additional 2 sets of injections. Participants will be assessed for a total of 1 year. A set of disease-specific and general quality-of-life questionnaires will be used to assess participants' outcomes. At study completion, participants who did not receive PrT will have the option to receive up to five sessions of PrT at no cost. Enrollment is limited to residents of Southern Wisconsin.

Eligibility

Ages Eligible for Study:	40 Years to 70 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Pain from knee osteoarthritis that has impacted life for 3 months to 10 years
X-ray results indicating knee osteoarthritis

Exclusion Criteria:

Knee osteoarthritis surgical candidate
History of total knee joint repair
Prior use of PrT
Prior fracture of the knee joint
Joint injection of steroids or other drugs within the past 3 months
Rheumatoid or inflammatory arthritis
Chronic use of narcotic medication
Other chronic pain diagnoses
diabetes mellitus
Body mass index (BMI) greater than 45
Unresolved litigation
Pregnancy
Co-morbidity that may interfere with the study

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00085722

Contacts


Contact: Jessica M. Grettie, BS	608-265-4200	jessica.grettie@fammed.wisc.edu

Contact: David P. Rabago, MD	608-265-2487	David.Rabago@fammed.wisc.edu

Locations


United States, Wisconsin
	Northeast Family Medical Center	Recruiting
	Madison, Wisconsin, United States, 53704
	Contact: David P. Rabago, MD 608-265-2487 david.rabago@fammed.wisc.edu
	Contact: Jessica M. Grettie, BS 608-265-4200 jessica.grettie@fammed.wisc.edu
	Principal Investigator: David P. Rabago, MD
	Sub-Investigator: Jeffery Patterson, MD
	University of Wisconsin General Clinical Research Center	Recruiting
	Madison, Wisconsin, United States, 53792
	Contact: David P. Rabago, MD 608-265-2487 david.rabago@fammed.wisc.edu
	Contact: Jessica M. Grettie, BS 608-265-4200 jessica.grettie@fammed.wisc.edu
	Principal Investigator: David P. Rabago, MD
	Sub-Investigator: Jeffery Patterson, MD

Sponsors and Collaborators

National Center for Complementary and Alternative Medicine (NCCAM)

Investigators


Principal Investigator:	David P. Rabago, MD	University of Wisconsin Dept of Family Medicine

More Information

University of Wisconsin Department of Family Medicine Web Site This link exits the ClinicalTrials.gov site

Publications:

Rejeski WJ, Ettinger WH Jr, Shumaker S, Heuser MD, James P, Monu J, Burns R. The evaluation of pain in patients with knee osteoarthritis: the knee pain scale. J Rheumatol. 1995 Jun;22(6):1124-9.

Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoarthritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med. 2000 Aug;6(4):311-20.

Eberle E, Ottillinger B. Clinically relevant change and clinically relevant difference in knee osteoarthritis. Osteoarthritis Cartilage. 1999 Sep;7(5):502-3. No abstract available.

Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993 Feb;6(1):23-33.

Ongley MJ, Klein RG, Dorman TA, Eek BC, Hubert LJ. A new approach to the treatment of chronic low back pain. Lancet. 1987 Jul 18;2(8551):143-6.

Dechow E, Davies RK, Carr AJ, Thompson PW. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999 Dec;38(12):1255-9.

Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2004 Jan 1;29(1):9-16; discussion 16.

Hackett GS, Hemwall GA, Montgomery GA. Ligament and Tendon Relaxation Treated by Prolotherapy. Fifth Ed. ed. Oak Park: Gustav A. Hemwall, 1993

Dorman TA. Prolotherapy: A survey. The Journal of Orthopaedic Medicine 1993;15(2):49-50

Reeves KD, Hassanein K. Randomized prospective double-blind placebo-controlled study of dextrose prolotherapy for knee osteoarthritis with or without ACL laxity. Altern Ther Health Med. 2000 Mar;6(2):68-74, 77-80.

Rogers WH, Wittink H, Wagner A, Cynn D, Carr DB. Assessing individual outcomes during outpatient multidisciplinary chronic pain treatment by means of an augmented SF-36. Pain Med. 2000 Mar;1(1):44-54.

Responsible Party:	University of Wisconsin Department of Family Medicine ( David Rabago, MD Assistant Professor )
Study ID Numbers:	K23 AT001879-01
First Received:	June 14, 2004
Last Updated:	August 11, 2008
ClinicalTrials.gov Identifier:	NCT00085722
Health Authority:	United States: Federal Government

Keywords provided by National Center for Complementary and Alternative Medicine (NCCAM):

Injection Therapy

Study placed in the following topic categories:

Musculoskeletal Diseases

Osteoarthritis

Joint Diseases

Arthritis

Lidocaine

Pain

Rheumatic Diseases

ClinicalTrials.gov processed this record on August 29, 2008

Sponsored by:	National Center for Complementary and Alternative Medicine (NCCAM)
Information provided by:	National Center for Complementary and Alternative Medicine (NCCAM)
ClinicalTrials.gov Identifier:	NCT00085722