There is no proven evidence of its effectiveness, except what the placebo effect may produce

Thank you for your remark. I have had a few intersting cases, and the injections needt o be repeated on a weekly basis. So I wonder if someone can do a controlled study? RCT s are defintely needed, of course. Unfortuntaely, dextrose 5% is cheap and cannot be patented, so it will be hard to find sponsorship. Yet it is safe and easy to apply. What I have found so far:

Over the last decade, low concentrations of glucose 5% (or dextrose 5%) have become more popular ([i], [ii], [iii], [iv], [v], [vi], [vii]). Clinical experience indicates that glucose 5% injections may be effective for the management of a variety of musculoskeletal conditions, particularly in a subgroup of patients who may respond positively to this approach. Originally, such injections were given subcutaneously along the Achilles tendon ([viii]) because that approach was less painful than conventional prolotherapy which uses deep injections to entheses at the periost. In contrast to hypertonic solutions, adding local anesthetics is not necessary. These glucose 5% injections can be administered into the dermis (ID), into muscles (IM), around tendons (PT), and into ligaments (IL). Although less common, one can also apply glucose injections adjacent to peripheral nerves ([ix]), into the epidural liquid ([x]), and into joint cavities.

[i] Maniquis-Smigel L, Reeves KD, Rosen JH, et al. . Short term analgesic effects of 5% dextrose epidural injection for chronic low back pain. A randomized controlled trial. Anesth Pain Med 2017;7:e42550.

[ii] Köroğlu, Özlem & Orscelik, Aydan & Karasimav, Özlem & Demir, Yasin & Solmaz, İlker. (2019). Is 5% dextrose prolotherapy effective for radicular low back pain? Gulhane Medical Journal . 2019, Vol. 61 Issue 3, p123-127. 5p.

[iii] Lyftogt, John. (2007). Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain. Australasian Musculoskel Med. 12. 107-109.

[iv] Weglein, AD. Neural Prolotherapy. Journal of Prolotherapy. 2001;3(2):639-643

[v] Paprottka KJ, Lehner A, Fendler WP, et al. Reduced periprocedural analgesia after replacement of water for injection with glucose 5% solution as the infusion medium for 90Y-Resin microspheres. J Nucl Med. 2016;57(11)(1679-1684).

[vi] Mansız-Kaplan B, Nacır B, Pervane-Vural S, Genç H. Pain relief in a patient with snapping scapula after 5% dextrose injection. Turk J Phys Med Rehabil. 2020 Aug 18;66(3):368-369. doi: 10.5606/tftrd.2020.4169. PMID: 33089095; PMCID: PMC7557628.

[vii] Solmaz İ, Akpancar S, Örsçelik A, Yener-Karasimav Ö, Gül D. Dextrose injections for failed back surgery syndrome: a consecutive case series. Eur Spine J. 2019 Jul;28(7):1610-1617. doi: 10.1007/s00586-019-06011-3. Epub 2019 May 21. PMID: 31115685

[viii] Lyftogt J. Subcutaneous prolotherapy for Achilles tendinopathy: The best solution? Australasian Musculoskeletal Medicine, 2007

[ix] García-Triana SA, Toro-Sashida MF, Larios-González XV, Fuentes-Orozco C, Mares-País R, Barbosa-Camacho FJ, Guzmán-Ramírez BG, Pintor-Belmontes KJ, Rodríguez-Navarro D, Brancaccio-Pérez IV, Esparza-Estrada I, Bernal-Hernández A, González-Ojeda A. The Benefit of Perineural Injection Treatment with Dextrose for Treatment of Chondromalacia Patella in Participants Receiving Home Physical Therapy: A Pilot Randomized Clinical Trial. J Altern Complement Med. 2020 Nov 20. doi: 10.1089/acm.2020.0287. Epub ahead of print. PMID: 33217236.

[x] Maniquis-Smigel L, Dean Reeves K, Jeffrey Rosen H, Lyftogt J, Graham-Coleman C, Cheng AL, Rabago D. Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial. Anesth Pain Med. 2016 Dec 6;7(1):e42550

Dear Dr Gala Francisco Javier Gala , I am very curious to see the study which says that the effect of Glucose 5% is only placebo. What was the control group like? We know that dry neelding and water injections also have temporary pain modulating effects (e.g., gate control), so designing a control group is very challenging. Especially when the skills of the physician when it comes to inject the right spots can be crucial to achieve good outcomes. Thank you for your interest. Jan Kersschot

Hello Tony Hall

Thank you for your reply. I am aware of the clinical experience in Australia and New Zealand (Dr Lyftogt) and Turkey with glucose 5% injections. I have added a few more of these publications in my articles and in my ebook (download free).

I was trained in 'real' prolotherapy by prof Patterson (Wisconsin). As the word prolotherapy originates from "proliferation", we believe it is better to reserve the term "prolotherapy" exclusively for injections with hyperosmolar solutions which create cell destrucion, an inflammatory reaction and subsequent reaction proliferation, as was seen with Phenol and sodium morrhuate in the old days (Hackett and Hemwall prolotherapy) and later on with hypertonic dextrose prolotherapy (HDP), where dextrose of 10% or 15% is used.

However, when dextrose 5% is injected, this solution is no longer hyperosmolar and doesn't evoke any inflammatory response. It cannot be used to shorten the ligaments or bands, which we can with "real" prolotherapy which is injected mainly near entheses of tendons and ligaments. The mechanism of action must be different. The "ATP hypothesis" of glucose 5% still needs to be proven. I hope you coud help us witht hat (see e-book).

Anyway, the term prolotherapy should not be used for glucose 5% solutions. We use the new term "glucotherapy" for that reason. It is also easier for the general public to remember this term. Glucotherapy is described as 5% sugarwater injections intradermally (SC and IC), im in muscular pain points and trigger points, in or near tendons and into ligaments.

There is also PIT, which is perineural injections of glucose 5% close to peripheral nerves. Some authors also inject glucose 5% into joint cavities and epidurally. These techniques all seem effective but are more sophisticated (require training or hospital environment). Glucopuncture is designed to be applied in private practices in the field. We also believe that it will be a good treeatment for musculoskeletal pain in low income countries.

More and more doctors are surprised how G5% can be so clinically efficient when it comes to pain modulation. The down side is that repetition is required, usually weekly sessions.

See also www.glucopuncture.com for free e-book

Controversy exists in the literature relating to its efficiency and safety.

Hi Tony, glucose 5% injections is surely 'softer' than corticosteroid injections, although several controlled studies on cortisone injections only show symptom suppression in the first weeks but no difference with placebo after a few months.

For fresh injuries, one needs only one or two sessions of glucose 5% injections, when dealing with pain which is there for months or years, usually between 3 and 10 sessions are required. So in that sense it is a bit softer like e.g., physiotherapy and exercises, but it is a completely different approach than acupuncture or massage. SOme patients seem to repsond well, others don't. We have to keep in mind that even water injections have short term pain modulating effects.

Anyway, I am not here to prove which therapy is the better one, I believe it depends on the individual case. But I am interested in knowing how glucose 5% injections can be modulating pain when injecting them intradermally, without adding local anesthetics. Even in cases with perssistent pain.

probably work as placebo effect

We notice two effects: gmlucose related effects, probably through ATP which provides energy (details in the book and articles about Glucopuncture)

and the nonspecific effects, such as needle effect, volume efect, bleeding effect and placebo effect.

These nonspecific effects are not exclusoive for G5W, of course

See also www.glucopuncture.com

Dear Dr. Jan Kersschot, at no time have I said anything about control groups or similar; I wanted to refer, and sorry if I have not been able to explain myself well, that, since there is no scientific evidence about its analgesic efficacy, and I have read enough about it, its supposed efficacy - which I am not saying does not exist - can be explained by the Placebo effect that, as we all know, is universal ... but in the case of pain even more and precisely by the three dimensions, according to the Model of the key or gate, which interact in it: Sensory / Discriminatory, Motivational / Affective and Rational / Cognitive; In this sense, and more succinctly, I therefore share what Dr. Shalendra Singh. Thanks you.

No,evidence proved that

Hello Francisco,

Thank you for your reply. I agree totally with what you write in your answer. Thank you.

And yes: the placebo is certainly part of it, as it is with cortisone injections, hyaluronic acid injections or PRP injections. It si unavoidable.

I am only curious how Glucose 5% seems to add an additional effect we don't see with procaine injections or cortisone injections. I am simply curious and am looking for a scientific explanation. I believe the ATP hypothesis makes sense, but we still need more research. That is why I am here to ask for that.

Are you familiar with this study?

Maniquis-Smigel L, Reeves KD, Rosen JH, et al. . Short term analgesic effects of 5% dextrose epidural injection for chronic low back pain. A randomized controlled trial. Anesth Pain Med 2017;7:e42550

In this article, the specific effects and the nonspecific effects are described briefly.