7496390_sThe current study shows that prolotherapy with hypertonic dextrose or prolozone (intraarticular ozone injection) can be effectively used in the nonoperative management of patients with KOA. Prolotherapy is an injection therapy for the management of chronic musculoskeletal disorders such as KOA (10). Although prolotherapy is being increasingly used worldwide, its mechanism of action in pain relief is not yet clearly understood. Several mechanisms have been proposed, such as accelerating the healing process of damaged tissue (10, 11), releasing growth factors (14-16), having a positive effect on the nociceptive system (33), and the effect of needle insertion and volume enhancement (34). Reeves and Hassanein found that prolotherapy with 10% dextrose resulted in significant pain relief, decrease in knee swelling, decrease in bulking episodes, and improvement in the knee range of motion. They also found, on the basis of radiographic images, that prolotherapy was associated with improvement in OA severity. In recent years, the treatment of several musculoskeletal disorders with ozone has increasingly attracted attention. Ozone is a toxic and soluble gas with high oxidative activity (35). Ozone has an antinociceptive effect with several mechanisms (35, 36). Paoloni et al. treated patients with lumbar disc herniation by using intramuscular oxygen-ozone injection. They observed that 61% of the patients became pain free compared with 33% of the control group (30). Li et al. and Mishra et al. reported improved function and decreased pain intensity after intraarticular injection of ozone in patients with KOA (24, 25). To our knowledge, there is no study comparing the effects of prolotherapy with hypertonic dextrose and injection of ozone. Therefore, it is possible to compare the outcomes of the current study with those of others. However, our findings confirmed the outcome of previous studies indicating the pain killing and therapeutic effects of prolotherapy with ozone or dextrose. In our study, the pain intensity was significantly reduced after the treatment. However, there was no statistically significant difference between the two groups. We believe that our study is limited by the small sample size; if more patients were investigated, it is possible that we could have found some differences between the two groups. In addition, we only investigated the short-term results; mid-term and long-term follow-up are required.

Hashemi M, et al. (2015). The effects of prolotherapy aith hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesth Pain Med. 5(5). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644302/.

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