Successful Treatment of Myofascial Pain Syndrome with Dextrose Prolotherapy: A Case Report

Case Diagnosis: Myofascial Pain Syndrome of the Low Back

Case Description or Program Description: A 45-year-old female with a history of complex regional pain syndrome (CRPS) of the left ankle from a military injury, fibromyalgia, depression, post-traumatic stress disorder (PTSD), and hypothyroidism presented with low back pain described as aching with periodic stabbing sensations and tightness. Initial treatments included modified activity, multimodal medications (tizanidine, gabapentin, methadone, ibuprofen, celecoxib, diclofenac), lidocaine patches, physical therapy, SI joint corticosteroid injection, and chiropractic care. On exam, she had reproducible trigger points in the bilateral iliolumbar, posterior sacroiliac, and multifidus muscles.

Given her refractory symptoms, she opted for dextrose prolotherapy with D5W, receiving three rounds at six-week intervals. A home exercise program was prescribed post-injection. She reported significant improvement and a return to her previous level of function.

Setting: Outpatient Interventional Pain Clinic

Assessment/Results: 3/27/24: D5W trigger point injections provided >50% pain relief, sustained for one month, with improved physical activity tolerance.
5/29/24: 70% improvement for six weeks, sustaining 50% relief at eight weeks but with diminishing efficacy.
9/4/24: 70% sustained improvement at eight weeks, increased physical activity, and high patient satisfaction.

Discussion (relevance): Disruptions in the fascial system are closely linked to musculoskeletal disorders, especially myofascial pain syndrome, underscoring its vital role in biomechanical stability and neuromuscular function. Dextrose prolotherapy may reduce facial and muscular tightness by modulating pain receptors and decreasing excessive acetylcholine release. Its hyperosmolar effect stimulates growth factors and improves circulation, promoting healing. Another potential mechanism of action is downregulation of inflammatory mediators, thus reducing neurogenic inflammation in chronic myofascial pain.

Conclusions: Myofascial dysfunction is an often-overlooked pain generator. This case highlights the efficacy of dextrose prolotherapy in reducing pain and restoring function. The patient’s positive response supports further investigation into prolotherapy as a treatment for myofascial pain syndrome.