Treatment of Referred Back Pain using Fascial Dextrose 5% Injections: A Case Report
Main Article Content
Abstract
The fascial system represents an intricate network within the human body, comprising both superficial and deep layers. Regional fascial dysfunctions can be related to overuse, trauma, stress and posture. Fascial dysfunction has been associated with both diminished range of motion as well as regional pain. Unfortunately, such tiny fascial lesions are not visible on ultrasound or MRI. Glucopuncture, a nonsteroidal injection technique, involves the administration of sugar water injections such as dextrose 5% (or glucose 5%) to treat regional pain and musculoskeletal dysfunction. This article is both a case report and a brief review article. It presents a patient with vague low back pain who received subcutaneous injections in the dorsal midline fascia. He experienced significant pain relief in the low back without receiving injections in the pain region itself. This clinical case highlights the potential of glucopuncture as a simple and safe method for modulating referred pain. This article also presents the interstitium as a potential way to explain the clinical outcome of this case. The difference between Glucopuncture and other nonsteroidal injection procedures is also discussed. This article makes also clear that further research is necessary to fully ascertain the efficacy and safety of intrafascial injections with dextrose 5% or glucose 5% for treating referred pain in the back.
Keywords:
Referred Pain, Fascia, Glucopuncture, Biotensegrity, Musculoskeletal Pain, Interstitium, Neuraltherapy, Biopuncture, Prolotherapy, PIT, TLA, Low Back Pain
Article Details
How to Cite
KERSSCHOT, J et al.
Treatment of Referred Back Pain using Fascial Dextrose 5% Injections: A Case Report.
Medical Research Archives, [S.l.], v. 13, n. 5, may 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6560>. Date accessed: 20 june 2025.
doi: https://doi.org/10.18103/mra.v13i5.6560.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Bordoni B, Mahabadi N, Varacallo MA. Anatomy, Fascia. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
2. Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R. The fascia: the forgotten structure. Ital J Anat Embryol. 2011;116(3):127-38.
3. Exeter D, Connell DA. Skeletal muscle: functional anatomy and pathophysiology. Semin Musculoskelet Radiol. 2010 Jun;14(2):97-105.
4. Phan V, Shah J, Tandon H, Srbely J, DeStefano S, Kumbhare D, Sikdar S, Clouse A, Gandhi A, Gerber L. Myofascial Pain Syndrome: A Narrative Review Identifying Inconsistencies in Nomenclature. PM R. 2020 Sep;12(9):916-925.
5. Kodama Y, Masuda S, Ohmori T, Kanamaru A, Tanaka M, Sakaguchi T, Nakagawa M. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering (Basel). 2023 Apr 14;10(4):474.
6. Frontera WR, Ochala J. Skeletal muscle: a brief review of structure and function. Calcif Tissue Int. 2015 Mar;96(3):183-95.
7. Brooks SV, Guzman SD, Ruiz LP. Skeletal muscle structure, physiology, and function. Handb Clin Neurol. 2023;195:3-16.
8. Yoshimoto Y, Oishi Y. Mechanisms of skeletal muscle-tendon development and regeneration/ healing as potential therapeutic targets. Pharmacol Ther. 2023 Mar;243:108357
9. Kodama Y, Masuda S, Ohmori T, Kanamaru A, Tanaka M, Sakaguchi T, Nakagawa M. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering (Basel). 2023 Apr 14;10(4):474.
10. Stecco C, Porzionato A, Macchi V, Tiengo C, Parenti A, Aldegheri R, Delmas V, De Caro R. Histological characteristics of the deep fascia of the upper limb. Ital J Anat Embryol. 2006 Apr-Jun; 111(2):105-10.
11. Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA. Defining the fascial system. J Bodyw Mov Ther. 2017 Jan;21(1):173-177.
12. Vieira L. Embryology of the Fascial System. Cureus. 2020 Aug 30;12(8):e10134.
13. Bordoni B. Improving the New Definition of Fascial System. Complement Med Res. 2019;26 (6):421-426.
14. Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA. Defining the fascial system. J Bodyw Mov Ther. 2017 Jan;21(1):173-177.
15. Bordoni B, Myers T. A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains. Cureus. 2020 Feb 24;12(2):e7092.
16. Kim MY, Na YM, Moon JH. Comparison on treatment effects of dextrose water, saline and lidocaine for trigger point injection. J Korean Acad Rehab Med 1997;21:967-973
17. Kersschot J, Karavani I. Isotonic Glucose Injections for Postherpetic Neuralgia in the Elderly. Cureus. 2022 Sep 29;14(9):e29740.
18. Kersschot J, Treatment of Dorsal Pain with Intrafascial Injections. Trends Gen Med. 2024; 2(1): 1-3.
19. Kersschot J, Glucopuncture: A Clinical Guide to Regional Glucose 5% Injections, B P International (India/UK), ebook May 2023
20. Kersschot J, Glucopuncture for Treatment of Fascial Pain in the Thumb. A Clinical Case. ISAR Journal of Medical and Pharmaceutical Sciences 2024 (1), 4: 1–5).
21. Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med. 2022 Jun 27;11(13):3705.
22. Nasiri A, Rezaei Motlagh F, Vafaei MA. Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients. Neurol Res. 2023 Jun;45(6): 554-563.
23. Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AE, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel). 2023 Mar 16;13(6):1138.
24. Kersschot J, Intra-articular Glucose Injections for Orthoregeneration of Frozen Shoulder. A Clinical Case. Medical Research Archives 2023, 11(8), 1-5.
25. Pandey N, Nayak P, Gahnolia V, A Randomized Control Trial on Efficacy of Analgesic Effect of 5% Dextrose Caudal Epidural Injection for Non-specific Low Back Pain. International Journal of Scientific Research, 2021, 10 (9), 11-13.
26. Smigel LR, Reeves KD, Lyftogt J, Rabago DP. Poster 385 Caudal Epidural Dextrose Injections (D5W) for Chronic Back Pain with Accompanying Buttock or Leg Pain: A Consecutive Patient Study with Long-Term Follow-up. PM R. 2016 Sep;8(9S): S286-S287.
27. Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med. 2022 Jun 27;11(13):3705.
28. Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AE, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel). 2023 Mar 16;13(6):1138.
29. Nasiri A, Rezaei Motlagh F, Vafaei MA. Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients. Neurol Res. 2023 Jun;45(6): 554-563.
30. Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697.
31. Cherng JH, Chang SJ, Tsai HD, Chun CF, Fan GY, Reeves KD, Lam KHS, Wu YT. The Potential of Glucose Treatment to Reduce Reactive Oxygen Species Production and Apoptosis of Inflamed Neural Cells In Vitro. Biomedicines. 2023; 11(7):1837.
32. Lam KHS, Su DCJ, Wu Y-T, Fajardo Pérez M, Reeves KD, Peng P, Fullerton B. Infraspinatus Fascial Dysfunction as a Cause of Painful Anterior Shoulder Snapping: Its Visualization via Dynamic Ultrasound and Its Resolution via Diagnostic Ultrasound-Guided Injection. Diagnostics. 2023; 13(15):2601.
33. Lam KHS, Hung CY, Chiang YP, Onishi K, Su DCJ, Clark TB, Reeves KD. Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms. J Pain Res. 2020 Aug 4;13:1957-1968.
34. Shi X, Xu H, Zhu J, Li G, Bai L. A Randomized Double-blind Trial of 5% Dextrose Versus Corticosteroid Hydrodissection for Meralgia Paresthetica. Pain Physician. 2024 Nov;27(8):E835-E842.
35. Oh MW, Park JI, Shim GY, Kong HH. Comparative Efficacy of 5% Dextrose and Corticosteroid Injections in Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2025 Feb;106(2):300-310.
36. Cherng JH, Chang SJ, Tsai HD, Chun CF, Fan GY, Reeves KD, Lam KHS, Wu YT. The Potential of Glucose Treatment to Reduce Reactive Oxygen Species Production and Apoptosis of Inflamed Neural Cells In Vitro. Biomedicines. 2023 Jun 26; 11(7):1837.
37. Gao N, Li M, Wang W, Liu Z, Guo Y. The dual role of TRPV1 in peripheral neuropathic pain: pain switches caused by its sensitization or desensitization. Front Mol Neurosci. 2024 Sep 9;17:1400118
38. Benias, P.C., Wells, R.G., Sackey-Aboagye, B. et al. Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Sci Rep 2018, 8, 4947.
39. Alexander CE, Cascio MA, Varacallo MA. Lumbosacral Facet Syndrome. 2023 Aug 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
40. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain. 2016 Oct;13: 67-75.
41. Lai WF, Yoon CH, Chiang MT, Hong YH, Chen HC, Song W, Chin YPH. The effectiveness of dextrose prolotherapy in plantar fasciitis: A systemic review and meta-analysis. Medicine (Baltimore). 2021 Dec 23;100(51):e28216.
42. Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, Hamidi Panah S, Tabatabaee SM, Azarakhsh A. Neurofascial Dextrose Prolotherapy for Managing Chronic Ankle Ligament Injury. Anesth Pain Med. 2022 Jan 23;12(1):e118317.
43. Zhu M, Rabago D, Chung VC, Reeves KD, Wong SY, Sit RW. Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022 Nov;103(11):2209-2218.
44. Catapano M, Zhang K, Mittal N, Sangha H, Onishi K, de Sa D. Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review. PM R. 2020 Mar;12(3):288-300. doi: 10.1002/pmrj.12268. Epub 2019 Dec 4. Erratum in: PM R. 2020 Oct;12(10):1064.
45. Chung MW, Hsu CY, Chung WK, Lin YN. Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth?: A systematic review and meta-analysis. Medicine (Baltimore). 2020 Nov 13;99(46):e23201.
46. Krstičević M, Jerić M, Došenović S, Jeličić Kadić A, Puljak L. Proliferative injection therapy for osteoarthritis: a systematic review. Int Orthop. 2017 Apr;41(4):671-679.
47. Kersschot J, Mathieu T. Treatment of Painless Nodules With Glucopuncture in Dupuytren's Disease in Men: A Clinical Case. Cureus. 2022 Nov 13;14(11):e31445.
48. Reeves KD, Atkins JR, Solso CR, Cheng CI, Thornell IM, Lam KHS, Wu YT, Motyka T, Rabago D. Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy. Biomedicines. 2025 Feb 4;13(2):350.
49. Khateri S, Nejad FB, Kazemi F, Alaei B, Azami M, Moradkhani A, Majidi L, Moradi Y. The effect of dextrose prolotherapy on patients diagnosed with knee osteoarthritis: A comprehensive systematic review and meta-analysis of interventional studies. Health Sci Rep. 2024 Jun 24;7(6):e2145.
50. Chang SF, Huang KC, Cheng CC, Su YP, Lee KC, Chen CN, Chang HI. Glucose adsorption to chitosan membranes increases proliferation of human chondrocyte via mammalian target of rapamycin complex 1 and sterol regulatory element-binding protein-1 signaling. J Cell Physiol. 2017 Oct;232 (10):2741-2749.
51. Arias-Vázquez PI, Tovilla-Zárate CA, Castillo-Avila RG, Legorreta-Ramírez BG, López-Narváez ML, Arcila-Novelo R, González-Castro TB. Hypertonic Dextrose Prolotherapy, an Alternative to Intra-Articular Injections With Hyaluronic Acid in the Treatment of Knee Osteoarthritis: Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2022 Sep 1;101(9):816-825.
52 https://www.iart.org/foundation
53. Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697.
54. Chen CPC, Suputtitada A. Prolotherapy at Multifidus Muscle versus Mechanical Needling and Sterile Water Injection in Lumbar Spinal Stenosis. J Pain Res. 2023 Jul 18;16:2477-2486.
55. Kersschot J. Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study. Arch Phys Med Rehabil. 2023 Jul;104(7): 1154-1155.
56. Lyftogt J, Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain. Australasian Musculoskel Med. 2007; 12 (1), 107-109.
57. Lyftogt J. Prolotherapy and Achilles tendinopathy: a prospective pilot study of an old treatment. Australas Musculoskel Med. 2005; 10:16-19.
58. Kersschot J, Treatment of irritable bowel syndrome with glucopuncture: a case report. Int J Health Sci Res. 2024; 14(7):235-240.
59. Choong JT, Suhaimi A, Su DC, Lam KHS. Perineural Injection Therapy for Hemiplegic Shoulder Pain: A Novel Management Approach. Cureus. 2025 Feb 19;17(2):e79332.
60. Kim H, Kim HJ, Jung YH, Do W, Kim EJ. The effect of perineural injection therapy on neuropathic pain: a retrospective study. J Dent Anesth Pain Med. 2024 Feb;24(1):47-56. doi: 10.17245/jdap m.2024.24.1.47. Epub 2024 Feb 1.
61. Vinyes D, Muñoz-Sellart M, Fischer L. Therapeutic Use of Low-Dose Local Anesthetics in Pain, Inflammation, and Other Clinical Conditions: A Systematic Scoping Review. J Clin Med. 2023 Nov 21;12(23):7221.
62. Rey Novoa M, Muñoz-Sellart M, Catalán Soriano M, Vinyes D. Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review. Complement Med Res. 2021;28(6):571-577.
63. Bashan I, Ozturk GY. Effect of Neural Therapy on shoulder dysfunction and pain in supraspinatus tendinopathy. Pak J Med Sci. 2022 Mar-Apr;38 (3Part-I):565-569.
64. Vinyes D, Muñoz-Sellart M, Gurevich M. Procaine Injections in Myofascial Tension Points in the Treatment of Anxiety Disorders: A Case Series. International Journal of Clinical Case Reports and Reviews. 2025, 22. 22. 10.31579/2690-4861/643.
65. Altınbilek T, Terzi R, Başaran A, Tolu S, Küçüksaraç S. Evaluation of the effects of neural therapy in patients diagnosed with fibromyalgia. Turkish Journal of Physical Medicine and Rehabilitation, 2019, 65(1), 1.
66. Tilscher H, Eder M, Infiltrationstherapie (Therapeutic Local Anesthesia), Hippokrates 1996, Third Edition
67. Kersschot J, Biopuncture, The Management of Common Orthopedic and Sports Disorders, Thieme Publishing 2014
68. Schneider C. Traumeel - an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. Int J Gen Med. 2011 Mar 25;4:225-34.
69. Ehlert D, Majjhoo A. Traumeel® Epidural Injection: A Viable Alternative to Corticosteroids - A Five-Patient Case Study. Cureus. 2019 Nov 19; 11(11):e6196.
2. Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R. The fascia: the forgotten structure. Ital J Anat Embryol. 2011;116(3):127-38.
3. Exeter D, Connell DA. Skeletal muscle: functional anatomy and pathophysiology. Semin Musculoskelet Radiol. 2010 Jun;14(2):97-105.
4. Phan V, Shah J, Tandon H, Srbely J, DeStefano S, Kumbhare D, Sikdar S, Clouse A, Gandhi A, Gerber L. Myofascial Pain Syndrome: A Narrative Review Identifying Inconsistencies in Nomenclature. PM R. 2020 Sep;12(9):916-925.
5. Kodama Y, Masuda S, Ohmori T, Kanamaru A, Tanaka M, Sakaguchi T, Nakagawa M. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering (Basel). 2023 Apr 14;10(4):474.
6. Frontera WR, Ochala J. Skeletal muscle: a brief review of structure and function. Calcif Tissue Int. 2015 Mar;96(3):183-95.
7. Brooks SV, Guzman SD, Ruiz LP. Skeletal muscle structure, physiology, and function. Handb Clin Neurol. 2023;195:3-16.
8. Yoshimoto Y, Oishi Y. Mechanisms of skeletal muscle-tendon development and regeneration/ healing as potential therapeutic targets. Pharmacol Ther. 2023 Mar;243:108357
9. Kodama Y, Masuda S, Ohmori T, Kanamaru A, Tanaka M, Sakaguchi T, Nakagawa M. Response to Mechanical Properties and Physiological Challenges of Fascia: Diagnosis and Rehabilitative Therapeutic Intervention for Myofascial System Disorders. Bioengineering (Basel). 2023 Apr 14;10(4):474.
10. Stecco C, Porzionato A, Macchi V, Tiengo C, Parenti A, Aldegheri R, Delmas V, De Caro R. Histological characteristics of the deep fascia of the upper limb. Ital J Anat Embryol. 2006 Apr-Jun; 111(2):105-10.
11. Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA. Defining the fascial system. J Bodyw Mov Ther. 2017 Jan;21(1):173-177.
12. Vieira L. Embryology of the Fascial System. Cureus. 2020 Aug 30;12(8):e10134.
13. Bordoni B. Improving the New Definition of Fascial System. Complement Med Res. 2019;26 (6):421-426.
14. Adstrum S, Hedley G, Schleip R, Stecco C, Yucesoy CA. Defining the fascial system. J Bodyw Mov Ther. 2017 Jan;21(1):173-177.
15. Bordoni B, Myers T. A Review of the Theoretical Fascial Models: Biotensegrity, Fascintegrity, and Myofascial Chains. Cureus. 2020 Feb 24;12(2):e7092.
16. Kim MY, Na YM, Moon JH. Comparison on treatment effects of dextrose water, saline and lidocaine for trigger point injection. J Korean Acad Rehab Med 1997;21:967-973
17. Kersschot J, Karavani I. Isotonic Glucose Injections for Postherpetic Neuralgia in the Elderly. Cureus. 2022 Sep 29;14(9):e29740.
18. Kersschot J, Treatment of Dorsal Pain with Intrafascial Injections. Trends Gen Med. 2024; 2(1): 1-3.
19. Kersschot J, Glucopuncture: A Clinical Guide to Regional Glucose 5% Injections, B P International (India/UK), ebook May 2023
20. Kersschot J, Glucopuncture for Treatment of Fascial Pain in the Thumb. A Clinical Case. ISAR Journal of Medical and Pharmaceutical Sciences 2024 (1), 4: 1–5).
21. Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med. 2022 Jun 27;11(13):3705.
22. Nasiri A, Rezaei Motlagh F, Vafaei MA. Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients. Neurol Res. 2023 Jun;45(6): 554-563.
23. Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AE, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel). 2023 Mar 16;13(6):1138.
24. Kersschot J, Intra-articular Glucose Injections for Orthoregeneration of Frozen Shoulder. A Clinical Case. Medical Research Archives 2023, 11(8), 1-5.
25. Pandey N, Nayak P, Gahnolia V, A Randomized Control Trial on Efficacy of Analgesic Effect of 5% Dextrose Caudal Epidural Injection for Non-specific Low Back Pain. International Journal of Scientific Research, 2021, 10 (9), 11-13.
26. Smigel LR, Reeves KD, Lyftogt J, Rabago DP. Poster 385 Caudal Epidural Dextrose Injections (D5W) for Chronic Back Pain with Accompanying Buttock or Leg Pain: A Consecutive Patient Study with Long-Term Follow-up. PM R. 2016 Sep;8(9S): S286-S287.
27. Chao TC, Reeves KD, Lam KHS, Li TY, Wu YT. The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study. J Clin Med. 2022 Jun 27;11(13):3705.
28. Lam KHS, Wu YT, Reeves KD, Galluccio F, Allam AE, Peng PWH. Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses. Diagnostics (Basel). 2023 Mar 16;13(6):1138.
29. Nasiri A, Rezaei Motlagh F, Vafaei MA. Efficacy comparison between ultrasound-guided injections of 5% dextrose with corticosteroids in carpal tunnel syndrome patients. Neurol Res. 2023 Jun;45(6): 554-563.
30. Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697.
31. Cherng JH, Chang SJ, Tsai HD, Chun CF, Fan GY, Reeves KD, Lam KHS, Wu YT. The Potential of Glucose Treatment to Reduce Reactive Oxygen Species Production and Apoptosis of Inflamed Neural Cells In Vitro. Biomedicines. 2023; 11(7):1837.
32. Lam KHS, Su DCJ, Wu Y-T, Fajardo Pérez M, Reeves KD, Peng P, Fullerton B. Infraspinatus Fascial Dysfunction as a Cause of Painful Anterior Shoulder Snapping: Its Visualization via Dynamic Ultrasound and Its Resolution via Diagnostic Ultrasound-Guided Injection. Diagnostics. 2023; 13(15):2601.
33. Lam KHS, Hung CY, Chiang YP, Onishi K, Su DCJ, Clark TB, Reeves KD. Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms. J Pain Res. 2020 Aug 4;13:1957-1968.
34. Shi X, Xu H, Zhu J, Li G, Bai L. A Randomized Double-blind Trial of 5% Dextrose Versus Corticosteroid Hydrodissection for Meralgia Paresthetica. Pain Physician. 2024 Nov;27(8):E835-E842.
35. Oh MW, Park JI, Shim GY, Kong HH. Comparative Efficacy of 5% Dextrose and Corticosteroid Injections in Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2025 Feb;106(2):300-310.
36. Cherng JH, Chang SJ, Tsai HD, Chun CF, Fan GY, Reeves KD, Lam KHS, Wu YT. The Potential of Glucose Treatment to Reduce Reactive Oxygen Species Production and Apoptosis of Inflamed Neural Cells In Vitro. Biomedicines. 2023 Jun 26; 11(7):1837.
37. Gao N, Li M, Wang W, Liu Z, Guo Y. The dual role of TRPV1 in peripheral neuropathic pain: pain switches caused by its sensitization or desensitization. Front Mol Neurosci. 2024 Sep 9;17:1400118
38. Benias, P.C., Wells, R.G., Sackey-Aboagye, B. et al. Structure and Distribution of an Unrecognized Interstitium in Human Tissues. Sci Rep 2018, 8, 4947.
39. Alexander CE, Cascio MA, Varacallo MA. Lumbosacral Facet Syndrome. 2023 Aug 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
40. Heller GZ, Manuguerra M, Chow R. How to analyze the Visual Analogue Scale: Myths, truths and clinical relevance. Scand J Pain. 2016 Oct;13: 67-75.
41. Lai WF, Yoon CH, Chiang MT, Hong YH, Chen HC, Song W, Chin YPH. The effectiveness of dextrose prolotherapy in plantar fasciitis: A systemic review and meta-analysis. Medicine (Baltimore). 2021 Dec 23;100(51):e28216.
42. Kazempour Mofrad M, Rezasoltani Z, Dadarkhah A, Hamidi Panah S, Tabatabaee SM, Azarakhsh A. Neurofascial Dextrose Prolotherapy for Managing Chronic Ankle Ligament Injury. Anesth Pain Med. 2022 Jan 23;12(1):e118317.
43. Zhu M, Rabago D, Chung VC, Reeves KD, Wong SY, Sit RW. Effects of Hypertonic Dextrose Injection (Prolotherapy) in Lateral Elbow Tendinosis: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2022 Nov;103(11):2209-2218.
44. Catapano M, Zhang K, Mittal N, Sangha H, Onishi K, de Sa D. Effectiveness of Dextrose Prolotherapy for Rotator Cuff Tendinopathy: A Systematic Review. PM R. 2020 Mar;12(3):288-300. doi: 10.1002/pmrj.12268. Epub 2019 Dec 4. Erratum in: PM R. 2020 Oct;12(10):1064.
45. Chung MW, Hsu CY, Chung WK, Lin YN. Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth?: A systematic review and meta-analysis. Medicine (Baltimore). 2020 Nov 13;99(46):e23201.
46. Krstičević M, Jerić M, Došenović S, Jeličić Kadić A, Puljak L. Proliferative injection therapy for osteoarthritis: a systematic review. Int Orthop. 2017 Apr;41(4):671-679.
47. Kersschot J, Mathieu T. Treatment of Painless Nodules With Glucopuncture in Dupuytren's Disease in Men: A Clinical Case. Cureus. 2022 Nov 13;14(11):e31445.
48. Reeves KD, Atkins JR, Solso CR, Cheng CI, Thornell IM, Lam KHS, Wu YT, Motyka T, Rabago D. Rapid Decrease in Dextrose Concentration After Intra-Articular Knee Injection: Implications for Mechanism of Action of Dextrose Prolotherapy. Biomedicines. 2025 Feb 4;13(2):350.
49. Khateri S, Nejad FB, Kazemi F, Alaei B, Azami M, Moradkhani A, Majidi L, Moradi Y. The effect of dextrose prolotherapy on patients diagnosed with knee osteoarthritis: A comprehensive systematic review and meta-analysis of interventional studies. Health Sci Rep. 2024 Jun 24;7(6):e2145.
50. Chang SF, Huang KC, Cheng CC, Su YP, Lee KC, Chen CN, Chang HI. Glucose adsorption to chitosan membranes increases proliferation of human chondrocyte via mammalian target of rapamycin complex 1 and sterol regulatory element-binding protein-1 signaling. J Cell Physiol. 2017 Oct;232 (10):2741-2749.
51. Arias-Vázquez PI, Tovilla-Zárate CA, Castillo-Avila RG, Legorreta-Ramírez BG, López-Narváez ML, Arcila-Novelo R, González-Castro TB. Hypertonic Dextrose Prolotherapy, an Alternative to Intra-Articular Injections With Hyaluronic Acid in the Treatment of Knee Osteoarthritis: Systematic Review and Meta-analysis. Am J Phys Med Rehabil. 2022 Sep 1;101(9):816-825.
52 https://www.iart.org/foundation
53. Babaei-Ghazani A, Moradnia S, Azar M, Forogh B, Ahadi T, Chaibakhsh S, Khodabandeh M, Eftekharsadat B. Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial. Pain Manag. 2022 Sep;12(6):687-697.
54. Chen CPC, Suputtitada A. Prolotherapy at Multifidus Muscle versus Mechanical Needling and Sterile Water Injection in Lumbar Spinal Stenosis. J Pain Res. 2023 Jul 18;16:2477-2486.
55. Kersschot J. Low-Dose Dextrose Prolotherapy as Effective as High-Dose Dextrose Prolotherapy in the Treatment of Lateral Epicondylitis? A Double-Blind, Ultrasound Guided, Randomized Controlled Study. Arch Phys Med Rehabil. 2023 Jul;104(7): 1154-1155.
56. Lyftogt J, Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain. Australasian Musculoskel Med. 2007; 12 (1), 107-109.
57. Lyftogt J. Prolotherapy and Achilles tendinopathy: a prospective pilot study of an old treatment. Australas Musculoskel Med. 2005; 10:16-19.
58. Kersschot J, Treatment of irritable bowel syndrome with glucopuncture: a case report. Int J Health Sci Res. 2024; 14(7):235-240.
59. Choong JT, Suhaimi A, Su DC, Lam KHS. Perineural Injection Therapy for Hemiplegic Shoulder Pain: A Novel Management Approach. Cureus. 2025 Feb 19;17(2):e79332.
60. Kim H, Kim HJ, Jung YH, Do W, Kim EJ. The effect of perineural injection therapy on neuropathic pain: a retrospective study. J Dent Anesth Pain Med. 2024 Feb;24(1):47-56. doi: 10.17245/jdap m.2024.24.1.47. Epub 2024 Feb 1.
61. Vinyes D, Muñoz-Sellart M, Fischer L. Therapeutic Use of Low-Dose Local Anesthetics in Pain, Inflammation, and Other Clinical Conditions: A Systematic Scoping Review. J Clin Med. 2023 Nov 21;12(23):7221.
62. Rey Novoa M, Muñoz-Sellart M, Catalán Soriano M, Vinyes D. Treatment of Localized Vulvar Pain with Neural Therapy: A Case Series and Literature Review. Complement Med Res. 2021;28(6):571-577.
63. Bashan I, Ozturk GY. Effect of Neural Therapy on shoulder dysfunction and pain in supraspinatus tendinopathy. Pak J Med Sci. 2022 Mar-Apr;38 (3Part-I):565-569.
64. Vinyes D, Muñoz-Sellart M, Gurevich M. Procaine Injections in Myofascial Tension Points in the Treatment of Anxiety Disorders: A Case Series. International Journal of Clinical Case Reports and Reviews. 2025, 22. 22. 10.31579/2690-4861/643.
65. Altınbilek T, Terzi R, Başaran A, Tolu S, Küçüksaraç S. Evaluation of the effects of neural therapy in patients diagnosed with fibromyalgia. Turkish Journal of Physical Medicine and Rehabilitation, 2019, 65(1), 1.
66. Tilscher H, Eder M, Infiltrationstherapie (Therapeutic Local Anesthesia), Hippokrates 1996, Third Edition
67. Kersschot J, Biopuncture, The Management of Common Orthopedic and Sports Disorders, Thieme Publishing 2014
68. Schneider C. Traumeel - an emerging option to nonsteroidal anti-inflammatory drugs in the management of acute musculoskeletal injuries. Int J Gen Med. 2011 Mar 25;4:225-34.
69. Ehlert D, Majjhoo A. Traumeel® Epidural Injection: A Viable Alternative to Corticosteroids - A Five-Patient Case Study. Cureus. 2019 Nov 19; 11(11):e6196.