Step-Up Regenerative Injection Therapy for Severe Chronic Low Back Pain Utilizing Epidural Dextrose Solution (Prolotherapy), Local Platelet-Rich Plasma, and Epidural Platelet-Rich Plasma: A Case Report and Suggested Protocol

Chronic low back pain (CLBP) is a prevalent problem that rarely resolves completely and frequently has a negative impact on mood, activity, and mobility. Conservative pharmacologic and non-pharmacologic therapies have limited efficacy, and there is an unmet therapeutic need for these patients. The authors report a case of a 38-year-old male patient with a 6-year history of moderate to severe back pain, significantly impaired mobility and neurologic deficits that were resistant to a wide range of conservative therapies. Physical exam and magnetic resonance imaging (MRI) revealed evidence of radiculopathy, with impaired sensation and strength that was consistent with a right L5 nerve root impingement. Repeated caudal epidural injection of dextrose solution caused rapid, though not durable, improvement in symptoms and mobility, with some effect on neurologic findings. Stepping up to caudal epidural platelet-rich plasma (PRP) injection combined with articular PRP injections at the sacroiliac joint and lumbar facet joints resulted in almost complete resolution of pain, marked improvements in mobility and resumption of physical activity. Also, after caudal epidural PRP injection the patient regained sensation and function over the right L5 distribution for the first time in 6 years. The injections were well tolerated, and the patient was very pleased with the therapy. The case report also includes a brief review of and suggested approach to injection therapy for the naturopathic physician treating resistant CLBP.