• Lorenzo Giordano, William D Murrell, and Nicola Maffulli.
• Department of Trauma and Orthopaedic Surgery, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, Salerno 84131, Italy.
• Br. Med. Bull. 2021 Jun 10; 138 (1): 96-111.

IntroductionLow back pain is common and imposes major societal burdens for patient suffering and costs. Prolotherapy injections are used for musculoskeletal conditions including tendinopathies, osteoarthritis and low back pain to enhance soft-tissue healing. This review aims to clarify the place of prolotherapy in chronic low back pain (CLBP).Sources Of DataUsing multiple databases, a systematic search was performed to identify studies detailing the use of prolotherapy to manage CLBP. A total of 12 articles was included in the present work.Areas Of AgreementConsidering the level of evidence and the quality of the studies assessed using the modified Coleman Score, prolotherapy is an effective management modality for CLBP patients in whom conservative therapies failed.Areas Of ControversyThe presence of co-interventions and the clinical heterogeneity of the work contributes to confound the overall conclusions.Growing Points And Areas For ResearchThe analysis of the studies included in the review, using appropriate tools, showed how their quality has decreased over the years, reflecting the need for appropriately powered well planned and performed randomized control trials.© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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