***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Knee osteoarthritis ( KOA ) is a common disabling disease . Limited studies have demonstrated that prolotherapy with dextrose or with prolozone can be helpful in the treatment of patients with KOA . Objectives : In the current study , we compared the results between these two treatment methods . Patients and Methods : In the current r and omized clinical trial , 80 patients with mild to moderate KOA were r and omly assigned equally into two groups ( ozone group and dextrose group ) . In each group , injections were repeated three times with 10-day intervals . Before the treatment and 3 months after the injections , the pain intensity was measured by using a visual analogue scale and the Western Ontario and McMaster university arthritis index scores . Finally , the results were compared between the two groups . Results : In the two groups , the pain intensity and WOMAC scores significantly decreased and increased , respectively ( P < 0.001 ) . However , there was no significant difference between the two groups . Conclusions : Prolotherapy with dextrose and with prolozone result in the same pain relief or functional improvement in patients with mild to moderate KOA OBJECTIVES Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain . The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies . It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy . The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain , compared with intra-articular steroid injection . DESIGN This was a prospect i ve , r and omized , controlled trial . SETTING S/LOCATION The study was conducted at an outpatient pain medicine clinic at Chonnam National University Hospital in Gwang-ju , Korea . SUBJECTS The study included patients with sacroiliac joint pain , confirmed by ≥50 % improvement in response to local anesthetic block , lasting 3 months or longer , and who failed medical treatment . INTERVENTIONS The treatment involved intra-articular dextrose water prolotherapy or triamcinolone acetonide injection using fluoroscopic guidance , with a biweekly schedule and maximum of three injections . OUTCOME MEASURES Pain and disability scores were assessed at baseline , 2 weeks , and monthly after completion of treatment . RESULTS The numbers of recruited patients were 23 and 25 for the prolotherapy and steroid groups , respectively . The pain and disability scores were significantly improved from baseline in both groups at the 2-week follow-up , with no significant difference between them . The cumulative incidence of ≥50 % pain relief at 15 months was 58.7 % ( 95 % confidence interval [ CI ] 37.9%-79.5 % ) in the prolotherapy group and 10.2 % ( 95 % CI 6.7%-27.1 % ) in the steroid group , as determined by Kaplan-Meier analysis ; there was a statistically significant difference between the groups ( log-rank p < 0.005 ) . CONCLUSIONS Intra-articular prolotherapy provided significant relief of sacroiliac joint pain , and its effects lasted longer than those of steroid injections . Further studies are needed to confirm the safety of the procedure and to vali date an appropriate injection protocol The effects from cervical facet joint injections in those patients who have been complaining cervical zygapophyseal joint pain were compared . The patients were diagnosed originally as myofascial pain syndrome ( MPS ) , cervical herniated nucleus pulposus ( HNP ) , and whiplash-associated disorders ( WAD ) . Patients with the zygapophyseal joints pain of C5 - 6 and C6 - 7 were classified by their pain origin as MPS , HNP , and WAD . All patients had been undergone cervical zygapophyseal joints injections with the mixture of lidocaine and triamcinolone unilaterally or bilaterally through the posterior approach under C-arm imaging guide . The therapeutic effects were compared with reduction of numeric rating scale ( NRS ) of pain before and immediately after blockade and symptom-free periods in each group after 12 months . Symptom duration s before injections were 16.1±9.6 , 4.6±1.9 and 4.1±1.1 months in each MPS , HNP , and WAD groups . The reductions of NRS immediately after the blockade among the three groups were not different . However , the symptom-free duration after blockade lasted longer in the HNP group than the other two groups . In patients with cervical zygapophyseal pain syndromes , the analgesic effect from cervical facet joint blocks lasted longer in cervical HNP than MPS or WAD The effectiveness and tolerance of therapeutic local anesthesia ( TLA ) with lidocaine was compared with those of oral diclofenac in a controlled , open , r and omized study involving 76 patients with gonalgia due to gonarthrosis or patellar chondropathy . During the course of the three-week ( maximum ) treatment , the summed score of pain at rest , pain on movement , and restricted mobility , taken as the target parameter of effectiveness , decreased significantly more markedly ( p = 0.008 ) under TLA , than under diclofenac .  Side effects involving mainly the gastrointestinal tract occurred significantly more frequently in the diclofenac group ( p = 0.012 ) . The results of this study indicate that in the treatment of localized joint pain of degenerative genesis , TLA with lidocaine is superior to NSAID treatment in terms of effectiveness and tolerance OBJECTIVES This study determined whether injection with hypertonic dextrose and morrhuate sodium ( prolotherapy ) using a pragmatic , clinical ly determined injection schedule for knee osteoarthritis ( KOA ) results in improved knee pain , function , and stiffness compared to baseline status . DESIGN This was a prospect i ve three-arm uncontrolled study with 1-year follow-up . SETTING The setting was outpatient . PARTICIPANTS The participants were 38 adults who had at least 3 months of symptomatic KOA and who were in the control groups of a prior prolotherapy r and omized controlled trial ( RCT ) ( Prior-Control ) , were ineligible for the RCT ( Prior-Ineligible ) , or were eligible but declined the RCT ( Prior-Declined ) . INTERVENTION The injection sessions at occurred at 1 , 5 , and 9 weeks with as-needed treatment at weeks 13 and 17 . Extra-articular injections of 15 % dextrose and 5 % morrhuate sodium were done at peri-articular tendon and ligament insertions . A single intra-articular injection of 6 mL 25 % dextrose was performed through an inferomedial approach . OUTCOME MEASURES The primary outcome measure was the vali date d Western Ontario McMaster University Osteoarthritis Index ( WOMAC ) . The secondary outcome measure was the Knee Pain Scale and postprocedure opioid medication use and participant satisfaction . RESULTS The Prior-Declined group reported the most severe baseline WOMAC score ( p=0.02 ) . Compared to baseline status , participants in the Prior-Control group reported a score change of 12.4±3.5 points ( 19.5 % , p=0.002 ) . Prior-Decline and Prior-Ineligible groups improved by 19.4±7.0 ( 42.9 % , p=0.05 ) and 17.8±3.9 ( 28.4 % , p=0.008 ) points , respectively ; 55.6 % of Prior-Control , 75 % of Prior-Decline , and 50 % of Prior-Ineligible participants reported score improvement in excess of the 12-point minimal clinical important difference on the WOMAC measure . Postprocedure opioid medication result ed in rapid diminution of prolotherapy injection pain . Satisfaction was high and there were no adverse events . CONCLUSIONS Prolotherapy using dextrose and morrhuate sodium injections for participants with mild-to-severe KOA result ed in safe , significant , sustained improvement of WOMAC-based knee pain , function , and stiffness scores compared to baseline status Background : Osteoarthritis is one of the most common diseases and the knee is the most commonly affected joint . Intra-articular prolotherapy is being utilized in acute and chronic pain management setting . This study was design ed to compare the efficacy of three methods of intra-articular knee joint therapies with erythropoietin , dextrose , and pulsed radiofrequency . Material s and Methods : After approval by the Ethics Committee and explaining the therapeutic method to volunteers , 70 patients who were suffering from primary knee osteoarthrosis went through one of the treatment methods ( erythropoietin , dextrose , and pulsed radiofrequency ) . The study was double-blind r and omized clinical trial performed from December 2012 to July 2013 . Patients ’ pain level was assessed through the visual analog pain scale ( VAS ) , and range of motion ( ROM ) was measured by goniometric method . Furthermore , patients ’ satisfaction was assessed before and after different treatment methods in weeks 2 , 4 , and 12 . For analysis , Chi-square , one-way ANOVA , and repeated measured ANOVA were utilized . Results : The demographic results among the three groups did not indicate any statistical difference . The mean VAS in erythropoietin group in the 2nd , 4th , and 12th weeks was 3.15 ± 1.08 , 3.15 ± 1.08 , and 3.5 ± 1.23 , respectively ( P ≤ 0.005 ) . Knee joint ROM in the erythropoietin group in the 2nd , 4th , and 12th weeks was 124 ± 1.50 , 124 ± 1.4 , and 123 ± 1.53 respectively ( P ≤ 0.005 ) . Satisfaction score in the 12th week in erythropoietin group was extremely satisfied 15 % , satisfied 55 % , and moderately satisfied 30 % , ( P = 0.005 ) . No specific side-effects were observed . Conclusion : Intra-articular prolotherapy with erythropoietin was more effective in terms of pain level reduction and ROM improvement compared with dextrose and pulsed radiofrequency Objectives : Prolotherapy is an injection-based complementary treatment , which has shown promising results in the treatment of different musculoskeletal disorders . The aim of this study was to determine the therapeutic efficacy of dextrose prolotherapy on pain , range of motion , and function in patients with knee osteoarthritis ( OA ) . Methods : In this single-arm prospect i ve study , participants with symptomatic moderate knee osteoarthritis underwent prolotherapy with intra-articular injection of 20 % dextrose water at baseline , and at 4 weeks and 8 weeks later . Patients were followed for 24 weeks . Pain severity at rest and activity , according to the visual analog scale ( VAS ) , articular range of motion ( ROM ) , and Western Ontario and McMaster Universities arthritis index ( WOMAC ) scores were measured at baseline , 4 , 8 , and 24 weeks later . Results : A total of 24 female patients ( average age : 58.37 ± 11.8 years old ) received 3-monthly injection therapies . Before the treatment , the mean articular range of motion was 105.41 ± 11.22 ° . Mean VAS scale at rest and activity was 8.83 ± 1.37 and 9.37 ± 1.31 , respectively . At the end of week 24 , knee ROM increased by 8 ° . Pain severity in rest and activity decreased to 4.87 ± 1.39 , 45.86 % , and 44.23 % , respectively ( p < 0.001 ) . Total WOMAC score and its subcategories showed a continuous improvement trend in all the evaluation sessions , so that at the end of the study , the total score decreased by 30.5 ± 14.27 points ( 49.58 % ) ( p < 0.001 ) . Improvements of all parameters were considerable until week 8 , and were maintained throughout the study period . Conclusions : Prolotherapy with three intra-articular injections of hypertonic dextrose given 4 weeks apart for selected patients with knee OA , result ed in significant improvement of vali date d pain , ROM , and WOMAC-based function scores , when baseline levels were compared at 24 weeks . Further studies with r and omized controlled trials involving a comparison group are suggested to confirm these findings PURPOSE Knee osteoarthritis is a common , debilitating chronic disease . Prolotherapy is an injection therapy for chronic musculoskeletal pain . We conducted a 3-arm , blinded ( injector , assessor , injection group participants ) , r and omized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis . METHODS Ninety adults with at least 3 months of painful knee osteoarthritis were r and omized to blinded injection ( dextrose prolotherapy or saline ) or at-home exercise . Extra- and intra-articular injections were done at 1 , 5 , and 9 weeks with as-needed additional treatments at weeks 13 and 17 . Exercise participants received an exercise manual and in-person instruction . Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index ( WOMAC ; 10 
    Output:
    
All studies concluded that prolotherapy was effective treatment for OA .
Discussion Limited evidence from low- quality studies indicates a beneficial effect of prolotherapy for OA management .