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AN OBSERVATIONAL STUDY ON DEXTROSE
PROLOTHERAPY
FOR UNRESOLVED NECK PAIN AT
AN OUTPATIENT CHARITY CLINIC IN RURAL ILLINOIS
ROSS A. HAUSER, M.D.; MARION A. HAUSER, MS RD
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ABSTRACT AND INTRODUCTION:
Abstract:
The optimal long-term, symptomatic therapy
for chronic neck pain has not been established. Accordingly, we
investigated the outcomes of patients undergoing Hemwall-Hackett
dextrose Prolotherapy treatment for unresolved neck pain at a charity
clinic in rural Illinois. We studied a sample of 98 patients who had
suffered with pain on average for 59 months and seen over 3 physicians
prior to being treated quarterly with Prolotherapy. On average 18 months
following their last Prolotherapy session, patients were contacted and
asked numerous questions in regard to their levels of pain and a variety
of physical and psychological symptoms, as well as activities of daily
living, before and after their last Prolotherapy treatment. The results
of this study showed that patients had a statistically significant
decline in their level of pain, stiffness and crunching sensation with
Prolotherapy. This included clients who were told by their M.D. (s) that
there were no other treatment options or that surgery was their only
answer for their chronic pain. More than 83% of patients showed
improvements in walking ability, exercise ability, anxiety, depression
and overall disability with Prolotherapy. Ninety percent of patients who
were on medications at the start of Prolotherapy were able to cut their
pain medication usage by 50% or more. Additional pain management care
was able to be lessened by 50% or more in 75% of cases with Prolotherapy.
Ninety-eight percent of patients stated their pain was better with
Prolotherapy. Ninety-seven percent of patients said Prolotherapy changed
their life for the better.
Objective: To investigate the
outcomes of patients undergoing Hemwall-Hackett dextrose Prolotherapy
treatment for chronic neck pain at an outpatient charity clinic in rural
Illinois.
Patients and Methods: Patients with
unresolved neck pain were treated with the Hemwall-Hackett technique of
dextrose Prolotherapy every three months and were included into an
observational study. The patients were called on the phone and asked to
answer detailed questions on the level of their neck pain, medication
usage, stiffness, walking ability, exercise ability, anxiety,
depression, activities of daily living and other quality of life issues
before and after receiving dextrose Prolotherapy.
Results:
A total of 98 neck patients were treated from 2000 to 2005 with
dextrose Prolotherapy. They had an average starting pain level of 5.6,
stiffness of 6.7 and crunching sensation of 5.1. Their ending pain,
stiffness and crunch sensation levels were 2.3, 2.4 and 2.1
respectively. For the subset of 43 patients who were told by their M.D.
(s) that no other treatment options for their chronic pain were
available the starting pain level was 5.2, stiffness 6.7 and crunching
sensation 6.3. Their ending pain, stiffness and crunching sensation
levels were 2.7, 2.5, and 2.6 respectively. Twenty-one of the patients
were told that neck surgery was their only treatment option. These
patients had a starting pain, stiffness and crunching sensation levels
of 6.7, 6.3, 4.3 and ending levels after Prolotherapy of 2.0, 2.3, and
2.0 respectively. In all three of the groups (all patients, no other
treatment options, and surgery only option) pain, stiffness and
crunching sensation improvements with Prolotherapy reached statistical
significance using a matched sample test. Overall 97% of patients had
some pain relief with Prolotherapy. Ninety-one percent considered the
Prolotherapy treatment on them to be very successful (greater than 50%
pain relief). In regard to range of motion, prior to Prolotherapy only
29% had 75% or greater of normal range of motion but this increased to
81% after Prolotherapy. 92% of patients on medications and 78% of those
using additional pain management care after Prolotherapy were able to
decrease them by 50% or more.
In regard to quality of life issues before
Prolotherapy, 48% of the chronic neck patients noted an overall
disability of 50% or more (could only do half or less of the tasks they
wanted to), whereas after Prolotherapy this decreased to 13%. Only 26%
of patients could exercise greater than 30 minutes before Prolotherapy
but 76% could do so after Prolotherapy. Prior to Prolotherapy, 53% of
patients had feelings of depression and 61% had anxiety whereas, after
Prolotherapy, only 16% had feelings of depression and 19% had anxious
thoughts. While 79% of patients noted that pain interrupted sleep, 88%
showed improvements in sleep after Prolotherapy. Ninety-nine percent of
patients noted that Prolotherapy has changed their life for the better.
Ninety-eight percent of patients said they still feel benefits from the
Prolotherapy they received. Overall, 97% of patients had improvement in
their pain with Prolotherapy.
Conclusion:
In this observational study, patients with unresolved neck pain
reported clinically relevant improvements in their pain level and
quality of life after receiving Hemwall-Hackett dextrose Prolotherapy.
Introduction:
Neck pain is a common condition affecting about 10% of the general
population of North America at any given time, each year up to 45%, and
over a lifetime 70%.1, 2, 3 Neck pain results in a
significant amount of disability and health care use in the United
States, with large personal and economic consequences.4, 5 As
the duration of neck symptoms increases, especially beyond six months,
ones mental health is negatively affected. Younger patients are more
impacted by neck and referral arm symptoms more than older patients.6
It is well documented the longer the pain persists the more likely it is
going to be chronic with up to 7% of patients ending up with chronic
neck pain.7, 8
While there is some consensus on how to treat acute painful neck
episodes, there is much debate on how to treat chronic neck pain. Most
monotherapies either do not work or have limited efficacy.9
Non-steroidal anti-inflammatory drugs and anti-depressants have some
short term benefit but no published data vindicate their long-term use.10
Manipulative therapy, physiotherapy and massage therapy all show some
temporary benefit but do little to curb long term pain.11,12,13
Some people turn to more invasive therapies like percutaneous
radiofrequency neurotomy or surgery, but long-term results have been
poor and surgeries are fraught with complications.14,15, 16, 17
Because of the limited response to traditional therapies, many people
are turning to alternative therapies including Prolotherapy for pain
control.18,19,20
Prolotherapy is becoming a widespread form of pain management in both
complementary and allopathic medicine.21,22 Its primary use
is in the pain management associated with tendinopathies and ligament
sprains in peripheral joints.23,24,25 It is also being used
in the treatment of spine and joint degenerative arthritis.26,27
Prolotherapy has long been used for chronic low back pain arising from
the sacroiliac joints and as an alternative to surgery.28,29,30
Prolotherapy has been shown in low back studies to improve pain levels
and range of motion.31,32 In double-blinded human studies the
evidence on the effectiveness of Prolotherapy has been considered
promising but mixed.33,34.35.36
George S. Hackett, M.D., coined the term Prolotherapy.37 As
he described it, “The treatment consists of the injection of a solution
within the relaxed ligament and tendon which will stimulate the
production of new fibrous tissue and bone cells that will strengthen the
‘weld’ of fibrous tissue and bone to stabilize the articulation and
permanently eliminate the disability.”38 Animal studies have
shown that Prolotherapy induces the production of new collagen by
stimulating the normal inflammatory reaction.39, 40 In
addition, animal studies have shown improvements in ligament and tendon
diameter and strength.41, 42 Dr. Hackett himself reported
good to excellent results in 90% percent of 82 consecutive patients he
treated with neck and/or headache pain using Prolotherapy. He surmised
the neck pain and referral headaches were from ligament damage from
whiplash-type injuries.43,44 Dr. Kayfetz and associates
confirmed these results in a similar group of patients.45,46
Recent research using flexion/extension x-rays to document cervical
spine instability and fluoroscopically-guided cervical Prolotherapy
demonstrated statistically significant correlations between a reduction
in both cervical flexion and extension translation and improvement in
the patients pain level.47 While these results are promising,
they looked primarily at neck pain control.
To evaluate the effectiveness of Hemwall-Hackett dextrose Prolotherapy,
not just on neck pain but on quality of life measures, this
observational study was undertaken.
PATIENTS AND METHODS
Framework and setting
In October 1994, the primary authors (R.H., M.H.) started a
Christian charity medical clinic called Beulah Land Natural Medicine
Clinic in an impoverished area in southern Illinois. The primary
modality of treated offered was Hemwall-Hackett dextrose Prolotherapy
for pain control. Dextrose was selected as the main ingredient in the
Prolotherapy solution because of it is the most common proliferant used
in Prolotherapy, it being readily available, inexpensive (compared to
other proliferants), and having a high safety profile. The clinic met
every three months until July 2005. All treatments were given free of
charge.
Patients
Patients who received Prolotherapy for their unresolved neck pain in
the years 2000 to 2005 were called by telephone and interviewed by a
data collector (D.P.) who had no prior knowledge of Prolotherapy.
General inclusion criteria were an age of at least 18 years, having an
unresolved neck pain condition that typically responds to Prolotherapy,
and a willingness to undergo at least four Prolotherapy sessions, unless
the pain remitted with less number of Prolotherapy sessions.
Interventions
The Hemwall-Hackett technique of Prolotherapy was used. Each patient
received 40 to 70 injections of a 15% dextrose, 0.2% lidocaine solution
with a total of 30 to 60 cc of solution used per neck and upper back.
Injections were given into and around the back of the head, neck and
upper back. The typical spots injected each with 0.5 to 1cc of solution
can be seen in Figure 1.
Tender areas injected included the
superior and inferior nuchal ridge, occiput, mastoid process, facet
joints, transverse processes, supraspinous processes, scapular border,
and clavicle. Typically the attachment of the suboccipital muscles,
upper trapezius, levator scapulae, and vertebral ligaments were
injected. No other therapies were used. As much as the pain would allow,
the patients were asked to cut down or stop other pain medications and
therapies they were using.
Outcomes
D.P. was the sole person obtaining the patient information during the
telephone interviews. The patients were asked a series of questions
about their pain and previous treatments before starting Prolotherapy.
Their response to Prolotherapy was also detailed with an emphasis on the
effect Prolotherapy had on their need for subsequent pain treatments and
their quality of life. Specifically, patients were asked questions
concerning years of pain, pain intensity, overall disability, number of
physicians seen and medications taken, quality of life concerns,
psychological factors and whether the response to Prolotherapy continued
after the Prolotherapy session stopped.
Analysis:
For the analysis, patient percentages of the various responses
were calculated. These responses gathered from clients before
Prolotherapy were then compared with the responses to the same questions
after Prolotherapy. A matched sample test was used to determine if there
were statistically significant improvements in the before and after
Prolotherapy measurements for pain, stiffness and crunching sensation.
The patient percentages were also calculated for clients who answered
“yes” to either of the following two questions: “Before starting
Prolotherapy it was the consensus of the my M.D. (s) that there were no
other treatment options that he or she knew of to get rid of my chronic
pain?” and “Before starting Prolotherapy my only other treatment option
was surgery.” A matched sample test was also used to determine if
statistically significant improvements in the before and after
Prolotherapy measurements for pain, stiffness and crunching sensation
occurred in the above two subgroups also.
Patient characteristics
From a total of 133 patients eligible for the study, complete
data was obtained on 98 of them. The main reasons for exclusion were
inability to come for treatments primarily because of
travel/distance/scheduling (38%), stopped treatments because of M.D.
recommendation (i.e. needed treatments more frequently), other medical
problems or on their own (24%), inability or unwillingness to answer
survey (9%), had Prolotherapy treatments at other locations (6%) and
other (23%).
Complete data was obtained on a total of 98 necks who met the inclusion
criteria. Of these, 70% (69) were female and 30% (29) were male. The
average age of the patients was 55 years-old. Patients reported
an average of four years eleven months of pain, 58% had pain for greater
than four years and 42% with pain greater than six years. The average
patient saw 4.0 M.D’s before receiving Prolotherapy. Twenty-one percent
stated that the consensus of their medical doctor(s) was that surgery
was the only answer to their pain problem, and 44% of patients were told
by their physicians that there were no other treatment options for their
chronic pain. Twenty-three percent were taking one and 33% were taking
two or more pharmaceutical drugs for pain (See Table 1).
Treatment Outcomes
Patients received an average of 4.2 Prolotherapy treatments per
neck. The average time of follow-up after their last Prolotherapy
session was 18 months.
Patients were asked to rate their pain and stiffness on a scale of 1 to
10 with 1 being no pain/stiffness and 10 being severe crippling
pain/stiffness. The 98 lower necks had an average starting pain level of
5.6, crunching sensation of 5.1 and stiffness of 6.7. Their ending pain,
crunching and stiffness levels were 2.3, 2.1, and 2.4 respectively.
(See Figure 2).
Patients were asked to rate their range of
motion on a scale of 1 to 7 with 1 being no motion, 2 through 5 were
percentages of normal motion, 6 was normal motion and 7 was excessive
motion. The average starting range of motion was 3.9 and ending was 5.1
Before Prolotherapy 38% had very limited motion (49% or less of normal
motion), this decreased to only 2% after Prolotherapy.(See Figure 3)
Ninety-seven percent of patients stated
their pain was better after Prolotherapy. Over seventy percent said the
improvements in their pain, crunching and stiffness since their last
Prolotherapy session have very much continued. Eighty-nine percent of
patients stated Prolotherapy relieved them of at least 50% of their
pain. 60% received greater than 75% pain relief. Only 1 patient had less
than 25% of their pain relieved with Prolotherapy. In regard to pain
medication usage, 72% were on no pain medications after Prolotherapy.
83% of patients on medications at the start of Prolotherapy were able to
decrease them by 75% or more after Prolotherapy. None of the patients
had to increase pain medication usage after stopping Prolotherapy.
Seventy-eight percent of clients using additional pain management
therapies before Prolotherapy were able to decrease them by 50% or more
because of Prolotherapy.
In regard to quality of life issues prior
to receiving Prolotherapy, 48% had an overall disability of at least 50%
(could only do about half of the tasks they wanted to). This decreased
to 13% after Prolotherapy. Sixty-eight percent noted they had at least a
25% overall disability prior to Prolotherapy, which decreased to 23%
after. (See Figure 4)
In regard to exercise or athletic ability
prior to Prolotherapy, 36% said it was totally compromised (couldn’t do
any athletics), 14% ranked it as severely compromised (less than 10
minutes), 21% ranked it as very compromised (less than 30 minutes) and a
total of 99% ranked it as at least somewhat compromised. After
Prolotherapy, 80% of patients were able to do 30 or more minutes of
exercise with 34% not being compromised at all. 80% of clients stated
that the improvement that received with Prolotherapy in regard to
exercise ability has very much continued (>75% of improvement). (See
Figure 5)
Before receiving
Prolotherapy, 14% of the patients were dependent on someone for
activities of daily living (dressing self and additional general self
care). This went down to 4% after Prolotherapy. There were 12 patients,
prior to Prolotherapy, that rated their dependency on someone else as
greater than minimum assist (25% or greater assist), but only one
patient rated needed that much assistance after Prolotherapy. One
hundred percent of patients stated these improvements have continued
since receiving Prolotherapy.
Before receiving Prolotherapy, 16% of
patients had some dependency as far as activities of daily living but
this went down to 6% after Prolotherapy. Before Prolotherapy 14%
considered themselves completely disabled as far as their work situation
but this decreased to 6% after Prolotherapy.
Prior to Prolotherapy, 54% of patients had
feelings of depression and 60% had feelings of anxiety. After
Prolotherapy, only 16% had depressed feelings and 19% had feelings of
anxiety. (See Figures 6 and 7). According to the patients, 78% of
the improvements in depression and anxiety have very much continued
(greater than 75% of the improvement remains).
In regard to sleep, 80% of patients felt
their pain interrupted their sleep. After Prolotherapy, 88% had
improvements in their sleeping ability and 75% of patients stated that
improvement has very mostly continued (greater than 50%).
To a simple yes or no question: ‘Has Prolotherapy changed your life for
the better?’ 97% of patients treated answered ‘yes’. In quantifying the
response, 74% felt their life was at least very much better from
Prolotherapy. Sixty-nine percent stated that the results from
Prolotherapy have very much continued to this day. Ninety-five percent
felt that they still have some benefits from the Prolotherapy they
received. When asked “Are there reasons besides the Prolotherapy effect
wearing off that are causing my continued pain/disability?’ 84% answered
‘yes’. The patients noted the reasons for some of their pain coming back
were: 45% because stopped Prolotherapy treatments too soon (before pain
completely gone), 21% re-injury, 10% new area of pain, 6% had increased
life stressors, and 18% had other explanations for the pain. Of the
clients whose pain recurred after Prolotherapy was stopped, 77% are
planning on receiving more Prolotherapy.
Seventy-three percent of patients knew someone who had received
Prolotherapy. Seventy-one percent came to receive their first
Prolotherapy session because of the recommendation of a friend. Ninety
percent of patients treated considered the Prolotherapy treatment on
them to be very successful (greater than 50 percent pain relief).
Ninety-nine percent noted the Prolotherapy was at least somewhat
successful (greater than 25 percent pain relief). Only one patient of
the ninety-eight noted that it made no change. No one said the
Prolotherapy treatments made them worse. Ninety-nine percent have
recommended Prolotherapy to someone.
Statistical
Analysis
A matched sample test was used to
calculate the difference in responses for all patients between the
before and after dextrose Prolotherapy measures for pain, crunching
sensation and stiffness. Using the matched sample test on all two
variables, all p values reached statistical significance at the 1%
level. The p values for pain and stiffness were all 0, as some of them
were to the 28th decimal.
As previously noted, 44% of patients (43
in number) prior to Prolotherapy were told that there were no other
treatment options for their pain. Forty-seven percent of these patients
had pain greater than 6 years and 67% had pain greater than 4 years. In
analyzing these patients, they had a starting average pain level of 7.5
and after Prolotherapy one of 2.7. Prior to Prolotherapy, 63% of the
patients rated their pain as a level 8 or higher and only 9% rated it a
3 or less. After Prolotherapy none rated it an 8 or higher and 63% rated
it a 3 or less. (See Figure 8).
Results with stiffness and crunch levels were similar with an average
starting level of 6.8 and 6.3 and ending levels of 2.5 and 2.6,
respectively. The improvements in pain, stiffness and crunching levels
reached statistical significance. In regard to range of motion, prior to
Prolotherapy only 26% had 75% or greater of normal motion but this
increased to 74% after Prolotherapy. As a group prior to Prolotherapy,
58% of them stated that they could not do at least 50% of the tasks they
wanted to do. This decreased to 14% after Prolotherapy. In regard to
range of motion, prior to Prolotherapy 74% noted less than half of
normal neck motion, but this declined to 26% after Prolotherapy. Before
Prolotherapy only 26% noted a slight restriction of motion (75%-99% of
normal motion) or normal motion, whereas after Prolotherapy this
increased to 75%.
Before Prolotherapy 36% could not exercise at all, whereas after
Prolotherapy this was down to 7%. Only 5% ranked their exercise ability
as not compromised before Prolotherapy, but after Prolotherapy 75% rated
it as not compromised. For those patients on pain medication, 97% of
them were able to decrease it by 50% or more. Seventy-eight percent of
them were able to decrease their need for additional pain therapies by
50% or more. Before Prolotherapy, 65% felt at least some depression and
65% also some anxiety. This decreased to 21% depressed and 30% anxious
after Prolotherapy.
Ninety-three percent of these patients
noted the Prolotherapy treatment on them gave them greater than 50% pain
relief with 58% of them receiving 75% or greater pain relief. One
hundred percent of them had 25% or greater pain relief. Eighty-six
percent of those on medications were able to decrease them by 75% or
more after Prolotherapy. Forty percent were able to get off of
prescription medications completely for pain. In response to the
question ‘Has Prolotherapy changed your life for the better?’ 95%
answered ‘yes’. All 100% of them have recommended Prolotherapy to
someone else. In this group of patients 91% noted that their overall
results from Prolotherapy have mostly continued to this day (greater
than 50%).
In regard to the question ‘Before starting Prolotherapy my only other
treatment option was surgery?’ 21% of the patients (21 in number)
answered ‘yes’. Ninety percent had pain greater than two years with
Forty-eight percent having pain greater than four years. Eighty-six
percent had seen two or more medical doctors. In analyzing data on these
patients, they started out with an average pain level of 6.6 which
decreased to 2.1 after Prolotherapy. Eighty-one percent of them having a
pain level of 3 or less after Prolotherapy. (See Figure 9)
Their starting stiffness and crunching
levels were 6.3 and 4.3 respectively. After Prolotherapy the ending
stiffness and crunching levels were 2.3 and 2.0. All pain, stiffness and
crunching level improvements reached statistical significance. Sixty-one
percent stated they had greater than 75% pain relief and a full 90% (19
of 21) had 50% or greater pain relief with Prolotherapy. In regard to
range of motion, only 29% had 75% or greater of normal range of motion
but this increased to 86% after Prolotherapy. Eighty-six percent noted
they could only exercise thirty minutes or less before Prolotherapy but
after Prolotherapy this decreased to 19%. (See Figure 10) Before
Prolotherapy, 43% considered themselves at least somewhat depressed and
38% having some anxiety. This decreased after Prolotherapy to 19%
somewhat depressed and 10% somewhat anxious. One hundred percent of
patients taking pain medication were able to decrease the dosage by 50%
or more. Forty-eight percent were able to get off of pain medications
all together. The need for additional pain management care also lessened
by 50% or more in 81% of the patients after Prolotherapy.
Only 5% of patients felt they were
disability free before Prolotherapy, but this increased to 76% after
Prolotherapy. Ninety-five percent of these patients stated in regard to
their pain that there were at least somewhat better due to Prolotherapy.
50% noted that they were radically better. All Twenty-one (100 percent)
of the patients knew someone who was helped with Prolotherapy and have
recommended Prolotherapy to someone else. Eight-one percent felt that
their lives were very much better because of Prolotherapy. All one
hundred percent said that Prolotherapy changed their life for the
better.
Discussion
Principle Findings
The results of this retrospective,
uncontrolled, observational study, show that Prolotherapy helps decrease
pain and improve the quality of life of patients with unresolved neck
pain. Decreases in pain, stiffness and crunching levels reached
statistical significance with Prolotherapy even in patients whose M.D’s
said there were no other treatment options for their neck pain or that
surgery was their only option. Sixty percent of patients had greater
than 75% of their pain relieved with Prolotherapy with 91% of percent of
patients stated Prolotherapy relieved them of at least 50% of their
pain. More than 80% showed improvements in walking ability, exercise
ability, anxiety, depression and overall disability with Prolotherapy.
Ninety percent of patients who were on medications were able to cut
their medication usage by 50% or more after Prolotherapy. They were able
to lessen additional pain management care by 50% or more in 75% of
cases. Ninety-eight percent of patients stated their pain was better
with Prolotherapy. Ninety seven percent said that dextrose Prolotherapy
changed their life for the better.
Strengths and Weaknesses
Our study cannot be compared to a clinical
trial in which an intervention is investigated under controlled
conditions. Instead, it’s aimed to document the response of patients
with unresolved neck pain to the Hemwall-Hackett technique of
Prolotherapy at a charity medical clinic. Clear strengths of the study
are the numerous quality of life parameters that were studied. Such
quality of life issues as walking ability, stiffness, range of motion,
activities of daily living, athletic (exercise) ability, dependency on
others, work ability, sleep, anxiety and depression, in addition to pain
level, are important factors affecting the person with unresolved neck
pain. Decreases in medication usage and additional pain management care
were also documented. The improvement in such a large of necks treated
solely by Prolotherapy is likely to have resulted from Prolotherapy.
Another strength is that many of the above parameters are objective. So
while there is no medical test to document pain improvement or the
progress with Prolotherapy, an increased ability to walk, exercise,
work, and use less medications and other pain therapies are objective
changes.
The quality of the cases treated in this
study is also strength. The average person in this study had unresolved
neck pain for four years eleven months and had seen over three
physicians already. Sixty-four (65%) of the patients were either told by
their M.D. (s) that there was no other treatment option for their pain
or that surgery was their only option. So clearly this patient
population represented chronic unresponsive neck pain. Having a
follow-up time on average of eighteen months since their last
Prolotherapy session also was a strength.
Because this was a charity medical clinic
with limited resources and personnel, the only therapy that was used was
Prolotherapy. The Prolotherapy treatments could only be given every
three months. In private practice, the Hemwall-Hackett technique of
dextrose Prolotherapy is typically given every four to six weeks. If a
client is not improving or has poor healing ability, the Prolotherapy
solutions may be changed and strengthened or the client is advised on
additional measures to improve their overall health. This can include
advice on diet, supplements, exercise, weight loss, changes in
medications, additional blood tests, and other medical care. Often
clients are weaned immediately off of anti-inflammatory and narcotic
medications that inhibit the inflammatory response that is needed to get
a healing effect from Prolotherapy. Since this was not done in this
study, the results at this charity clinic are an indication of the
lowest level of success with Hemwall-Hackett Prolotherapy. This makes
the results even that much more impressive.
A shortcoming of our study is the
subjective nature of some of the evaluated parameters. Subjective
parameters of this sort included pain, anxiety, depression and
disability levels. The results relied on the answers to questions by the
patients. Another shortcoming is the additional pain management care
that they were receiving was not controlled. What was documented was the
change that occurred in it with Prolotherapy. There was also a lack of
X-ray and MRI correlation for diagnosis and response to treatment. A
lack of physical examination documentation in the patients’ chart made
categorization of the patients into various diagnostic parameters
impossible.
Interpretation of Findings
Current conventional therapy for unresolved neck pain include:
medical treatment with analgesics, non-steroidal anti-inflammatory
drugs, anti-depressant medications, epidural or other steroid shots,
trigger point injections, muscle strengthening exercises, physiotherapy,
weight loss, rest, massage therapy, intradiscal electrothermal therapy,
manipulation, neck braces, implanted spinal cord stimulators or morphine
pumps, surgical treatments that range from disc replacements to fusions,
multidisciplinary group rehabilitation, education and counseling. The
results of such therapies often leave the patients with residual pain.9-17
Because of this many patients with chronic neck pain are searching for
alternative treatments for their pain.18 One of the
treatments they are trying is Prolotherapy.47
Prolotherapy is the injection of a solution for the purpose of
tightening and strengthening weak tendons, ligaments or joint capsules.
Prolotherapy works by stimulating the body to repair these soft tissue
structures. It starts and accelerates the inflammatory healing cascade
by which fibroblasts proliferate. Fibroblasts are the cells through
which collagen is made and by which ligaments and tendons repair.
Prolotherapy has been shown in one double blinded animal study in a
six-week period to increase ligament mass by 44 percent, ligament
thickness by 27 percent and the ligament-bone junction strength by 28
percent.48 In human studies on Prolotherapy, biopsies
performed after the completion of Prolotherapy showed statistically
significant increases in collagen fiber and ligament diameter of 60
percent.49,50 Fluoroscopically guided cervical Prolotherapy
for instability has shown statistically significant results in regard to
pain relief correlating it with improvements in the instability with
blinded pre and post radiographic readings.51 Prolotherapy
for chronic spinal pain including in the neck has also been shown to
improve ones ability to work.52
While the exact cause of chronic neck pain is still debated, this
study did show that the Hemwall Hackett technique of dextrose
Prolotherapy improves not only the pain level and work ability of those
with chronic neck pain it improved a host of other quality of life
measures. The Hemwall Hackett technique of dextrose Prolotherapy to the
neck involves injections into all the various trigger points in the
neck. In this study, specifically the injections were given at the
fibro-osseous junction of various soft tissues that attach to the
superior and inferior nuchal ridge, greater occipital protuberance, as
well as the cervical facets and transverse processes. The posterolateral
clavicle and superior medial border of the scapula were also injected.
It is this thoroughness in each treatment using the Hemwall-Hackett
technique of Prolotherapy that most likely is responsible for the
significant improvements in this patient population. Despite on average
having had the pain for almost five years and 44% of the patients being
told by their M.D’s that there were no other treatment options available
for them and 21% being told that surgery was their only answer, dextrose
Prolotherapy caused a statistically significant decline in their
unresolved neck pain, stiffness and crunching sensation. Ninety-one
percent said the dextrose Prolotherapy on them was very successful
giving them greater than 50% pain relief. More than 83% showed
improvements in walking ability, exercise ability, anxiety, depression
and overall disability with Prolotherapy. Overall 98% of patients stated
their pain was better with Prolotherapy. Ninety-eight percent felt that
they still had some benefits from the Prolotherapy they received on
average eighteen months prior. Ninety-seven percent treated said the
Hemwall-Hackett dextrose Prolotherapy changed their life for the better.
Conclusions
The Hemwall-Hackett technique of dextrose Prolotherapy used on
patients who had an average duration of four years eleven months of
unresolved neck pain who were eighteen months out from their last
Prolotherapy session was shown in this observational study to improve
their quality of life. They reported less pain, stiffness, crunching
sensation, disability, depressed and anxious thoughts, medication and
other pain therapy usage, as well as improved walking ability, range of
motion, sleep, exercise ability, and activities of daily living.
Therefore, Prolotherapy is a treatment that should be highly considered
for people suffering with unresolved neck pain.
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