A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Shoulder Pain at an Outpatient Charity Clinic in Rural Illinois

Authors: Ross A. Hauser, MD & Marion A. Hauser, MS, RD

Shoulder pain is one of the most common reasons patients give for a physician pain visit, third only to headache and back pain.¹ It is a significant cause of morbidity worldwide with an incidence of 11-19 cases per 1,000 patients per year.² The prevalence increases with age, shoulder pain affecting 21% of persons 70 years and older.³ The incidence of shoulder pain is escalating, especially among office workers with intensive computer use.^4,5 Because this occupational hazard is likely to increase in the future, it is all the more important to find effective therapies to treat chronic shoulder pain. Current conventional therapies for unresolved shoulder pain include: medical treatment with analgesics, non-steroidal anti-inflammatory drugs, anti-depressant medications, steroid shots, trigger point injections, muscle strengthening exercises, physiotherapy, acupuncture, chiropractic care, rest, massage therapy, manipulation, orthotics, surgical treatments including arthroscopy or total shoulder replacement, multidisciplinary group rehabilitation, education and counseling. The results of such therapies often leave the patients with residual pain.^6-11

Prolotherapy is gaining in popularity as a pain management therapy in both complementary and allopathic medicine.^12-15 Its primary use is in the pain management associated with tendinopathies and ligament sprains in peripheral joints.^16,17 It also has a long history of being used in the treatment of spine and joint degenerative arthritis.^18-20 In double-blind human studies the evidence on the effectiveness of Prolotherapy has been considered promising but mixed.^21-23 Prolotherapy treatment is now done at some major medical centers and universities.^24,25

George S. Hackett, MD, coined the term Prolotherapy.²⁶ 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.”²⁷ Animal studies have shown that Prolotherapy induces the production of new collagen by stimulating the normal inflammatory reaction.^28,29 In addition, animal studies have shown improvements in ligament and tendon diameter and strength.^30,31 Human studies have shown improvements in pain symptoms including those with chronic low back pain.^32-35 Studies on the effectiveness of Prolotherapy on knee pain have been promising.^36,37 Though Prolotherapists routinely treat shoulder problems with Prolotherapy³⁸, no studies have been published to date. To evaluate the effectiveness of Hackett-Hemwall dextrose Prolotherapy, not just on shoulder pain but on quality of life measures, this observational retrospective study was undertaken.

Objective: To investigate the outcomes of patients undergoing Hackett-Hemwall dextrose Prolotherapy treatment for unresolved shoulder pain at a charity clinic in rural Illinois.

Patients and Methods: Patients with unresolved shoulder pain treated with dextrose Prolotherapy every three months were included into an observational study. The patients were called on the phone and asked to answer detailed questions on the level of their shoulder pain, stiffness, range of motion, medication usage, anxiety, depression, activities of daily living, and other quality of life measures before and after receiving dextrose Prolotherapy.

Results: Complete data was available on 94 shoulders who were treated during the years 2001-2005. The average starting shoulder pain level was 7.1 and ending shoulder pain level was 2.3. A matched sample paired t-test was used to calculate the difference in responses between the before and after measures for pain and stiffness for the 94 shoulder patients. The paired t-ratios for both pain and stiffness on the 94 shoulders were highly significant, using N pairs minus one as the degrees of freedom. For the entire 94 shoulder study participants the paired t-ratio was significant for pain relief at t(93)=-13.3 p<.0000001. In regard to stiffness, this also reached the highly statistically significant range with the paired t-ratio being t(93) = 15.77 p<.0000001. Range of motion improvement also reached statistical significance at t(93) = -13.13 p<.0000001.

In the subgroup who were told surgery was their only option the paired t-ratio was significant for pain relief at t(19)=11.38 p<.0000001. For stiffness in the subgroup of patients told surgery was their only option the paired t-ratio was significant for stiffness relief at t(19)=5.85 p<.0000001. Shoulder range of motion showed the paired t-ratio as significant at t(19) = -8.82 p<.0000001.

In patients told that no other treatment option existed, the results were also highly significant. In this subgroup of 37 patients, pain relief reached statistical significance with the paired t-ratio being t(36)=17.92 p<.0000001. For stiffness before and after Prolotherapy in this subgroup who were told there were no other treatment options, the paired t-ratio was also significant for stiffness at t(36)=10.31 p<.0000001 and for range of motion at t(36) = -10.82 p<.0000001.

The percentage of patients that had improvements in their pain after treatment with Prolotherapy was 97%. The percentage of patients that were able to decrease their medication usage by 75% or more was 87%. More than 76% of patients were able to decrease their additional pain treatments by 75% or more. Anxiety and depression symptoms were present in 47% and 55% respectively before Prolotherapy and only in 12% and 19% respectively after Prolotherapy. While 62% of patients could exercise less than 30 minutes prior to Prolotherapy, this dropped to 22% after Prolotherapy. Ninety-seven percent of patients felt Prolotherapy improved their life overall.

Conclusions: In this retrospective study, patients with an average of 53 months of chronic shoulder pain, even those whose medical doctors told them there was no other treatment for their pain or that surgery was their only option, reported clinically relevant improvements in their pain level and quality of life after receiving Hackett-Hemwall dextrose Prolotherapy.