|
|
STATISTICAL ANALYSIS
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 40 patients. Using the paired t-test, all p values for pain and stiffness for the two groups reached statistical significance at the p < 0.000001 level or less. (See Table 2.)
| Table 2. Summary of results of Hackett-Hemwall dextrose Prolotherapy hand study. |
| Total number of patients |
40
|
| Average months of pain |
55
|
| Average pain level before Prolotherapy |
5.9
|
| Average pain level after Prolotherapy |
2.6
|
| Paired t ration |
15.534
|
| P value |
p < .000001
|
| Average stiffness level before Prolotherapy |
5.6
|
| Average stiffness level after Prolotherapy |
2.7
|
| Paired t ration |
13.477
|
| P value |
p < .000001
|
| Greater then 50% pain relief |
82%
|
Discussion
PRINCIPLE FINDINGS
The results of this retrospective, uncontrolled observational study, show that Prolotherapy helps decrease pain and stiffness in patients with previously unresolved hand/ finger pain. The Hackett-Hemwall dextrose Prolotherapy gave 82% of them 50% or more pain relief. Medication use was also lessened after Prolotherapy.
STRENGTHS AND LIMITATIONS
ComplOur study cannot be compared to a clinical trial in which an intervention is investigated under controlled conditions. Instead, it is intended to document the response of patients with unresolved hand and finger pain and stiffness to Prolotherapy at a charity medical clinic.
The quality of the cases is a strength in this study. The average reported length of pain was four years, seven months. The average patient had seen 2.8 MD’s prior to receiving Prolotherapy. Plainly, these represented chronic unresponsive hand and finger pain cases. The only therapy provided for the patients at the clinic was Prolotherapy, which was administered every three months. In private practice, Hackett-Hemwall dextrose Prolotherapy is typically given every four to six weeks. The treating physician may also assess and recommend additional measures to improve a patient’s overall health, such as diet/nutritional intervention, exercise, work/ergonomic changes, changes in medications, and other medical care. Patients are often weaned off anti-inflammatory and opiod medications prior to, or at the start of the treatment series. Since this was a free medical clinic where no additional services were able to be rendered, the results of this study are likely an indication of the lowest level of success with Hackett-Hemwall dextrose Prolotherapy. This makes the results more remarkable. Decrease in pain medication was also documented.
A shortcoming of the study is the subjective nature of the evaluated parameters, including pain and stiffness levels. However, the documented decrease in medication was documented and objective. An additional limitation of our study is the lack of radiologic (X-ray or MRI) correlation for diagnosis and response to treatment. Further, there was a lack of physical examination documentation to group the patients into various diagnostic categories.
INTERPRETATION OF FINDINGS
Hackett-Hemwall dextrose Prolotherapy was shown to be very effective in reducing pain and stiffness in this group of patients with unresolved hand and finger pain. 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.38 Fibroblasts are the cells through which collagen is made and by which ligaments, cartilage, and tendons repair.39 Prolotherapy has been shown in one double-blinded animal study in a six-week period to increase ligament mass by 44%, ligament thickness by 27% and the ligament-bone junction strength by 28%.40 In other studies on Prolotherapy, biopsies performed after the completion of Prolotherapy showed statistically significant increases in tendon and ligament collagen fiber and diameter of 60%.41, 42 This is significant since ligament injury has been implicated as the cause of degenerative osteoarthritis in joints.43 When a ligament is damaged, stretched, or torn, it can cause joint instability. The joint instability due to the ligament injury/laxity causes uneven stress distribution, which leads to joint degeneration and resulting pain and can help identify those who are predisposed to the development of OA.44, 45 Although the joints in the hands and fingers are non-weight bearing, they are very mobile and subject to cartilage breakdown from overuse or excessive force.46
As Fleming et al. explain in their article on ligament injuries and osteoarthritis, “The ligament-injured joint is at high risk for osteoarthritis. Current conservative (e.g. rehabilitation) and surgical (e.g. reconstruction) treatment options appear not to reduce osteoarthritis following ligament injury. Mechanical instability is the likely initiator of osteoarthritis in the ligament-injured patient.”47 The stability of the carpometacarpal joints of the fingers and thumbs depends on the integrity of the articular surfaces of the bones and on the health of the ligaments and muscles attached to them.48 Without addressing the ligament laxity, sequelae from ligament injury can include chronic pain, chronically unstable or deformed joints.49
Current conservative and traditional chronic pain treatments, such as for hand pain, do not work to repair ligament laxity, but generally do temporarily block the pain.50 Because Prolotherapy corrects underlying ligament physiology and biomechanics, it has the potential not only stop the pain but also the degenerative process.51 In his study on finger pain, Dr. K. Dean Reeves and associates showed that six series of injections of dextrose Prolotherapy not only caused improvements in pain and range of motion of the fingers, but also statistically significant improvement in joint narrowing score on Xrays compared to placebo.52 This current study adds to the scientific literature that Prolotherapy helps decrease pain, stiffness, and medication usage for patients suffering with chronic hand and finger pain. More research is needed to see if indeed Prolotherapy can actually reverse the arthritic process.
 |
 |
