Prolotherapy Research - Neck Pain

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 treatment offered was Hemwall-Hackett dextrose prolotherapy for pain control. Dextrose was selected as the main ingredient in the prolotherapy solution because it is the most common proliferant used in prolotherapy, is readily available, is inexpensive when compared to other proliferants, and has a high safety profile. The clinic met every three months starting in 2000 until July 2005. All treatments were given free of charge.

Patient Criteria. General inclusion criteria include being at least 18 years old, 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 a lesser number of sessions).

Figure 1. Typical Injection Sites for Hemwall-Hackett Dextrose Prolotherapy of the Neck

Interventions. 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 are illustrated 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. The patients were asked to cut down or stop other pain medications and therapies they were using as much as the pain would allow.

Data Collection. Patients were called by telephone and interviewed by a data collector (D.P.) who had no prior knowledge of prolotherapy both before and after conclusion of treatments. D.P. was the sole person obtaining the patient information during the telephone interviews. The patients were asked a series of detailed questions about their pain and previous treatments before starting prolotherapy. Their response to prolotherapy treatments was also documented in detail with an emphasis on the effect the treatments 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, medications taken, stiffness, walking and exercise ability, activities of daily living, quality of life concerns, and psychological factors. Also noted was whether the post-treatment benefits continued substantially after the sessions concluded.

Statistical 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 treatment.

Patient Characteristics. From a total of 133 patients eligible for the study, complete data was obtained on a total of 98 patients who met the inclusion criteria. Of those excluded, the main reasons for were:

• inability to come for treatments primarily because of travel/distance/scheduling (38%),
• stopped treatments because of MD recommendation (i.e. needed treatments more frequently), other medical problems, or of their own volition (24%),
• inability or unwillingness to answer survey (9%),
• had prolotherapy treatments at other locations (6%), and
• other (23%).

Of the 98 study participants, 70% (69) were female and 30%(29) were male. The average age was 55 years-old. Patients reported an average of 4.9 years of pain. Fifty eight percent had pain longer than four years and 42% had pain longer than six years. The average patient saw 4 medical doctors 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 pharmaceutical drug, while 33% were taking two or more drugs for pain(see Table 1).

Neck study reference:
Hauser R, Hauser M. Dextrose Prolotherapy for unresolved neck pain. Practical Pain Management. 2007; 7(8):56-69.