Prolotherapy Research - Neck Pain

Subgroup Analysis

Patient percentages were also calculated for patients who answered “yes” to either of the following two statements:

1. Before starting prolotherapy it was the consensus of my medical doctor(s) that there were no other treatment options that he/she knew of to get rid of my chronic pain.” and
2. Before starting prolotherapy my only other treatment option was surgery.”

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 in the above two subgroups. 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.

No Other Treatment Options’ Subgroup. Forty-three patients had been told by their doctors that there were no other treatment options for their pain prior to presenting for prolotherapy. Forty-seven percent of these patients had pain greater than 6 years and 67% had pain greater than 4 years. Table 2 presents a summary of outcomes at follow up for this subgroup.

Ninety-three percent of these 43 patients noted that prolotherapy treatments gave them greater than 50% pain relief with 58% of them receiving 75% or greater pain relief (see Figure 8). 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 43 of them have recommended prolotherapy to someone else. In this group of 43 patients, 91% noted that their overall results from prolotherapy have mostly continued to this day (greater than 50%).

Figure 8. Starting and ending pain level before and after Hemwall-Hackett Prolotherapy in 43 Patients that were Told there No Other Option for their Pain.

Surgery Is Only Treatment Option’ Subgroup.
Twenty-one patients had been told by their doctors that there were no other treatment options for their pain prior to presenting for prolotherapy. 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. Table 3 presents a summary of outcomes at follow up for this subgroup.

Eighty-one percent of this group of 21 experienced a pain level of 3 or less after prolotherapy (see Figure 9). 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. Eighty-six percent noted they could only exercise thirty minutes or less before prolotherapy but after prolotherapy the percentage decreased to 19% (see Figure 10).

Figure 9. Starting and ending pain level before and after Hemwall-Hackett Dextrose Prolotherapy in 21 Patients that were told there was no treatment option other than surgery.

One hundred percent of patients taking pain medication were able to decrease their 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.

Figure 10. Starting and ending athletic (exercise) ability before and after Hemwall-Hackett dextrose prolotherapy in 21 patients that were told there was no other treatment option other than surgery.

Ninety-five percent of these patients stated that their pain was 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. Eighty-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.

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 even in patients whose medical doctors 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 and 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 treatment. 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 decreased with prolotherapy. Ninety-seven percent said that dextrose prolotherapy changed their life for the better.

Study Strengths and Weaknesses. Our study cannot be compared to a clinical trial in which an intervention is investigated under controlled conditions. Instead, its aim was to document the response of patients with unresolved neck pain to the Hemwall-Hackett technique of dextrose prolotherapy. Clear strengths of the study are the numerous quality of life parameters that were studied. Quality of life issues such 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 percentage of study subjects who were treated solely by prolotherapy is likely to have resulted from that treatment. Many of the above parameters are objective outcomes with progress noted in the increased ability to walk, exercise, work, and the need for less medications or other pain therapies.

The quality of the cases treated in this study is notable. The average person in this study had unresolved neck pain for 4.9 years and had seen four physicians prior to prolotherapy treatment. Sixty-four (65%) of the patients were either told by their medical doctors 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 of eighteen months, on average, since their last treatment session provided a measure of the long-lasting effect of this modality.

Because this was a charity medical clinic with limited resources and personnel, the only therapy offered was prolotherapy treatments 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 about 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 any anti-inflammatory and narcotic medications that inhibit the inflammatory response that is needed to get a healing effect from prolotherapy. Since none of these were done in this study, the results of this study are expected to be least optimum level of success achievable with Hemwall-Hackett dextrose 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 that any additional pain management care that they may have been receiving was not controlled. 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. 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, but also 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. Specifically, in this study, injections were given at the fibroosseous 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 that most likely is responsible for the significant improvements in this patient population, with a statistically significant decline in their unresolved neck pain, stiffness, and crunching sensation.

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