Patients and Methods |
FRAMEWORK AND SETTING
In October 1994, the primary authors of this study opened a Christian charity clinic called Beulah Land Natural Medicine Clinic located in an impoverished area of rural southern Illinois. An all volunteer staff composed of MDs, RNs, clinical assistants, and administrative staff ran the clinic every three months until July, 2005. Hackett-Hemwall dextrose prolotherapy was utilized as the treatment of choice. Dextrose was selected because it is the most common proliferant used in prolotherapy. The patients traveled from many different areas of the country to receive prolotherapy—primarily from Kentucky, Missouri, and Illinois. The patients were seen and treated free of charge.
PATIENTS
Patients who received prolotherapy for their unresolved wrist pain in the years 2000 to 2005 were called by telephone and interviewed by an independent data collector (D.P.) who had no prior prolotherapy knowledge. General inclusion criteria were the following: at least 18 years of age, presence of an unresolved wrist pain condition that typically responds to prolotherapy, and a willingness to undergo at least four prolotherapy sessions, unless the pain remitted with fewer prolotherapy sessions. Typical wrist conditions that responded to prolotherapy included carpal instability, tendinopathy, ligament sprain, and wrist degenerative arthritis. Patients who were thought to have median nerve entrapment were not included.
INTERVENTIONS
The 31 wrist pain patients each received prolotherapy for their painful condition using the Hackett-Hemwall technique of prolotherapy. Each patient received 20 to 30 injections of a 15% dextrose, 0.2% lidocaine solution with a total of 15 to 30cc of solution used per wrist. Injections were given into and around the painful and/or tender-to-touch areas of the wrist. Figure 1 outlines the typical injection sites where 0.5 to 1cc of solution were given. Tender areas injected included the carpal bones, as well as ligament and tendon attachments in the wrist. The patients were asked to reduce or eliminate pain medications as much as the pain would allow.
OUTCOMES
Only one person (D.P.) conducted the telephone interviews and obtained patient data. The patients were asked a series of questions related to pain and various symptoms before starting prolotherapy. Their response to prolotherapy was also detailed with an emphasis on the effect prolotherapy had on their wrist pain, stiffness, and quality of life. Data collection consisted of questions concerning years of pain, pain intensity, stiffness, number of physicians seen, medications taken, quality of life concerns, psychological factors and whether the response to prolotherapy continued after the prolotherapy sessions ended.
STATISTICAL ANALYSIS
An independent data analyst (D.G.) tabulated, graphed, and presented the results of the data collected by D.P. during the telephone interviews. The responses gathered from patients before prolotherapy were compared with the responses to the same questions after prolotherapy. Results were also calculated for two subgroups of patients who were either told that no other treatments were available in the opinion of the patients’ physicians or who were told prior to starting prolotherapy that surgery was their only option for their wrist pain. A matched sample paired t-test was used to determine statistically significant improvements in the before-and-after prolotherapy measurements for pain, stiffness, and exercise ability in all wrists, as well as the two subgroups described above.
PATIENT CHARACTERISTICS
Complete data was obtained on a total of thirty-one wrist pain patients who met the inclusion criteria. Eighteen (63%) were female and thirteen (37%) were male, with an average patient age of 55 years. Patients reported an average wrist pain duration of four years and four months and the average patient saw 2.6 MDs before receiving prolotherapy. The average patient was taking 1.1 pain medications prior to receiving prolotherapy. Fourteen (45%) were told by their physicians that no other treatment options for their chronic wrist pain existed. Five (16%) stated that the only other treatment option given for their wrist pain was surgery. A summary of the patient demographics is presented in Table 1.
| Table 1. Patient Characteristics Prior to Prolotherapy. |
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