Treatment Outcomes |
TREATMENT OUTCOMES
Patients received an average of 3.6 prolotherapy treatments per wrist. The average time of follow-up after their last prolotherapy session was twenty-two months.
Patients were asked to rate their pain and stiffness levels on a scale of 1 to 10 with 1 being no pain/stiffness and 10 being severe crippling pain/stiffness. Starting pain level averaged 5.5 and stiffness 3.7. Ending pain and stiffness levels were both 1.4 after prolotherapy. Seventy-four percent exhibited a starting pain level of 5 or greater, while only 13% had a starting pain level of two or less; whereas after prolotherapy zero reported a pain level of 5 or greater, while 90% had achieved a pain level of two or less (see Figure 2).
| Figure 2. Pain levels before and after receiving Hackett-Hemwall dextrose prolotherapy in 31 patients with unresolved wrist pain. |
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Ninety-seven percent of patients reported improvement in pain, with 88% showing improvement in stiffness after prolotherapy. Over 90% reported that pain and stiffness improvements have been sustained 100% since their last prolotherapy treatment. Ninety percent of patients stated prolotherapy relieved them of at least 50% of their pain. Sixtyone percent received greater than 75% pain relief. Ninety-seven percent of patients achieved at least 25% pain relief with prolotherapy. In regard to pain medication usage, before prolotherapy the average patient was taking 1.1 pain medications, but this decreased to 0.2 medications after prolotherapy. Prior to prolotherapy 17 (55%) of the patients were taking one or more medications, but at follow-up, 22 months after their last prolotherapy session, only 7 (23%) patients were taking one pain medication. 100% of patients who were not taking pain medications at the time their prolotherapy sessions ended never returned to needing pain medications.
Eighteen patients (58%) reported wrists with incomplete range of motion before prolotherapy. After prolotherapy, only six (19%) patients reported incomplete range of motion in their wrists (see Figure 3). Patients average wrist crepitation was 2.8 before prolotherapy, but only 1.5 after prolotherapy.
| Figure 3. Range of motion levels before and after receiving Hackett-Hemwall dextrose prolotherapy in 31 patients with unresolved wrist pain. |
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In regard to quality of life issues prior to receiving prolotherapy, 80% were totally independent in activities of daily living, but this increased to 94% after prolotherapy. In regard to exercise ability before prolotherapy, only 36% could exercise greater than 30 minutes, but after prolotherapy this increased to 87 % (see Figure 4).
| Figure 4. Exercise ability before and after receiving Hackett-Hemwall dextrose prolotherapy in 31 patients with wrist pain. |
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Feelings of depression were reported in 32% and feelings of anxiety were reported in 38% of the patients prior to prolotherapy treatment. After prolotherapy, feelings of depression were reported in 10% and feelings of anxiety were reported in 16% of the patients (see Figures 5 and 6).
| Figure 5. Depression levels before and after receiving Hackett-Hemwall dextrose prolotherapy in 31 patients with wrist pain. |
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| Figure 6. Anxiety levels before and after receiving Hackett-Hemwall dextrose prolotherapy in 31 patients with wrist pain. |
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Interrupted sleep due to wrist pain was reported by 55% of the patients prior to prolotherapy treatment while improvement in sleep was reported by 82% of the patients after prolotherapy treatment.
To a simple yes or no question, “Has prolotherapy changed your life for the better?” All of the patients treated answered “yes.” Seventy-seven percent of the patients reported that, overall, greater than 75% of their improvements resulting from prolotherapy remained positive after prolotherapy treatments ended. Of those whose pain/disability had increased since stopping the prolotherapy, 81% noted reasons for this occurrence. Fifty-five percent claimed the prolotherapy was stopped too soon (before 100% pain relief was achieved). Twenty-two percent reported a re-injury to the area. One hundred percent of patients knew someone who had received prolotherapy. Sixty-eight percent came to receive their first prolotherapy session on the recommendation of a friend. One hundred percent of patients have recommended prolotherapy to someone.
RESULTS FOR THOSE TOLD NO OTHER TREATMENT OPTIONS WERE AVAILABLE OR SURGERY WAS THEIR ONLY TREATMENT OPTION
As previously noted, prior to prolotherapy 14 (45%) patients were told no other treatment options were available for their wrist pain. As a group they suffered with pain an average of 66 months. Analysis of these patients revealed a starting average pain level of 6.2 and a post-prolotherapy pain level of 1.5. Wrist stiffness averaged 4.0 prior to prolotherapy treatments and improved to 1.5 after completing the treatments. Eleven out of fourteen (78%) achieved 50% or greater pain relief. Prior to prolotherapy only 36% of the patients could exercise longer than 30 minutes, but this increased to 78% after prolotherapy.
Five patients (16%) were told that surgery was the only option available to eliminate their wrist pain. Their average pain duration prior to prolotherapy was 39 months. Their starting average pain level was 4.8 before prolotherapy, which declined to 1.2 after prolotherapy. Reported wrist stiffness was 1.8 prior to prolotherapy and 1.0 after completing their prolotherapy treatments. All five patients (100%) exhibited 50% or greater pain relief. One out of five of the patients could exercise longer than 30 minutes prior to prolotherapy, but this number increased to four out of five after prolotherapy (see Table 2).
STATISTICAL ANALYSIS
A matched sample paired t-test was used to calculate the difference in responses between the before and after measures for pain, stiffness, and exercise ability for the 31 patients—including the subgroup of 14 patients who were told by their medical doctor(s) that no other treatment options were available, and the subgroup of five patients who were told by their medical doctor( s) that surgery was their only option. Using a paired sample t-test, all p values for pain in all three groups reached statistical significance at the p<.008 level. The p values for stiffness in the total group (31 patients) with wrist pain and the subgroup of 14 patients reached statistical significance at the p<0.004 level. The p values for exercise ability, for the 31 total patients with wrist pain and the subgroup of 14 patients, reached statistical significance at the p<0.0001 level (see Table 2).
| Table 2. Summary of results for retrospective study of patients with wrist pain treated with dextrose prolotherapy. |
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