Patients and Methods

Framework and Setting. In October 1994, the authors 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 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 until it ended in July 2005. All treatments were given free of charge.

FIGURE 1. Typical injection sites for Hemwall-Hackett dextrose Prolotherapy of the TMJ.

Patient Criteria. General inclusion criteria included being at least 18 years old, having TMD for more than six months, and a willingness to undergo at least four prolotherapy sessions (unless the pain remitted with fewer sessions).

Interventions. Each patient received four to six injections of a 15% dextrose, 0.2% lidocaine solution with a total of two to four cc’s of solution used per temporomandibular joint. Typically, one cc of solution was injected into the joint and the remaining solution was injected onto the TMJ ligament and capsular attachments on the zygomatic arch and mandibular condyle and neck (See Figures 1 and 2). The patients were asked to hold their mouths half open while the injections were given. No other therapies were used. The patients were asked to reduce or stop other pain medications and therapies they were using as much as the pain would allow.

FIGURE 2. Ligamentous structures of the TMJ typically treated with Hemwall-Hackett dextrose Prolotherapy.

Data Collection. Patients who were seen in the clinic in the years from 2001- 2005 and met the inclusion criteria were called by telephone and interviewed by an independent data collector who had no prior knowledge of prolotherapy and was the sole data collector gathering 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, as well as their quality of life. Specifically, patients were asked questions concerning years of pain, pain intensity, overall disability, number of physicians seen, medications taken, stiffness, crunching sensations in the joint, 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, the results of the patient responses were calculated by another independent data collector who had no prior knowledge of prolotherapy. Pre-prolotherapy treatment responses were compared with the patients’ responses to the same questions after prolotherapy treatment.

Patient Characteristics. Complete data was obtained on 14 patients who met the inclusion criteria. Of the 14 study participants, 63% were female and 37% were male. The average age was 50. Patients reported an average of 5.4 years in pain. Fifty-one percent had pain greater than six years. The average patient saw four medical doctors before receiving prolotherapy. Fifty percent of the patients were told by their physicians that no other treatment options existed for their pain problem and 14% were told that surgery was their only option. Thirty-one percent were taking one pharmaceutical drug, while 39% were taking two or more drugs for pain (See Table 1).

TMJ Study reference:
Hauser, R, and Hauser, M. Dextrose Prolotherapy and Pain of Chronic TMJ Dysfunction Practical Pain Management Nov/Dec 2007; pp 49-57.