Dextrose Prolotherapy for Unresolved Neck Pain
Neck pain is a common condition affecting about 10% of the general population of North America at any given time, over a year up to 45%, and over a lifetime 70%.1-3 Neck pain results in a significant amount of disability and health care use in the United States, with large personal and economic consequences.4,5 As the duration of neck symptoms increases, especially beyond six months, one’s mental health is negatively affected. Younger patients are more impacted by neck and referral arm symptoms more than older patients.6 It is well documented that the longer the pain persists, the more likely it will become chronic—with up to 7% of patients ending up with chronic neck pain.7,8
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While there is some consensus on how to treat acute painful neck episodes, there is much debate on how to treat chronic neck pain. Most monotherapies either do not work or have limited efficacy.9 Non-steroidal anti-inflammatory drugs and anti-depressants have some short term benefit but no published data vindicate their long-term use.10 Manipulative therapy, physiotherapy, and massage therapy all show some temporary benefit but do little to curb long-term pain.11,12,13 Some people turn to more invasive therapies like percutaneous radiofrequency neurotomy or surgery, but long-term results have been poor and surgeries are fraught with complications.14-17 Because of the limited response to traditional therapies, many people are turning to alternative therapies including prolotherapy for pain control.18-20
Prolotherapy is becoming a widespread form of pain management in both complementary and allopathic medicine.21,22 Its primary use is in pain management associated with tendin-opathies and ligament sprains in peripheral joints.23-25 It is also being used in the treatment of spine and joint degenerative arthritis.26,27 Prolotherapy has long been used for chronic low back pain arising from the sacroiliac joints and as an alternative to surgery.28-30 Prolotherapy has been shown in low back studies to improve pain levels and range of motion.31,32 In double-blinded human studies, the evidence on the effectiveness of prolotherapy has been considered promising but mixed.33-36
Current conventional therapy for unresolved neck pain include: medical treatment with analgesics, non-steroidal anti-inflammatory drugs, anti-depressant medications, epidural or other steroid shots, trigger point injections, muscle strengthening exercises, physiotherapy, weight loss, rest, massage therapy, intradiscal electrothermal therapy, manipulation, neck braces, implanted spinal cord stimulators or morphine pumps, surgical treatments that range from disc replacements to fusions, multidisciplinary group rehabilitation, education, and counseling. The results of such therapies often leave the patients with residual pain.9-17 Because of this, many patients with chronic neck pain are searching for alternative treatments for their pain.18 One of the treatments they find promising is prolotherapy.37
Prolotherapy is the injection of a solution for the purpose of tightening and strengthening weak tendons, ligaments or joint capsules. Prolotherapy works by stimulating the body to repair these soft tissue structures. It starts and accelerates the inflammatory healing cascade by which fibroblasts proliferate. Fibroblasts are the cells through which collagen is made and by which ligaments and tendons repair. Prolotherapy has been shown in one double-blinded animal study over a six-week period to increase ligament mass by 44 percent, ligament thickness by 27 percent, and the ligament-bone junction strength by 28 percent.38 In human studies on prolotherapy, biopsies performed after the completion of treatment showed statistically significant increases in collagen fiber and ligament diameter of 60 percent.39,40 Fluoroscopically-guided cervical prolotherapy for instability has shown statistically significant results in regard to pain relief and correlates with improvements in the instability with blinded pre- and post-radiographic readings.41 Prolotherapy for chronic spinal pain and the neck has also been shown to improve one’s ability to work.42
George S. Hackett, MD, coined the term prolotherapy.43 As he described it, “The treatment consists of the injection of a solution within the relaxed ligament and tendon which will stimulate the production of new fibrous tissue and bone cells that will strengthen the ‘weld’ of fibrous tissue and bone to stabilize the articulation and permanently eliminate the disability.”44 Animal studies have shown that prolotherapy induces the production of new collagen by stimulating the normal inflammatory reaction.45,46 In addition, animal studies have shown improvements in ligament and tendon diameter and strength.47,48 Dr. Hackett himself reported good to excellent results in 90% percent of 82 consecutive patients he treated with neck and/or headache pain using prolotherapy. He surmised the neck pain and referral headaches were from ligament damage from whiplash-type injuries.49,50 Dr. Kayfetz and associates confirmed these results in a similar group of patients.51,52 Recent research, using flexion/extension x-rays to document cervical spine instability and fluoroscopically-guided cervical prolotherapy, demonstrated statistically significant correlations between a reduction in both cervical flexion and extension translation and improvement in the patients pain level.37 While these results are promising, they looked primarily at neck pain control.
The observational study described in this article was undertaken to evaluate the effectiveness of Hemwall-Hackett dextrose prolotherapy not just for neck pain but also quality of life measures.
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).