Prolotherapy for Neck Pain and Cervical Instability

MR received a cervical fusion after falling from a ladder, but symptoms worsened despite fusion and rehabilitation. Three years later he undertook Prolotherapy, and after his initial treatment, MR had relief from headaches, dizziness, insomnia and neck pain for the first time in years, with friends noting he even looked like a different person.

A 47-year-old female with a history of trauma presented to our clinic in 2013 with headaches, chronic pain in the neck and upper limbs, and intermittent tingling in one arm. Pain was exacerbated by head movement. The patient was treated with dextrose prolotherapy at each of four visits over five months. At visit 2, tingling and crepitation had abated, while pain intensity was unchanged. At visit 3, headaches had resolved, and pain had become more localized. At visit 4, pain intensity had decreased significantly, crepitation had resolved completely, and she had begun bicycle exercise.

JK suffered a whiplash injury at age 44 which rapidly progressed from a headache to difficulty walking and talking. She saw multiple specialists in her search for answers and received differing opinions on her condition. For almost 10 years prior to being seen at Caring Medical, JK experienced headaches, dizziness, elevated heart rate, and drop attacks. After analysis by Dr. Hauser, including a digital motion x-ray (DMX), she was diagnosed with cervical instability. JK underwent 3 treatments of Prolotherapy, one of those included Platelet Rich Plasma. Not only were her symptoms alleviated, but she has not experienced a drop attack since her last treatment!

After catching a falling 30lb box, RB experienced right-sided neck and sternoclavicular pain. Cervical instability symptoms like tinnitus, difficulty swallowing, heel/toe numbness and migraines developed. She received physical therapy & chiropractic with minimal relief. Two orthopedic surgeons relayed that surgery would be too dangerous. Discouraged, RB sought Regenerative Injection Therapy, but her initial Prolotherapist did not perform a comprehensive treatment. Although symptoms decreased for a time, they later returned. Doing more research into more comprehensive Prolotherapy techniques, RB decided to try Caring Medical. She received comprehensive Prolotherapy and PRP treatment under ultrasound guidance. After 3 Comprehensive Prolotherapy treatments with added Platelet Rich Plasma, RB saw a 95% improvement and returned to the activities she enjoyed.

CB was a 52 year old woman who came to Caring Medical after suffering for more than a year with neck pain, nausea, blurred vision, muscle spasms, and other symptoms associated with cervical instability. She had attempted many routes of care including; chiropractic, acupuncture, epidurals, and physical therapy. All with no relief! CB had been mistakenly diagnosed with Thoracic Outlet Syndrome by another physician who was unfamiliar with spinal instability. She had a standard MRI which showed spondylosis. Before treatment with Caring Medical she was taking between 10 and 12 tablets of Advil a day for her pain. She was no longer able to continue her active lifestyle and felt her quality of life had greatly diminished. CB received 6 rounds of Prolotherapy with Platelet Rich Plasma to her cervical and thoracic spine after being diagnosed with disc displacement and radiculopathy. She noticed improvement with each treatment, but after her last treatment she reported 100% pain relief!

SS came to Caring Medical describing symptoms of “maddening body itching,” which began a year prior, after taking prednisone. Zyrtec relieved the itch temporarily. Other symptoms included worsening migraines, intense sinus symptoms and neck “crunching noises” with head movement. Vagus nerve entrapment was suspected, and Prolotherapy to the neck was given to stabilize the loose vertebrae. Symptoms resolved, including migraines and itching, after only two treatments.

DE visited Caring Medical at the recommendation of her chiropractor after she was diagnosed with a herniated disc in her neck at the age of 48. She had been suffering for 6 weeks with neck pain and numbness in her left arm. DE received 5 rounds of Comprehensive Dextrose Prolotherapy to her cervical spine. She is now able to exercise and play golf pain-free!

BF, age 86, developed neck pain after rehabbing a shoulder injury. Diagnostic scans of the cervical spine showed osteoarthritis and forward head posture. After physical therapy and myofascial release treatments failed to help restore full function, she presented to Caring Medical with pain at the base of her skull and limited cervical rotation. The Prolotherapist recommended 5 to 6 treatments of H3 Prolotherapy while wearing a cervical collar between treatments, for added stability. She reported steady improvement with each treatment and was able to lessen the time she needed to wear the collar, as the area stabilized. After her 6th treatment, she reported feeling 98% better. She no longer had any neck pain or need to wear the collar. While BF may need to return in the future for an occasional treatment due to her forward head posture, she is now able to use her sewing machine as much as she would like without worrying about neck pain.

JG suffered from neck instability symptoms for 3 years after an injury before consulting with Caring Medical. He presented with many different symptoms including constant vertigo, increased heart rate, photophobia, and radiculopathy. JG considered himself completely disabled as he could not play with his children, exercise, drive, or work out of the home. He only felt some relief when laying down on a flat surface. He had seen a chiropractor for one neck adjustment which left him unable to walk for 6 months. JG had to adjust his career in order to work from home and constantly wear a neck collar for stability. Upon physical and Digital Motion X-ray exam in our clinic, he was diagnosed with severe upper cervical instability and loss of lordotic curve. It was estimated that he would need at least 8 H3 Prolotherapy treatments due to the severity of his condition. He began monthly treatments and, with each visit, he reported improvement. After 3 treatments of H3 Prolotherapy, JG reported that his dizziness, headaches, and photophobia had lessened in frequency. A Digital Motion X-ray was done to gauge and confirm improvement. He was cleared to begin Caring Cervical Realignment Therapy in conjunction with his H3 Prolotherapy treatments. He was recently seen for his 8th and possibly final visit where he reported 90% improvement. Prior to being seen at Caring Medical, JG had almost lost hope that he would ever live a “normal life” again. He had been told by multiple physicians that he would not be able to find a cure. With help from Caring Medical, he was able to play with his kids and start exercising again. When we last spoke, JG expressed gratitude for having his life back.

E.O., a 33-year-old man from Ireland, presented to Caring Medical and Rehabilitation in September 2013 for an evaluation of his chronic neck pain and tinnitus that he suffered after a bicycle accident in 2008. The patient’s neck pain was bilateral and constant, which prevented him from sleeping well. He admitted to taking tramadol and diazepam as needed for neck pain. In addition to the pain and tinnitus, the patient reported crepitation in his cervical spine and a history of vertigo and dizziness, but denied any radiculopathy. E.O. had previously tried chiropractic care (including manipulations) and physical therapy without relief. E.O. received four prolotherapy treatments to his posterior neck over the next 5 months with gradual improvement of symptoms.

The patient was injected with 55-75 cc of solution at each visit, including PRP to the facet joints of C1-C3 bilaterally and with standard solution (15% dextrose, 0.1% procaine, and 10% sarapin) to the remaining areas (C4-C7). An additional 0.5 to 1.0 cc of polidocanol was included in each syringe at each treatment. After two treatments, E.O. reported 40% improvement. The patient said that the crepitation in his neck had decreased significantly and his main complaint was no longer pain, just neck weakness. He no longer needed to take tramadol or diazepam for pain.

At his fourth and final visit, E.O. reported that his neck still felt weak, but neck crepitation was still reduced. E.O. said that he was continuing to avoid self-manipulation, which had become easier to refrain from. Since he still lived in Ireland, E.O. became unable to travel to travel to the United States to continue treatment, but reported that he was maintaining improvement upon phone follow up in November 2014. At that time, E.O. said that he was continuing to improve in terms of pain and function in the hope that he could begin running again as a hobby. Read the entire case report here.

P.V., a 43-year-old male, came to our chronic pain clinic in August 2012 for treatment to his posterior neck. The patient had been in a motor vehicle accident 20 years ago. Eight months after the accident, he began to suffer from neck pain that had intensified over time. At the initial appointment, P.V. had burning pain that radiated from his neck down through his shoulders and arms to his fingers. These symptoms improved upon lying down, but increased when he stood up. When his neck pain was intense, P.V. experienced eye pain and cervical headaches. P.V. admitted that he self-manipulated his neck, which made him feel better temporarily. About a year prior to coming to our clinic, this patient had plain radiographs taken of his cervical spine, which showed disc degeneration at multiple levels. The orthopedic surgeon who ordered the radiographs did not think the discs were causing his pain, so P.V. was only managing his pain with occasional acetaminophen.

P.V. underwent a series of five prolotherapy treatments to his entire posterior cervical spine, including C1 (Figure 6). At each session, 60-90 cc of solution was administered throughout these locations. The solution consisted of 15% dextrose, 0.1% procaine, and 10% sarapin with the addition of 1 cc polidocanol per 10 cc syringe. The standard course for prolotherapy involves treatment every 4 to 6 weeks until symptoms are resolved, but P.V. received prolotherapy to his neck every 8 weeks due to his schedule. His last treatment was in March 2013.

With each treatment, P.V. noticed a decrease in his symptoms until his headaches, eye and facial pain, and radiculopathy were completely relieved. After his first treatment, the patient noticed a decrease in crepitation and radiculopathy symptoms. By his third treatment, his headaches and neck pain had reduced significantly. After his last appointment, P.V. reported substantial decreases in his pain and associated symptoms. During the time in between prolotherapy sessions, the patient wore a hard cervical collar during the day and a soft cervical collar at night. Since P.V. worked at a restaurant, it was imperative for him to wear a hard collar during the day to prevent excess rotation or flexion of his neck as he moved around the kitchen, as well as to prevent self-manipulation. As his symptoms continued to resolve, the patient was able to discontinue use of the collars. The patient’s last follow up by phone was in March 2014, when P.V. reported his neck was doing well and pain remained resolved. Read the entire case report here.

N.N., a 57-year-old female, consulted Caring Medical and Rehabilitation for chronic neck pain and associated symptoms in August 2012. This patient suffered a motor vehicle accident at the age of 16 years old. Symptoms included severe headaches, jaw aches, neck and shoulder pain, brain fog, and eye pain. On average, her neck pain was 6 on a scale of 0 to 10 (0 meaning no pain and 10 being the worst pain possible) and frequency was 10 of 10 (100% of the time). N.N. brought a recent x-ray report to her first appointment that showed mild cervical degeneration without foraminal narrowing. The patient reported that she could feel her head "shift" when she did not wear a cervical collar.

N.N. was diagnosed with cervical instability and received four prolotherapy treatments at Caring Medical over an 11-month span to alleviate her pain and symptoms. Ideally, patients with this condition should receive treatment every 4 to 6 weeks. The patient’s neck, including C1, was treated at every visit (Figure 6) with 45 to 110 cc of solution, including 10% dextrose, 0.1% procaine, and 10% sarapin with an additional 1 cc of polidocanol added to each 10 cc syringe (maximum 10 cc total). It was recommended that N.N. wear a hard cervical collar (Aspen® collar, Aspen Medical Products, Irvine, CA) to prevent excessive motion of her cervical spine, especially C1-C2. Although the patient was not compliant with wearing a hard collar, she did wear a soft cervical collar which did help.

After her first treatment, N.N. reported a reduction in her headaches and pain, and stated that it felt as if her neck was becoming more stable. By her third visit, N.N. estimated she was about 80% better. At her fourth and final treatment in July 2013, N.N. could sleep on her side without her neck shifting and reported a 90% improvement in all other symptoms. At the patient’s last telephone follow up in March 2014, N.N. reported that she was doing well and had maintained her improvement. Read the entire case report here.

E.G., a 31-year-old female was first treated at our clinic in October 2012 for chronic neck pain of more than 10 years duration and associated suboccipital migraines. In 2001, E.G.’s job required her to do a lot of heavy lifting. It is thought that she injured her neck during that time, as that is when her neck pain began. At her initial visit, E.G. said that her pain was worse in the suboccipital area and she experienced significant crepitation upon neck movement. She admitted to self-manipulating her neck multiple times per hour as a way to temporarily relieve pain. Prior diagnostics of CT and x-ray showed the beginning stages of osteoarthritis. E.G. had tried chiropractic care, physical therapy, and medications to treat her chronic neck pain and migraines, but without relief.

E.G. underwent a series of six prolotherapy treatments to her complete cervical spine, including C1 (Figure 6). A total of 60-70 cc of solution was injected throughout these structures each time. Standard prolotherapy solution (15% dextrose, 0.1% procaine, and 10% sarapin) was used with the addition of 0.5 cc polidocanol per syringe at the first and second visit, and 1.0 cc polidocanol per syringe on the third through sixth visits. (It is customary to increase this dosage if the patient does not appear to be improving at an expected rate.) Each treatment was spaced approximately 4 weeks from the previous one, with the exception of the patient’s sixth session, which was 6 weeks after her fifth session. (The standard course of prolotherapy for cervical instability is treatment every 4 to 6 weeks.) After each treatment, E.G. slowly noticed a decrease of her symptoms. Throughout this time, she wore a soft cervical collar as needed for neck pain and what she described as "neck fatigue." The collar prevented her from self-manipulating her neck on a regular basis and minimally to moderately helped relieve her neck pain when it was really bothering her. At her fourth treatment, she reported that she was having more "good days" than "bad days" and the severity of her migraines had significantly decreased. By her sixth and final visit in March 2013, E.G. reported an 85% improvement with complete reduction in crepitation and migraine headaches. The patient was unavailable after this date for further follow up of long-term results. Read the entire case report here.

C.H., a 35-year-old male, was seen at Caring Medical and Rehabilitation for chronic neck pain following a motor vehicle accident in 2010. Along with neck pain, the patient began to experience associated symptoms of blurred vision, eye floaters, dizziness, and ear fullness on the left side. He also experienced migraines on a regular basis and reported that he had recurring crepitation in his neck with movement. C.H. was taking naproxen frequently for his migraine headaches. He had been seeing a chiropractor regularly for 8 months for high-velocity manipulations and self-manipulating his neck on his own for temporary relief. C.H. denied any numbness, tingling, or radiculopathy symptoms.

C.H. received five prolotherapy treatments between April 2012 and December 2012 for Barré-Liéou syndrome. The patient’s right neck was only treated at the first visit while the left neck was treated every time (Figure 6). This was based on C.H.’s symptoms and pain location at each visit. An injection of 40-60 cc of solution was given at each treatment, consisting of 15% dextrose, 0.1% procaine, and 10% sarapin. It was recommended that the patient wear a hard cervical collar (Aspen® collar) 24 hours per day every day for 4 weeks after treatment, but the C.H. only wore it during the day and not while sleeping. For his last four treatment sessions, 1 cc of polidocanol was added to each 10 cc syringe to increase healing. Over this time, C.H. reported significant decreases in crepitation, blurry vision, migraines, and ear fullness. At his last visit in December 2012, the patient reported 90% overall improvement in his neck pain and associated symptoms since starting prolotherapy. Upon follow up in March 2014, the patient reported that he was no longer experiencing neck pain, no longer needed to wear a cervical collar, and could exercise without any restrictions. Read the entire case report here.

E.G., a 26-year-old female, came to our chronic pain clinic in June 2013 for prolotherapy treatment to her neck. Following a motor vehicle accident in 2011, E.G. was still suffering from chronic neck pain, dizziness, nausea, muscle spasms, and radiating pain into her shoulders. She had previously been diagnosed with whiplash injury and tried chiropractic care, physical therapy, and massage therapy—all without relief of her symptoms. The patient’s MRI was normal except for some mild loss of the lordotic curve. Her digital motion x-ray (DMX) showed damage to multiple ligaments (posterior and anterior longitudinal ligaments, capsular ligaments, and the alar and accessory ligaments) and upper cervical instability. Due to E.G.’s chronic neck discomfort, she was taking tramadol 50 mg every 4 to 6 hours daily for pain.

E.G. underwent a series of six prolotherapy treatments over the next 9 months. She was treated with a 15% dextrose, 0.1% procaine, and 10% sarapin solution with an additional 1 cc of polidocanol per syringe. A total of 60-100 cc of solution was used at each treatment (Figure 6). In the time between her first and second treatment in June and July 2013, E.G. wore a soft cervical collar at least half of the time daily. After her first two treatments, the patient noticed that her headaches were decreasing in frequency and severity, but she was still struggling with the other symptoms. At her third visit in August, E.G. was also treated with PRP. This solution was targeted at C0-C3 facet joints bilaterally while the other treated areas received the previous solution. At her fourth visit in September, her nausea and dizziness had completely absolved. By her fifth visit in November 2013, E.G. reported 75% overall improvement and explained that she no longer needed to take tramadol every 4 to 6 hours. At that point, she reported only requiring 1.5 tablets per day. At her next appointment and treatment in February 2014, E.G. reported 75% overall improvement and reported that her headaches were continuing to decrease significantly. Read the entire case report here.

W.G., a 43-year-old male, presented to our clinic for prolotherapy treatment to his neck for chronic neck pain and daily migraines. The patient had a history of whiplash injury and multiple concussions that he suffered while playing football in high school and college. At the time, W.G.’s most recent MRI showed multiple bulging discs. He had previously tried National Upper Cervical Chiropractic Association (NUCCA) style of manipulation, a gentle and noninvasive technique to reduce C1 subluxation, but the chiropractor was unable to stabilize C1 and C2. The patient’s DMX showed upper cervical instability and injury to multiple ligaments, including the posterior and anterior longitudinal ligaments, multiple capsular ligaments, and the accessory and alar ligaments. W.G. admitted to regular, daily self-manipulation of his cervical spine for temporary pain relief.

W.G. received five prolotherapy treatments between March 2012 and June 2012. The last three treatments were performed under fluoroscopic guidance (Figure 6) with 45-80 cc of total solution at each treatment session. (It should be noted that the standard course of prolotherapy treatments are typically administered 4 to 6 weeks apart, but in some patients they can be given at shorter intervals without harm to the patient.) The solution consisted of 15% dextrose, 0.1 % procaine, and 10% sarapin. At his first and second treatments, an addition of 0.5 cc of sodium morrhuate was included in each 10 cc syringe. At the patient’s third visit, the amount of sodium morrhuate was increased to 1.0 cc to stimulate more healing. At his fourth and fifth visit, 1.0 cc of polidocanol was added to each syringe, as sodium morrhuate was no longer manufactured. With each treatment, W.G. noticed a continual decrease in neck pain, crepitation, and migraines. At his last follow up in April 2014, W.G. remained free of migraines and only occasionally suffered from subtle neck pain. Read the entire case report here.

D.K., a 53-year-old female, came to Caring Medical and Rehabilitation in 2011 for treatment of chronic neck pain that had lasted more than 35 years and underlying upper cervical instability. The patient said that her right side was more painful than her left. D.K. had been undergoing NUCCA chiropractic care for four months previous to her initial visit. At that time, her adjustments were not holding for more than a day, forcing her to get NUCCA three times per week. The patient denied any self-manipulation of her cervical spine. D.K. reported intermittent numbness and tingling in her wrists and upper extremities, neck stiffness, and crepitation. In addition, she suffered from dizziness and difficulty concentrating when her cervical vertebrae were out of alignment.

D.K. received 13 prolotherapy treatments from August 2011 to December 2012. It was recommended that she wear a soft cervical collar in between treatments to help her avoid extraneous rotation and movement of her neck. All 13 treatments involved injections to her neck and four of the sessions included treatments to her stylomandibular ligaments as well (Figure 6). D.K. received treatment with a variety of solutions, including standard solution (15% dextrose, 0.1% procaine, and 10% sarapin) with additional sodium morrhuate or polidocanol, platelet-rich plasma, and direct tibial bone marrow. Throughout the duration of treatments, D.K. reported continual improvement with progressive relief of symptoms. While most of her treatments occurred in a private office setting, three treatment sessions (specifically visits 7, 8, and 9) were performed under fluoroscopic guidance and at a nearby chiropractic office.

By her seventh treatment in March 2012, D.K. was reporting 50% improvement in her neck pain and associated symptoms. At that point, she was still experiencing crepitus and stiffness in her posterior neck. A DMX was performed to objectively evaluate the patient’s cervical instability. Results revealed straightening of the normal lordosis, areas of anterolisthesis and retrolisthesis, damage to her posterior and anterior longitudinal ligaments, capsular ligaments, and alar and accessory ligaments, and abnormal lateral translation of C1 on C2. By her twelfth session in October 2012, D.K. reported 70% overall improvement. Upon her last telephone follow up in March 2014, D.K. no longer complained of pain, crepitation, or stiffness in her upper cervical vertebrae, including C1 and C2, and no longer needed to see a chiropractor for adjustments. Read the entire case report here.

A 47-year-old female with a history of trauma presented to our clinic in 2013 with headaches, chronic pain in the neck and upper limbs, and intermittent tingling in one arm. Pain was exacerbated by head movement. Examination showed crepitation at C0 – C2, and severe spasms and tenderness in the trapezius and paraspinal muscles. The patient was treated with dextrose prolotherapy at each of four visits over five months. Digital motion X-ray (DMX) was performed between visits 1 and 2, showing straightening of cervical lordosis and upper and lower cervical instability, with offsets of right and left lateral masses of C1 on C2, anterolisthesis of C2 on C3 and of C3 on C4, capsular ligament damage at C6-C7 and facet hypertrophy at C4-C5. At visit 2, tingling and crepitation had abated, while pain intensity was unchanged. At visit 3, headaches had resolved, and pain had become more localized. At visit 4, pain intensity had decreased significantly, crepitation had resolved completely, and she had begun bicycle exercise. DMX one month after visit 4 showed persistent straightening of lordosis and facet hypertrophy, as well as some anterolisthesis, while the offsets of the lateral masses of C1 on C2 with rotation were reduced by 33-50%. Read the entire case report here.

Although unaware of any precipitating factor, LL experienced tinnitus, sternoclavicular swelling, dizziness, neck stiffness/pain, muscle pain and feeling off-balance from vertigo twice weekly. After 18 months of suffering, LL pursued relief with Prolotherapy. Examination and radiographs revealed cervical instability with severe atlas subluxation. Repeat x-rays post-Prolotherapy treatment demonstrated correction of the subluxation, but more importantly all of the symptomatology and pain had completely subsided after 8 treatments.