Prolotherapy treatments for chronic neck pain after an automobile accident | Case review of three patients

Ross A. Hauser, MD. Caring Medical Florida
Danielle R. Steilen-Matias, MMS, PA-C. Caring Medical Florida

Prolotherapy treatments for chronic neck pain after an automobile accident | Case review of three patients

Documenting the results of our patients in leading medical journals helps us to provide our fellow health care providers and patients the information they need to help make informed decisions. In this case paper, we review three patients who were involved in an automobile accident, suffered from whiplash associated disorders and other symptoms, and were treated with Prolotherapy.

Introduction: Prolotherapy is the injection of (in most cases) of a simple dextrose solution. The goal of the treatment is to naturally tighten and strengthen weak tendons, ligaments or joint capsules. In this case the cervical neck region. Prolotherapy works by stimulating the body to accelerate the inflammatory healing response. It is within this inflammatory stage of healing that collagen is made that provides the building blocks to repair ligaments and tendons repair.

It was important for us to document case studies in peer-reviewed literature because there was so little research on this subject.

In 2007, Dr. Robert Allen Hooper of the University of Calgary published his case series on 18 patients who had cervical neck facet joint Prolotherapy injections following a worsening of their chronic whiplash associated disorders. Here is a brief summary of his findings published in the medical journal Pain Physician (1).

Eighteen consecutive patients were treated with intra-articular (into the cervical neck joints) prolotherapy.
Fifteen patients completed treatment.
- Three patients had bilateral treatment, leaving 18 sides for analysis.
Mean Neck Disability Index (NDI) pre-treatment was:
- 24.71
- and decreased post-treatment to 14.21 (2 months),
- 13.45 (6 months), 10.94 (12 months).
Symptoms for 14 patients were from a motor vehicle accident, of which 13 were in litigation. Patients attending physiotherapy over the course of treatment had better outcomes than those without physiotherapy. Women needed more injections (5.4) than men (3.2).

In one of our research papers, The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study, (2) co-authored by Caring Medical’s Ross Hauser MD and Danielle R. Steilen-Matias, PA-C, we were able to site Dr. Hooper’s research as well as other papers that supported the use of Prolotherapy for a neck pain and related symptom relief. In this paper our team wrote of our own results:

“Following a series of proliferative injections, performed in a private sub-specialty pain clinic, patient- reported assessments were measured using questionnaire data, including range of motion (ROM), crunching, stiffness, pain level, numbness, and exercise ability, between 1 and 39 months post-treatment (mean = 24 months) . . .
“This retrospective case series represents one of the few studies supporting the use of Prolotherapy in the treatment of chronic neck pain and cervical instability. The study results are compelling as they indicate a positive correlation between (Prolotherapy) injections and reductions in pain and improved functionality.”
“20 of 21 patients reported post-treatment reduction in all three pain categories (while at rest, during normal activity and exercise), and 20 of 21 patients reported improvement in all four functional categories (stiffness, ROM, crepitation/crunching, and numbness). “

Let’s get to the three case studies we published:

These cases studies are excerpts from our peer-reviewed study published in the European Journal of Preventive Medicine.(3)

A 43 year-old man with pain 20 years after his automobile accident

PV is a 43-year-old male who came to our chronic pain clinic in August 2012 for treatment of his neck pain.

Our interview with PV at his first appointment

PV had been in a motor vehicle accident 20 years prior.
Eight months after the accident, he began to suffer from neck pain that had intensified over time.
At the initial appointment, PV had burning pain that radiated from his neck down through his shoulders and arms to his fingers.
- These symptoms improved when he laid down, but increased when he stood up.
- When his neck pain was most intense, PV experienced eye pain and cervical headaches.
PV found that self-manipulating or “cracking,” his neck, gave him temporary relief.
About a year prior to coming to our clinic, PV 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 PV was only managing his pain with occasional acetaminophen.
PV underwent a series of five Prolotherapy treatments to his entire posterior (rear) cervical spine, including C1
The standard course for Prolotherapy involves treatment every 4 to 6 weeks until symptoms are resolved, but PV received Prolotherapy to his neck every 8 weeks due to his schedule. His last treatment was in March 2013.

Our treatment program and results

With each treatment, PV 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 (crunching) and radiculopathy symptoms.
By his third treatment, his headaches and neck pain had reduced significantly.
After his last appointment, PV 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 PV 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 the use of the collars. The patient’s last follow up by phone was in March 2014, when PV reported his neck was doing well and the pain was gone.

A 26 year-old woman with pain 20 years after his automobile accident

Our interview with EG at her first appointment

EG, 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 EG’s chronic neck discomfort, she was taking tramadol 50 mg every 4 to 6 hours daily for pain.

Digital motion x-ray
In this video, Ross Hauser, MD is performing Prolotherapy under DMX guidance to the upper cervical region.

Our treatment program and results

EG underwent a series of six prolotherapy treatments over the next 9 months.
In the time between her first and second treatment in June and July 2013, EG 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, EG 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.

A 35 year-old man with pain following a motor vehicle accident

Our interview with CH at his first appointment

CH, 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.
CH 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.

Our treatment program and results

CH received five prolotherapy treatments between April 2012 and December 2012.
The patient’s right neck was only treated at the first visit while the left neck was treated every time.
This was based on C.H.’s symptoms and pain location at each visit.
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 CH only wore it during the day and not while sleeping.
For his last four treatment sessions, 1 cc of polidocanol (an irritant medication that increases localized inflammation – the healing mechanism) 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 a 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.

These are only three examples, but examples that appeared in a peer-reviewed journal. If you are having symptoms of whiplash associated disorders or the problems described by these patients, our team will be happy to discuss your case with you and see if Prolotherapy may be warranted.

Do you have a question about your neck pain? You can get help and information from our Caring Medical Staff

References

1 Hooper RA, Frizzell JB, Faris P. Case Series on Chronic Whiplash-Related Neck Pain Treated with Intraarticular Zygapophysial Joint Regeneration Injection Therapy. Pain Physician. 2007 Mar;10(2):313. [Google Scholar]
2 Ross Hauser, MD, Steilen-Matias D, Gordin K. The biology of prolotherapy and its application in clinical cervical spine instability and chronic neck pain: a retrospective study. European Journal of Preventive Medicine. 2015;3(4):85-102. [Google Scholar]
3 Hauser RA, Steilen D, Sprague IS. Cervical Instability as a Cause of Barré-Liéou Syndrome and Definitive Treatment with Prolotherapy: A Case Series. European Journal of Preventive Medicine. 2015;3(5):155-66. [Google Scholar]