Prolotherapy for neck pain after automobile accidents

Prolotherapy Whiplash injury Ross Hauser MD

Ross Hauser, MD

Documenting 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 a solution for the purpose of tightening and strengthening 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.These cases studies are excerpts from our peer-reviewed study published in the European Journal of Preventive Medicine.(1)

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 temporarily 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.

In this video, Ross Hauser, MD demonstrates Prolotherapy to the cervical spine. This is a more comprehensive approach to get permanent headache and neck pain relief and is an alternative to spinal fusion, laminectomy, chronic chiropractic adjustments or unsuccessful physical therapy exercises.

Our treatment program and results

  • 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.

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 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 prior to treatment, a consultation to Prolotherapy may be warranted.

Do you have a question about your neck pain? Contact the author

Reference
1 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]


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