Prolotherapy for Post-Traumatic Neck Pain Caused by a Whiplash Type Injury
Over 2.3 million people were injured on U.S. roadways in 2013. When looking at injuries sustained from nonfatal crashes, whiplash is among one of most commonly reported injuries. Whiplash can also occur from other traumatic events including falls, sports injuries, physical violence and work related accidents.
The term “Whiplash” is actually a generic term referring to a rapid forward then backward motion of the head and head. The true definition of whiplash debateable. In medical terms, this is a hyperflexion – hyperextension or acceleration-deceleration type injury. With the forces that cause this type of injury, the cervical spine is believed to go beyond its normal range of motion and has the potential to injure the surrounding soft tissue structures (ligaments) and discs. As a protective mechanism, the neurological system attempts to stabilize the area by contracting the surrounding muscles. There are several known factors (and some unknown) which may determine the extent of injury. This includes prior level of health, physical condition, posture or position of neck at the time of impact, and awareness of pending impact.
Commonly reported symptoms of a whiplash type injury include immediate or a delayed onset of neck pain with or without referred pain to the upper back and shoulders, tingling and numbness to the upper extremities, headaches, dizziness, and blurred vision. Often patients will complain of referred pain to the arm(s) which may include tingling and numbness, yet clinically there may be no loss of strength, sensation, or function.
Treatment for whiplash injuries has also been all across the board. Some focus on rest and immobilization of the neck while the general consensus for treatment for those with a whiplash type injury (without neurologic deficit) has been promoting an active lifestyle. Specific treatments may include non-steroidal anti-inflammatory medication and physical therapy.
Taken from a 2008 systematic review and meta-analysis of the literature, Kamper et al looked at 37 published articles focused on acute whiplash injuries. The findings from this showed that a significant proportion of those injured recovered in the first three months following an accident. The authors concluded that pain and disability tends to reduce most rapidly during the initial 3 months but after that time period, little improvement occurs.
There are many inconsistencies in looking at what factors are important for determining the prognosis. Some of the postulated factors found in the literature associated with a poor recovery include high pain levels, disability levels, depression, and neck range of motion, mechanical hyperalgesia, and the presence of post-traumatic stress symptoms.
So what treatment options exist for those who do not improve initially and develop chronic pain? Some are told to live with the pain while surgery may be recommended for others. Prolotherapy may be a reasonable option for this subset of patients. While the literature is very limited in regards to studies involving prolotherapy for post-traumatic neck pain or whiplash, reports from as early as the 1960’s published in the literature, showed treatment success in the range of 90% for this specific application. An observational study published by Hauser et al (2007) showed significant improvements in pain levels, cervical range of motion, and disability levels for the study population. Hooper et al (2007) reported on 18 patients treated with dextrose Prolotherapy. The findings from this study were similar to Hauser et al. Significant improvements were seen in pain scores and disability measures. Limited conclusions can be drawn based on the methodology and outcomes of these types of studies, however, the results do show the potential for prolotherapy as a viable treatment for those with chronic neck pain from a whiplash type injury.
U.S. Department of Transportation. NHTSA. Traffic Safety Facts. December 2014.
Kamper SJ., Rebbeck TJ., Maher CG., McAuley JH., Sterling M. Course and prognostic factors of whiplash: a systematic review and meta-analysis. Pain. 2008 Sept 15; 138(3): 617-629.
Hackett G. Prolotherapy in whiplash and low back pain. Postgraduate Medicine. 1960. pp 214-219.
Hauser RA, Hauser MA. Dextrose Prolotherapy for Unresolved Neck Pain. Practical Pain Management. 2007.
Hooper RA, Frizzell JB., Faris P. Case Series on Whiplash Related Neck Pain Treated with Zygspophysial Joint Regeneration Injection Therapy. Pain Physician. 2007 Mar; 10(2): 313-8.