Side effects and adverse events related to prolotherapy for back and neck pain

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Arch Phys Med Rehabil. 2006 Jul;87(7):909-13.

Side effects and adverse events related to intraligamentous injection

of sclerosing solutions (prolotherapy) for back and neck pain: A

survey of practitioners.

Dagenais S, Ogunseitan O, Haldeman S, Wooley JR, Newcomb RL.

Department of Pediatrics, University of Ottawa, ON, Canada.

OBJECTIVE: To study the side effects and adverse events related to

intraligamentous injection of sclerosing solutions (prolotherapy) for

back and neck pain.

DESIGN: Practitioner postal survey. SETTING: Postal survey of

practitioners of prolotherapy for back and neck pain in the United

States and Canada.

PARTICIPANTS: A sample of prolotherapy practitioners from 2

professional organizations were surveyed about their training and

experience, use of specific treatment procedures, estimated

prevalence of side effects, and adverse events related to

prolotherapy for back and neck pain.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Prevalence of side effects and adverse events.

RESULTS: Surveys were completed by 171 practitioners (response rate,

50%). Ninety-eight percent held medical degrees, and 83% were board

certified in various disciplines. Respondents had a median of 10

years of experience, during which they had treated a median of 500

patients and given a median of 2000 treatments. Side effects with the

highest median estimated prevalence were pain (70%), stiffness (25%),

and bruising (5%). There were 472 reports of adverse events,

including 69 that required hospitalization and 5 that resulted in

permanent injury secondary to nerve injury. The vast majority (80%)

were related to needle injuries such as spinal headache (n = 164),

pneumothorax (n=123), temporary systemic reactions (n = 73), nerve

damage (n = 54), hemorrhage (n = 27), nonsevere spinal cord insult

(ie, meningitis, paralysis, spinal cord injury) (n = 9), and disk

injury (n = 2).

CONCLUSIONS: Side effects related to prolotherapy for back and neck

pain, such as temporary postinjection pain, stiffness, and bruising,

are common and benign. Adverse events related to prolotherapy for

back and neck pain are similar in nature to other widely used spinal

injection procedures. Further study is needed to fully describe the

adverse event profile of prolotherapy for back and neck pain.