Side effects and adverse events related to intraligamentous injection of sclerosing solutions (Prolotherapy) for back and neck pain: A survey of practitioners

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.