title: Side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain: A survey of practitioners.
abstract: OBJECTIVE
  To study the side effects and adverse events related to intraligamentous injection of sclerosing solutions (prolotherapy) for back and neck pain.
  
  
  METHODS
  Practitioner postal survey.
  
  
  METHODS
  Postal survey of practitioners of prolotherapy for back and neck pain in the United States and Canada.
  
  
  METHODS
  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.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.
authors.affiliation: Department of Pediatrics, University of Ottawa, ON, Canada. simon@camresearch.com
authors.forename: Simon
authors.initials: S
authors.lastname: Dagenais
authors.forename: Oladele
authors.initials: O
authors.lastname: Ogunseitan
authors.forename: Scott
authors.initials: S
authors.lastname: Haldeman
authors.forename: James R
authors.initials: JR
authors.lastname: Wooley
authors.forename: Robert L
authors.initials: RL
authors.lastname: Newcomb
mesh_terms: D001416:Back Pain / Q000628:therapy*; D002170:Canada; D000529:Complementary Therapies / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects*; D008022:Ligaments / Q000187:drug effects; D008297:Male; D019547:Neck Pain / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012597:Sclerosing Solutions / Q000009:adverse effects*; D014481:United States
chemical_list: D012597:Sclerosing Solutions