Dr. John Lyftogt, from New Zealand, struggled for years to help find some relief for his chronic pain patients. He developed a treatment that he termed Neural Prolotherapy while working on relieving Achilles tendonopathy. Neural Prolotherapy is an injection therapy with 5% dextrose (sugar) that focuses on treating the nerves in the skin that have become injured and entrapped due to inflammation. Although the nerves are superficial, the pain they create is often felt in the deeper tissues. The injection of low-dose dextrose changes the pain signaling and stops neurogenic inflammation (what your doctor may have called neuropathic pain). The dextrose solution also has a regenerative effect on the entrapped nerves helping them to heal and preventing recurrence.
Dr. Berghamer: “I first encountered Dr. Lyftogt at an AAOM conference in Las Vegas where he was presenting “Neural Prolotherapy” for the first time. I was skeptical that the treatment of cutaneous nerves with such low dose dextrose could effectively treat deep lumbar pain like Dr. Lyftogt claimed. I learned the technique, came back to my clinic and began to get immediate results. I found that if I treated the superficial nerves first with neural prolotherapy, the need for deeper prolotherapy injections was minimized or unnecessary. And when I combined neural prolotherapy with prolotherapy or PRP, the results were faster and more complete.
However, it wasn’t until I treated post-herpetic neuralgia with Neural Prolotherapy that I fully realized the power of this amazing technique. A patient that I had seen once the year before for PHN came back to my clinic with the same pain that she had come to me with. I had treated her with B12 and procaine injections (Neural Therapy) which resolved her pain in the short term but did not have lasting effect. Over the previous year, she had taken many pain killers, topical analgesics, had acupuncture and myofascial release and many other treatments. She had spend thousands of dollars with very limited success. She was desperate. I suggested we try Neural Prolotherapy. I completed one session with her and she left the office. Four hours later she called me, ecstatic! Her pain, which she had had for 1 1/2 years was 90% gone! After one treatment! She was 100% cured after 3 treatments. Since then, I have treated over 20 cases of post-herpetic neuralgia, all with the same result: no more pain!”
How does Neural Prolotherapy treatment work?
5% Dextrose is injected beneath the skin surface with a tiny needle over the commonly constricted regions of nerves. Patients with nerve pain (neurogenic pain) experience pain relief within seconds. This is often a surprise to the patient!
The 5% dextrose works by immediately blocking the receptor in the nerve (TRPV-1 or Capsacin receptor) which is the principal regulator of pain and inflammation. Changing the receptors in the nerve allow for healing to deeper structures like tendons, ligaments and joints (Hilton’s law). Other substances also can block this receptor like procaine, magnesium and salt which may explain why Epsom salt bath soaks are so popular; however, unlike dextrose these othe substances do not reset the receptors, they only temporarily block them. Vitamin D is also being researched for it’s effect on nerve pain.
What is the treatment like?
Dr. Berghamer will track the pain by feeling for inflammed nerves in the skin. These nerves aren’t usually palpable but when they are inflammed and constricted they feel like small taut hoses that can be exquisitely painful to touch. Once the nerves have been tracked they are injected along their lengths with 5% dextrose. The number of injections is quite variable but because the nerves are irritated they can be intense – much like a number of small bee stings. Most patients require between 3 – 8 series of injections for complete resolution of pain. It is not uncommon for new areas that were originally masked to have to be treated as well. Because the treatment is diagnostic (a painful injection indicates immediately if there is nerve injury involvement), patients will notice some improvement right away. For some people this relief lasts generally for several days; however, if the injury has been endured for a long period then the length of relief may be short. Subsequent treatments result in progressively longer improvements until complete relief is achieved in most patients.
Are there any side effects to Neural Prolotherapy?
At most the patient may have some brief tenderness, itchiness and/or bruising at the injection site. Physical activity is not restricted post-injection, with most patients returning to their usual workouts the same day or next day. More than 98% of patients tolerate the minimal discomfort associated with the injections without a problem. The occasional patient who is needle phobic or pain sensitive may not be a good candidate.
What conditions may benefit from Neural Prolotherapy?
Fibromyalgia, post-herpetic neuralgia, headaches, migraines, whiplash, neck pain, shoulder pain, elbow pain, wrist pain, hand pain, low back pain, hip pain, knee pain, foot pain, ankle pain; tendinitis, arthritis, bursitis, sciatica and muscle/ligament injuries also benefit from Neural Prolotherapy.
To read more about Neural Prolotherapy, click here.