As a physiatrist who specializes in improving people’s quality of life, I see hundreds of patients who are disabled from chronic pain and have “maxed out” on the usual conservative measures and are essentially hanging at the end of their ropes with little hope for relief. In my search to help my patients, I discovered prolotherapy in 2002, a therapy for chronic musculoskeletal pain based on injecting dextrose into weakened or injured ligaments, tendons and cartilage, so as to allow your body’s own healing mechanism to strengthen and stabilize the joints, resulting in pain relief.
Immersed in this paradigm, I treated thousands of patients with great success. The pain diminished and the patients gradually returned to their usual function.
Continuing to travel abroad on medical missions and to teach other physicians on Prolotherapy, I heard about Perineural Injection Therapy (aka: Neural Prolotherapy) in 2009, as an equally effective and less painful procedure.
John Lyftogt MD, from New Zealand , discovered that dextrose near nerve injections, targeting the sensory unmyelinated fibers, relieve pain instantly and eventually cures neuropathic pain and other chronic conditions. As an electrodiagnostician, the topic aroused my curiosity as I know that only nerves can communicate to our brain for us to experience the pain sensation.
In November 2009, I attended the first Perineural Injection Treatment Workshop held in Christ church, New Zealand. The concepts of Neurogenic Inflammation and Hilton’s Law were emphasized. My training in Physical Medicine & Rehabilitation and Electrodiagnosis helped me to understand this language. Neurogenic inflammation precedes Immune Inflammation. Dr Lyftogt treated many of his own patients who presented complex problems of the neck, knee, low back, and each patient, after applying this treatment, had instant relief of their pain. This was a mind blowing experience. I realized the powerful painkiller effect of dextrose. Dr Lyftogt and his patients also commented on the long term cumulative action of this procedure, resulting in cure with repeated treatments.
Since then, I have had the same experience with my patients have hosted several PIT conference and workshops in Hawaii and in Chicago . I am honored to help spread the word about this fantastic treatment and continue to travel abroad to share my experience as we are enriched, forming a bigger family of PIT practitioners. Since its discovery, it has benefited thousands of my patients. The analgesic effect has been reproduced consistently and predictably by all who have tried it. My Research study “ 5% dextrose caudal for low back pain” supports this.
As expected, the knowledge is quickly spreading in the world of chronic pain physicians. Dr Lyftogt and others he have trained and shared this technique to about 1000 physicians from almost every continent of the world.
Repeated treatments with buffered D5W have demostrated a steady reduction in all signs of neurogenic inflammation. It is proven in scientific studies that TRPV1 expressed sensory nerves are stimulated by glucopenia . Dextrose, an energy molecule, via K+ tandem channels, has a potent TRPV1 antagonistic effect and reverses glucopenia in unmyelinated C sensory nerve cells.
This is the science of Perineural Injection Treatment and the paradigm shift that is changing the world of Pain.
I am passionate to share this knowledge so it can benefit so many people who need our help in getting their lives back. I am privileged to be part of this team of helping people and to be in this journey of gratification, along with meeting a great group of friends along the way.
Growing evidence implicates chemical irritation of the dorsal root ganglion and peripheral nerves from cytokines (TNFa) and up regulation of TRPV1 are the major cause of neuropathic pain. When TRPV1 of the sensory unmyelinated c fibers are upregulated, there is an increase release of SubP and CGRP, producing pain and when there is chronic release of these neuropeptides, there is degeneration and disrepair when chronic.
Dr Lyftogt's Theory is that Chronic Pain is a homeostatic sensation reflecting the disturbance of homeostasis and energy balance. Dextrose is energy that can produce 28 ATP in the aerobic Kreb cycle, and ATP is needed for tissue maintenance and repair and many other biological processes. Hypoglycemia within the nerve cell is a trigger that there is impaired energy balance and increases the firing rate and spike potentials of nerve cell, producing pain. This has been shown in the study of corneal nerves by Maclver in 1992 Anesthesiology Publication where they produced a hypoglycemic environment in corneal nerve cell, which in turn increased spike potential activity.
Perineural injection of D5W reverses this glucopenia :
- Glucose sensing neurons are K+ channels that open up ,causing repolarization and hyperpolarization of the membrane potential and reducing the spike potentials. These K+ channels are also called TREK1
- These K+ channels are colocalized with TRPV1, therefore downregulates the release of SubP and CGRP, allowing normal maintenance and renewal and reversing degeneration.
All these complex myriad ion channels are embedded in the lipid bilayer cell membrane of sensory nerves.These information about ion channels and their functions are searchable in scientific literature.
There are also channels called glucose transporters on the membrane, ) and there are many different GLUT and is specific to each tissue leading to disease of that particular organ (ie: liver, kidney, pancreas). GLUT3 is specific to peripheral sensory nerve and it can well be a problem only with GLUT3 that is causing neuropathic pain in non diabetic patients.
In diabetic patients, the problem may well be insulin or it can be the multiple glucose transporters . Insulin may have an adverse effect on glucose transporter.
Perineural injection treatment is being taught globally , and everyone who has tried it has experienced its beneficial effects. We are learning new things everyday and still have many questions left unanswered. There are thousands of successful anecdotal cases, and there are ongoing studies on the role of dextrose in neuropathic pain including my D5W caudal study, which although of very small sample size, it is a randomized control trial and double blinded study with strong observation of the analgesic pattern and the cumulative benefits with repeated injections. I will be presenting my poster abstract on Efficacy of Dextrose caudal at the 2016 AAPMR academy meeting in New Orleans.
(Thank you Drs John Lyftogt, Dean Reeves, David dela Mora, Irene Briceno Felix, Steven Cavallino, Lee Wolfer).