Neural Prolotherapy: A progressive approach to pain management.

Neural protherapy (perineural injection technique) for pain in Moncton

One of the most overlooked causes of acute and chronic pain are the peripheral nerves. There are lots of therapies aimed at healing your muscles (e.g. massage, physiotherapy, therapeutic ultrasound, etc), and there are therapies for realigning your spine (e.g. chiropractic). There are drugs to decrease inflammation (e.g. advil), and there are nutrients aimed at rebuilding your joints (e.g. glucosamine). There are therapies that temporarily numb the nerves (e.g. electrical TENS machine, creams, drugs, etc), but nothing is aimed at healing the nerves. This is surprising since it is the nerves that are responsible for transmitting the pain signals to your brain.

 

Therefore, when it comes to both acute and chronic pain, why is no one looking at healing the nerves? 

 

There is a unique therapy that does exactly that - Neural Prolotherapy (NPT). NPT (also called perineural injection technique) restores unhealthy nerves into healthy nerves by targeting a specific type of nerve called peptidergic sensocrine nerves. When they are healthy, these nerves release anti-inflammatory and healing molecules to help heal the nearby muscles, joints, and other nerves (e.g. somatostatin and galanin). However, if these nerves become injured or irritated, healing is halted, and instead they release hormones that stimulate pain and inflammation (e.g. substance P and calcitonin gene-related peptide (CGRP)). Neural Prolotherapy switches the nerves out of ‘inflammatory mode’ and back into ‘healing mode’ by inhibiting a receptor on the nerve surface called TRPV1.

 

Dr. Lyftogt, an MD in New Zealand and originator of NPT, describes that nerve inflammation is the most overlooked and undertreated component in pain management, and is the true cause of a lot of people’s chronic pain. Professor Douglas Zochodne, in his 2008 book Neurobiology of Peripheral Nerve Regeneration, also agrees that pain is caused by malfunctioning nerves: “Neuropathic pain is a severe and debilitating pain that can render patients unable to walk, work, sleep or enjoy life…[Full] and effective regeneration of the peripheral nervous system usually extinguishes this pain.”

 

The process by which nerves become inflamed and malfunctioning is easier than you may think. Some of the most common causes of nerve damage result from nutrient deficiencies (e.g. Vitamin B12 deficiency), nerve compression or overuse (e.g. carpal tunnel, tight inflexible muscles, etc), surgery or direct trauma (e.g. knee replacement surgery), diabetes (e.g. peripheral neuropathy), infection of the nerve (e.g. post shingles pain, Lyme disease, etc), drug side-effects (e.g. chemotherapy), autoimmune disease (e.g. multiple sclerosis), etc. All of these can cause the nerve to switch from being a healthy nerve to being an inflamed nerve. This now unhealthy nerve sends continuous pain signals to the brain.

 

Neural prolotherapy involves a series of microinjections just below the surface of the skin using a needle that is not much thicker than human hair. The injections are performed at locations where the nerve has become inflamed and at tender points along the nerve’s path. Once all tender points have been injected, the patient is asked to identify any areas of residual pain; he/she points to specific sites that still hurt, and those are infused as well. In most cases, patients report significant pain reduction by the time they leave the office. Although some insertion points will sting, patients typically report minimal discomfort and will frequently encourage the clinician to address several “fine tuning” points by the end of the procedure.

 

At the Moncton Naturopathic Medical Clinic we believe it is important to determine the root cause of your health concern. As mentioned before, pain is often rooted in nerve inflammation, and restoring the health of irritated and inflamed nerves is an important step in becoming pain free. Neural prolotherapy is an effective therapy that addresses this often overlooked piece of the pain puzzle, and is successfully incorporated into other physical therapies and pain management programs. For more information about neural prolotherapy please see the 'frequently asked questions' below or contact our clinic (506-382-1329).

 

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Frequently Asked Questions: Neural Prolotherapy 

I have been in pain for many years. Can this treatment work for me?

Many people, some of whom had been suffering from as long as 40 years, have obtained relief from neural prolotherapy. 

 

How do I know if this is right for me?

All pain has some degree of nerve involvement. The goal with the first couple treatments of neural prolotherapy is to determine what percentage of your pain is coming from nerve inflammation. After the second or third treatment we will know if neural prolotherapy is only going to be able to help reduce your pain by 10% or if it is going to be able to reduce your pain by 100%. If it is only 10%, then we will recommend another approach specific to your pain. 

 

Does this treatments work all the time?

To my knowledge, no treatment works all the time. While there is no magic bullet, you can expect neural prolotherapy therapy to work approximately 85% of the time. For actual percentages of success for specific conditions please see “conditions treated” below.

 

What conditions does it treat?

Neuroprolotherapy treats pain, so if pain is present the treatment has the potential to resolve it.  According to Dr. Lyftogt’s clinical studies the percentage of patients who achieve at least satisfactory clinical results are:

-          Achilles tendon pain (93%)

-          Hamstring pain (90%)

-          Shoulder pain (88%)

-          Tennis elbow (100%)

-          Compartment Syndrome (78%)

-          Groin pain (90%)

-          Knee pain (89%)

-          Neck pain (90%)

-          Back pain (90%)

Other conditions:

-           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, bunions, sciatica and muscle/ligament injuries also benefit from Neural Prolotherapy.

 

Are these treatments painful?

Most neural prolotherapy treatments are almost painless: the needle used is approximately the size of a hair. With this treatment, the pain relief is almost immediate: it comes within a few seconds of the injection. However, there are some areas of the body that are more sensitive than others.

 

More than 98% of patients tolerate the minimal discomfort associated with the injections without a problem. Dr. Anhorn will do all he can to ensure the treatments are well tolerated and comfortable. 

 

Once the pain is gone, how long will I be pain free?

With neural prolotherapy, at the end of the first session, you should be pain free for anywhere from four hours to four days. If your pain comes back within an hour of the session, it is unlikely that neural prolotherapy will work for you. With every session, you remain pain-free for longer and longer periods until your pain doesn’t come back. It may never come back after that. 

 

I have been told I need surgery. Should I consider this treatment as an alternative?

For some people, surgery is the only way to repair damage to the body. It might be worth trying this treatment while you are waiting for surgery, as it is safe, rarely has side effects, and you can always cancel the surgery if you find your symptoms are relieved.

 

Will I have to come back? How often?

At first, neural prolotherapy only gives temporary relief, and you have to come back about once a week for about a month. Then, as you remain pain-free for longer and longer periods, you come back about once every other week for another two months or so.

 

What should I expect during a neural prolotherapy treatment?

The initial session will involve an assessment of the painful area(s) (inspection, palpation, possible orthopaedic testing) to determine which points need to be injected.  The number of injections can range from 5-15 per painful area.  The injections are very superficial, only going into the fat layer just under the skin (subcutaneous layer).  One phenomenal feature of neural prolotherapy is that, if effective, it will reduce pain immediately.  This immediate effect will last on average from 4 hours to 4 days.  It is important to remember that while this acute pain relief is of great comfort to the patient, the true value is in the long-term tissue healing that occurs after that immediate relief abates.

 

How many treatments are required?

Most patients require between 3 – 8 series of injections for complete resolution of pain. Patients typically report a 10-20% cumulative pain improvement with each session. It is not uncommon for new areas that were originally masked to have to be treated as well.

 

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.

 

How much does it cost?

The cost is divided into visit time and the cost of the injectable. After the initial visit, the cost for a neural prolotherapy session is approximately $50-$75 for the visit and $10-$30 for injectable costs. When added together an average neural prolotherapy session costs between $60-$90.

 

Is the cost covered by health insurance?

Most health insurance plans cover a significant portion of the visit fees. The injectable costs ($10-$30) is not usually covered. However, we suggest to the patients to check with their individual insurance policy to determine the actual amounts covered.

 

Do I need a referral?

No referral is necessary. Please contact Pam at 506-382-1329 to schedule your appointment or if you have any further questions.

 

 

Published in the Times & Transcript July 31, 2013. Dr. Nicholas Anhorn, BSc, ND is a medically-trained licensed Naturopathic Doctor in Moncton, New Brunswick.  Dr. Anhorn is currently accepting patients at the Moncton Naturopathic Medical Clinic. 

 

 

Back to Dr. Anhorn's full list of articles.  

Click to see Dr. Anhorn's full bio and list of trainings.

Ready to book an appointment?

 

 

Related articles:

Pain management based on five key principles

Taking steps to become migraine free

Neural Prolotherapy: A progressive approach to pain management.

Advanced Pain Injections: Using Prolozone for Regeneration and Healing

Prolotherapy – Regenerative injection therapy (RIT) for joints, ligaments, tendons, and more.

 

 

 

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