Sugar Coated Nerves: The Pseudo-Science of Neural Prolotherapy

Sugar Coated Nerves: The Pseudo-Science of Neural Prolotherapy

Dr. John Quintner

Dr. John Quintner

(Editor’s Note:  John Quintner, MD, is a rheumatologist and pain medicine specialist in Australia who recently retired from clinical practice. He has published numerous articles on chronic pain in Pain Medicine, Clinical Journal of Pain, The Lancet and other medical journals.)

 The latest fads from the shadowy world of pseudo-science have always been quick to take off. For those who are keen on approaching pain sufferers with their sharp needles, the invention of Neural Prolotherapy by Dr. John Lyftogt, of Christchurch in New Zealand, must have come as a godsend.

In theory, Neural Prolotherapy is the injection of sugar (glucose) just below the skin to promote the healing of nerves and tissues damaged by neuropathy, sports injuries and other types of chronic pain conditions. “Prolo” is short for proliferation and derives from the Latin “to regenerate or rebuild”.

A quick search on the Internet reveals that Neural Prolotherapy is being taken seriously by a number of health practitioners who one might have expected to have known better than to accept it so uncritically. 

bigstock-needle injectionProlotherapy with injectable substances (such as autologous platelet rich plasma, autologous blood, and bone marrow aspirate) acclaimed as growth factors is now the subject of intensive research.

But Dr. Lyftogt favors hypertonic sugar injections.

Here are some remarkable extracts from his website:

 After the success of Neural Prolotherapy with Achilles tendonitis other persistent painful conditions of the neck, back, shoulders, elbows, wrists, knees, ankles and feet have been effectively treated by targeting the local inflamed superficial nerves with micro-injections of low dose Glucose.”

My Comment: there have been no properly conducted clinical trials of Neural Prolotherapy.

“More recently Dr. Lyftogt has developed effective neural prolotherapy treatment protocols for Migraine, Fibromyalgia, CRPS, compartment syndrome and other difficult to treat persistent painful conditions.”

My Comment: Again, no clinical trials have been conducted. The evidence is purely anecdotal and subject to all forms of bias.

“Neural prolotherapy is an effective novel and evolving treatment for non-malignant persistent pain, based on sound neuroscientific principles.”

“Subcutaneous prolotherapy with a series of percutaneous near nerve injections has been shown to be an effective treatment for a variety of recalcitrant painful conditions caused by prolonged neurogenic inflammation.”

My Comment: This is the logical fallacy called circular argument: the conclusion is assumed before the evidence is presented. Dr. Lyftogt offers no evidence that these conditions are associated with “prolonged neurogenic inflammation”.

Dr. Lyftogt targets the “guilty” superficial nerves by injecting 5% Mannitol or 5% dextrose and thereby claims to modulate the neurogenic inflammation that he believes is responsible for neuropathic pain. He refers to the work of a highly regarded authority:

“Quintessential to the working hypothesis that subcutaneous prolotherapy treats prolonged pathological neurogenic inflammation is the work by Douglas W. Zochodne from the Neuroscientific Research Unit at Calgary University.” [1]

When contacted by the author, Professor Zochodne replied: “I can indicate that I have no interest in it, have not endorsed it or plan to endorse it and am disappointed our work would be quoted for something without evidence.” 

 But there is more!

“(Dr. Lyftogt) hypothesizes that subcutaneous prolotherapy injections of hypertonic glucose and 0.1% lignocaine induce apoptosis of proliferating peptidergic noceffectors (i.e. SP and CGRP) and neovessels by reducing VEGF (vascular endothelial growth factor) levels and restoring ‘effective repair processes’ with reduction of pain.” [2]

My Comment: In this author’s opinion, this is pure speculation.

On his website and in a recent email to Associate Professor Geoff Bove, a world leader in experimental studies of nervi nervorum (“the nerves of the nerves”), Dr. Lyftogt claims that his injections target specific receptors (TRPV1) present on the nervi nervorum.

“The very small nerve fibers, innervating the nerve trunk, identified as unmyelinated C-fibers or ‘Nervi Nervorum’ are responsible for pain and swelling of the protective sheath of the nerve trunk. This was already demonstrated 125 years ago by Professor John Marshall from London and called neuralgia. It is now called ‘neurogenic inflammation’.”

My Comment: Dr. Marshall was in fact advocating “nerve stretching” in his Bradshaw Lecture given in London. Fortunately, this form of treatment has long been abandoned as being both ineffective and potentially dangerous.

Dr. Bove made the following personal response to Dr. Lyftogt in relation to his facile incrimination of the nervi nervorum:

“Dextrose does not do anything to TRPV1 receptors, and it is certainly not selective for abnormal ones (and there is no knowledge that those exist). You are not targeting nervi nervorum other than in your mind; they are few and far between on the small peripheral nerves, and maybe nonexistent. 

Regardless, you have nothing to offer regarding the injected dextrose reducing their function and thus reducing neurogenic inflammation, or reducing neurogenic inflammation at all.” 

The Bottom Line

According to Dr Lyftogt: “The growing scientific evidence supporting the view that neuropathic pain syndromes are caused by unremitting peripheral neurogenic inflammation involving the autonomic and sensory nerves may lead to renewed interest in prolotherapy and neural therapy as these treatments are effective and seem to target the PNS.” [3]

However, Dr. Lyftogt has yet to demonstrate the presence of the unremitting (enhanced) neurogenic inflammation that he claims to have identified and treated with his sugar injections.

The question as to the efficacy of Neural Prolotherapy, as practiced and taught around the world by Dr. Lyftogt, is outside the scope of this article. There are no published trials upon which to base any firm conclusions.

Anecdotally, there may be face validity for this treatment but to date there has been no discussion of placebo effect, observer bias, expectation bias, or reversion to the mean of the conditions being treated.

But what is abundantly clear is that published animal experimental research by leading neurobiologists Professor Douglas Zochodne and Associate Professor Geoffrey Bove does NOT in any way support Dr. Lyftogt’s hypothesis. This should be the end of the story, but I suspect that the aphorism by Francis Bacon is as true today as it was over 400 years ago:

The human understanding when it has once adopted an opinion draws all things else to support and agree with it. And though there be a greater number and weight of instances to be found on the other side, yet these it either neglects or despises, or else – by some distinction sets aside and rejects, in order that by this great and pernicious determination the authority of its former conclusion may remain inviolate” — Francis Bacon (1620)

All we can do is hope that good science will triumph over its rival.

References

1. Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Australasian Musculoskeletal Medicine November, 2007: 83-85.

2. Lyftogt J. Prolotherapy for recalcitrant lumbago. Australasian Musculoskeletal Medicine May 2008: 18-20.

3. Lyftogt J. Pain conundrums: which hypothesis? Australasian Musculoskeletal Medicine November 2008: 72-7

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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(This will be considered blasphemy to some)
Modern Medicine has devolved into a “murkiness” that is the twisting together of universal truths, presumed truths and personal conclusions.

I use the term to describe all the Universal Laws that Can’t be broken. PERIOD! These are the laws of Science, Chemistry, Physics, Biology and Cellular that we as humans have deduce from observation, experimentation and logic.

Whatever is in a human mind or developed from our minds are beliefs, ideas, concepts or theories. These can be “broken”, changed, modified or revised.

Whatever I or you believe, experience or witness are solely ours to use to formulate personal conclusions. These make up the raw materials to then be applied into the methods of science.

What I see as miracles can only come from Mother Nature. Miracles of medicine are seen in vaccines, antibiotics, hypertension, diabetes and thyroid medicines, some orthopedic, GYN, brain and heart surgeries … to name a few.

Magic in medicine comes from an idea that a stainless steel titanium block of metal are more advantageous to restoring God given joints. Thinking science can find chronic pain with technology is a major flaw in logic but is the standard of care today. If this was a universal truth then finding pain would be like finding cancer and treating cancer or a tumor, which is not so.. Repairing chronic pain with surgery is the one “magic trick” that concerns me the most because I witness the failures on a daily basis.

Perpetrating Mother Nature without acknowledging her contributions is deception of the highest degree, and those mis-Leaders should be ashamed and reprimanded.

@Quintner
I see you have not reviewed the work of C. Chan Gunn and Cannon’s Law which are rooted in the Universal Laws which make them unbreakable. Until they are repealed, modified, updated, clarified by a few independent scientist, they will be absolutely true forever.

@ Dr Cohn. I happen to take science very seriously. Therefore I cannot agree with you that our colleague has developed a potentially valid theory. As for the efficacy of his treatment, there is no published data available. All we have to go on is anecdotal evidence that suggests the benefits may be due in large part to contextual factors.

John Quintner, Physician in Pain Medicine

@ Dr Rodrigues. Truth Therapy, Dancing with Mother Nature, Worship of Past Masters, & Beware of False Prophets!

Could this be the start of a pseudo-religious movement that will spread across the world of pain, all on the point of a stainless steel needle?

Thank you for your thoughts, Dr. Rodriguez. I do not approach patients with a new therapy, lightly. I do, however, believe what I see with my own eyes and experience within my own practice. Thus far, the results are amazing, but I still await the results of long-term outcomes.

Dr. Quintner, I also thank you for your thoughts. As you can see, however, I take my trials seriously and with more than a grain of salt. Outcomes will be seen over the long-haul. My concern is summed up, however, by the title of your article, “Sugar Coated Nerves: The Pseudo-Science of Neural Prolotherapy”. I have watched Dr. Lyftogt teach this course and never does he claim to have all the answers. He is very careful to qualify his statements as Theories, not absolutes. Moreover, he has done his research very deeply and may have put together information from century-old research melding it with new research to develop a working theory which HE strongly hopes someone will test. He admits that he is not a researcher, but a treating physician. It will be up to the academics to validate or disprove his theories.

Dismissing a potentially valid theory with significant case history support as ‘pseudoscience,’ however, is unnecessary and disrespectful to a very hard-working colleague.

The surprise and amazement will be a pleasurable and rewarding experience from now on.
This therapy is Truth Therapy and will lead to a complete cure or an ongoing treatment.

If complete cure:
Apply the tenets of wellness, take magnesium and have patients be proactive to “lock in” the cure.
If the cure is incomplete:
The therapy still must be applied within an ongoing treatment package for 2 months or 10 years.
I have patients who will pop-in to the office a year after their last treatment to “refresh” the healing process.

IMO
The only way the therapy works is from human contributions to Mother Nature and the process.
Get excited but don’t get too cocky, because you are just the assistant to Nature. Dance with her and the results will be profound. Step on her toes or try to trick her and she will punch you in the nose. Since you’re working WITH Mother Nature you should place all your fears aside, follow her leads and goodness will emerge.

Also you will find that the standard rules and regulations of medicine and pain therapy are written without this therapy in mind, which makes these rules inadequate. The only rules you follow are Mother Nature’s and the only person who can guide you on how to apply them come from the patients themselves. Since chronic pain is invisible to technology and scans, they are the sole source of for guidance, trust them implicitly, they will tell you the answers.

In my office, I tell the patient point blank, if they do not get better, it’s on me missing a key injection point or overlooking a precipitating or aggravating factor in the history or physical exam. There many of these corruptors and the discovery process may take a few months to uncover.

The only way this therapy fails is the result of solely human errors:
The main error would be in how religiously you adhere to a belief, your own or a mentor. I would suggest you get all the related textbooks of the last century and put them side by side to envision what those Masters envisioned. They all use the same tools with a slightly different logic. They all are imperfect but together they all cover the others imperfections which will better your clinical outcomes. If you decide you will negate an author’s contributions, that would be considered a human error and your most severe pain cases will suffer under this error.

Warning. Please do not get distracted by false prophets who will cast doubt, they refuse to understand these points; pain is uniquely personal and invisible; refuse to believe patients can be in such agony without a structural cause; refuse to believe a low-tech simplistic set of injections have a better outcome than the higher cost operating room versions; refuse to believe the positive evidence you collect in your office.

@ Dr Cohn. Please read my article wherein you will find the following:

“The question as to the efficacy of Neural Prolotherapy, as practiced and taught around the world by Dr. Lyftogt, is outside the scope of this article. There are no published trials upon which to base any firm conclusions.”

But before extrapolating from the short-term positive results of Dr Lyftogt’s treatment regimen on your selected patients a word of caution is needed.

As Carlino et al. (2104) remind us: “Any consultation, diagnostic procedure or treatment is carried out within a context, a context which itself may be a crucial determinant of symptom perception and therapeutic outcome.”

I must reserve my judgment on treatment efficacy until publication of the RCT.

Carlino E, Frisaldi E, Benedetti F. Pain and the context. Nat Rev Rheumatol. 25 February 2014 doi:10.1038/nrrheum.2014.17

I find this whole argument pointless. The injection of glucose at 5% is innocuous and harmless at its worst.

Having taken a workshop in Kansas City, MO only 4 weeks ago, I came back with hope and skepticism. I work in a pain practice, using a combination of therapies to resolve, not manage, patients’ pain. Like Dr. Lyftogt, my only concern is whether or not a therapy works, not whether or not it has a perfect explanation or theory underlying it.

Over the past 2 weeks, I have utilized Dr. Lyftogt’s methods in appropriate patients 13 times (without charge to the patients) and with the patients’ understanding that this is a test of a new form of treatment and have achieved instant and total resolution of pain and increased function 10 of 13 times. That is a better record than any medication I have ever used or most treatments. I obviously have not had the opportunity to see the long-term outcome, yet, but the short-term response in nothing short of phenomenal.

Instead of sitting and pontificating on the merits of this therapy, why not try it, yourself, and see whether it has merit. If Dr. Lyftogt’s theories are ass-backwards, so what? His observations on efficacy or spot-on. Come up with better theories, if you have some and begin testing them. Dr. Lyftogt’s studies on his own patient population have significant scientific merit and at least one RCT, I understand, is on the way.

My own short-term population study will never be published because I am not a researcher, I am simply a treating physician willing to entertain the possibility that someone who has put a great deal of effort and thought into a new theory and devised a possible treatment may be onto something. So far, his methods – whether the theory is right or wrong – have had amazing results for my patient population.

I will continue to utilize this treatment and perfect my skills in diagnosis and treatment as long as my patients continue to gain benefit with no significant adverse reactions – and thus far, there have been none more than mild bruising.

I’m glad you’re here, a doctor listening to me rant. At any rate: I know trigger point is based on this principle of bringing healing agents to an affected area by doing minor damage to a muscle. (I’m a patient not a doctor, so this may be the wrong way to say this.) I had Botox which was new at the time, and it is based on a living bacteria designed with a “shelf life” which had shown to be an anti-inflammatory in plastic surgery cases. It didn’t work for me, except for a short lived relief, but it was ordered by a doctor and approved by insurance, so of course I approved them also. I had already found out what happens when you say “No” to a treatment and I will never do that again. But when you think of the crazy, seemingly nonsensical treatments out there that we are subjected to at the whim and approval of doctors working with insurance agents, why not add more? The fact is that most of these remedies help between 10 and 20% of the subjects, give or take. That seems to be the way of pain treatment here in the US, a rep tells a doctor of a new “remedy, the doctor sees if insurance approves it and if so, it happens and money spreads to everyone, except of course, the patient. I would say all of my treatments didn’t work, except for a trial and error meds regimen. Some even hurt the situation. But they did help some people. Like my neurontin, which for me was a miracle drug; for others is a damaging drug and it was originally intended for epileptics. Or Vioxx, taken from the shelves for a problem with some patients having heart problems from it. As it turns out, it was a relatively “safe” drug but the lawsuits and fines and penalties caused it to be permanently shelved. Celebrex went through the same scrutiny but made it back to the shelves. I had been on both for over a year in my long line of drug trials. So here I am 10 years later having tried so many things that didn’t work, most of them “new” to the pain world, left to slowly deteriorate with only pain meds to comfort me. Then someone steps in and limits my morphine which cut my regimen in half and caused 2 months of setbacks, some of which were permanent. I was able to qualify to get the other half back because my pain level and consistency fell into that of a cancer patient, and for them, the pain meds limit didn’t apply. So someones’ making these rules up and deciding our fate for us, and apparently cares more about money and the bottom line than they do about the well being of the patient. I’m so sorry to have to admit that what you quoted by Dr. Bernard Lown, is strikingly true. If only the system would begin to… Read more »
John Quintner, Physician in Pain Medicine

@ Dennis. We are in agreement – “Education and awareness are the lights in this darkness and empowerment is what allows us to put the pain monster in its place.”

Part of the educational process has to be about safeguarding yourself against the claims of people who are offering you treatment that has no rational scientific basis.

In the context of the present discussion, needling (whether “dry” or “wet”) of muscles falls into this category. I know that many physical therapists in both our countries believe in and practice such needling techniques when they treat people in pain. They even attend courses and pay large sums of money to learn just where to insert (and not to insert) their needles.

In truth, this form of treatment is guided by the ancient principle of homeopathy – “like cures like”. One has to injure a muscle with a needle in order to heal an injured muscle. The fact that no one has ever demonstrated muscle injury in the first place does not dissuade them in the least.

Your claim that you have been mistreated by the medical system has been echoed many times by those who write of their experiences on this website.

I am in no position to comment on your medical system but Bernard Lown, Emeritus Professor at Harvard School of Public Health and a Senior Physician at the Brigham and Women’s Hospital, Boston, and a co-recipient of the 1985 Nobel Peace Prize for his work in prevention of nuclear war, wrote of the changes to health care in the United states in this way:

“Health care in America is in deep crisis. A public service has been transformed into a for-profit enterprise in which physicians are ‘health care providers’, patients are consumers, and both subserve corporate interests. The effect has been to convert medicine into a business, deprofessionalise doctors and, far worse, depersonalize patients.”

Yes, there are many cases to answer, but is anyone really listening?

Dr. Quintner, Thank you for your words and your education. It helps a lot. Know that when I speak of “Pain” and quelling it, I am speaking more of the life one falls into due to pain rather than the actual pain sensation. When I speak of quelling it, or crushing it, or more to the point – “bringing it down to size,” I am speaking of taming the beast so we, as patients, can get our “old” lives back as much as possible. That we might find happiness and quality and become productive and meaningful again.

I am a huge proponent of anything that does this and I have learned that people are very unique, and finding treatment plans should be tailored to their uniqueness. This is why, the more available treatments, whether they be drugs or procedures or therapies, the better chance we may all find what works for us and the measure of what works is the measure of how happy and productive we are.

“The Pain Syndrome” is based on a fear we have of unending, constant pain – of feeling our way through the dark trying to understand how our lives became so negative and how we can find our way back. Education and awareness are the lights in this darkness and empowerment is what allows us to put the pain monster in its place. Every time I hear of a new technique I get excited that this may help someone else find what my drug regimen did for me, allow them to feel a little more “normal”. Once the monster is cut down to size we can then start to manage the sensation of pain, and our lives again.

I know that my disease will continue to deteriorate and I can’t believe how limited my physical life is now, compared to 5 years ago, but the pain and sickness I feel now isn’t even on the radar compared with the “pain” of not knowing, the pain of being stuck in the “Cycle”, of being mistreated by the medical system. I know now, that I will die having seen the happiest moments of my life AFTER I knocked the pain monster down.

Thanks to Nuerontin being tried as pain med, or morphine being brought into my mix, and great physical therapy techniques which were revolutionary at the time, I can make this bold statement. Where would I be if these were never allowed to be tried on people like myself? What did I have to lose in trying them?

In order to quell the pain pandemic sweeping this country we need to become much more aggressive in getting people out of the Pain Cycle. The medical system itself needs to step out of its own darkness and understand pain as a lifestyle not just a sensation. It can be seen as negative – or positive. Again doc, I appreciate this dialogue. This is where all good change begins.

John Quintner, Physician in Pain Medicine

@ Dennis. Your use of the word “quell” is interesting in relation to pain. It means “to crush,” “to suppress,” “to forcibly overcome,” or “reduce to submission.”

However, pain is not a tangible “thing” or object that can be quelled. It is a particularly unpleasant lived experience for most people.

All experiences can be modified, and that which we call “pain” is no exception. Drugs can be effective for some people, but it needs to be emphasized that there are an increasing number of non-drug options available for which there is some evidence of efficacy beyond that of placebo etc.

The health dollars saved from curtailing unnecessary investigations and irrational treatment could well be put to better use by our respective communities.

For starters, free access of people in pain to inter-disciplinary pain education programmes would be well worth funding. Research into the regulation of stress response genes (epigenetics) could benefit people like you. Anyway, this is my hope.

Finally, the ancient Romans had a saying that is still relevant today: Divinum est sedare dolorum (“to relieve pain is Divine”).

When I talk to groups of people in pain, I always add “Doctors ain’t Gods. Everyone nods their head in tacit agreement.

Agreed Dr. Quintner, (sorry this is so long but I couldn’t stop.) in the ideal model this is true. In the overprotective justice system in the US this is also true. In the ethical halls of medicine, the same truth. Both of you are correct, in the ideal. But we are in pain. This is not the ideal. I’m not talking about tooth ache pain or strained muscle pain, I’m talking about serious bone, nerve and muscle diseases that are extremely and constantly painful. If we were patients in the hospital morphine and fentanyl would be used a lot and right away, and when I get this in the hospital, I become very alert, very “normal”, very energetic, ready to get stuff done. I usually get so much pain meds (surgical reasons) that I feel this way 3 or 4 days after I get out. So of course, if I wasn’t a thinking person, the incentive here is to go to the hospital as much as possible, and since my disease is rare and very serious, over the heads of most ER techs and docs, They throw these drugs at me, thank God, because there’s not much else they can do. I’ve seen a lot of street addicts and users, and they seem to get a “high” or buzz from these meds, but they could take nowhere near the amount I can, and I never get a buzz, just feel more “normal.” I use this as a measurement of who has serious pain and who is looking to mask some emotional pain. This isn’t ideal, but is also the truth. I think we as patients should be referred and allowed to make our own decisions as to when we could try a new procedure, and in this case, I would. You guys are holding water and I’m on fire. I tried Vioxx, Celebrex and Botox when they first came out as pain meds. They didn’t help me – but didn’t hurt either. And somehow, these had been approved. When I had insurance I got everything including a synthetic morphine program designed to increase the dosage until it worked so you could return to work. I loved it and I worked a lot. Unfortunately, it was very expensive. When it stopped, for financial reasons, so did my working days. Hmmm. Not ideal, but starkly true. How about the procedures that are unnecessary but you get them because your insurance approves them? I even got a brain scan one time! Go figure, not only the cost of that scan, but what about the radiation inflicted on me for no reason? How many unneeded procedures were done only because they were approved and if you added up the radiation amount, was this the cause of my Prostate cancer? We won’t know because Medicare won’t approve any pictures to check on things, including my bone disease. Poor people’s insurance. Not ideal, but very truthful. So as much as I hate being a realist and… Read more »
John Quintner, Rheumatologist

@ Dennis. In your own words, “Educate and Make Aware!” This is what the discussion is all about. Everyone is free to make a choice in the interests of their health care.

There are many health professionals, and others, who will happily insert needles into various parts of your anatomy, and all will claim curative powers for their respective technique. Ask them for proof beyond their own experience and you will receive blank looks.

As far as medical practitioners are concerned, we are bound by the rules of ethical practice and should we choose to step outside of them, censure from regulatory authorities will come our way. Yes, the public does need protection, even if only from itself.

Agreed!
This is what I know and more importantly what I don’t know! Understanding the difference between what is absolute truth, what is my opinions, what the patient feels and what is in textbooks. I have been shocked by the little that I do know and comfortable and at peace with what I don’t. To get to peace, I had to separate out the laws of mother nature; from what I’ve witnessed in my journey and what I have read in textbooks.

This truth is universal:
The laws of mother nature can not be fully known, broken, assumed, altered or discounted, they are completely perfect and will never forsake me or anyone else. So in this entire scenario mother nature has the absolute truth and the patient knows his/her own truth.

What a patient feels is their absolutely true:
Who is the client or customer? The patient believes they are in pain because their are in the body that is telling them the truth. They know what helps and what harms so we must take the first hand word of the patient! NO scan or test can do this. Take the word of the scan or MRI and you have betrayed the patient’s wishes.

What the therapy does to the human body is absolute:
What I know is how to use a few simplistic tools that are made of slender stainless steel solid filament-wires and the other a hollow needle with a beveled tip. So if I use these tools and the patient states that their pain is better and they can move more freely, then that is the most profound scientific data one can ascertain. This cause and effect is felt immediately witnessed by the patient and is not up for debate.

What is debatable:
What man as created, his opinions, ideas and what he thinks is the least significant component and thus of little significance; The written words of man are our account of what we have witnessed, true or false and should be debated until dispelled or adapted.

The ultimate goal:
What anyone else can not do is disavow a patient’s word of how they feel or there real life testimony as it relates to their pain and therapy. The patient should be in charge of his or her destiny and given all options available no matter if it is old, new, traditional or nontraditional, the patient will tell us if it is the best for their personal situation.

Drs.: You both seem like educated men who truly care about helping people, but would you put the egos aside for a minute and think: “How is this helping those in pain?” You both have a legit argument but assuming this treatment is somewhat safe shouldn’t the priority argument be “How can we try this on people in severe pain?” I’d like to hear about that.

Why is it that something like this is done in many countries, but in this country we are still in the doctor to doctor arguing stage? What avenues would the treatment have to take to get it to the public as soon as possible? What are the hurdles? Who will be involved? Why does it take so long? Why can’t it be tried on the real severe cases, like those close to suicide?

Who cares right now who is right and who is wrong? With your intelligence and apparent passion you should have a meeting to decide how to expedite it to trials. Put your heads together with a different agenda, getting the treatment to us! Have this argument at the local doctor bar or debate club. This is a good debate and necessary, just not here. Live by the rule, “How will this immediately help people in pain?”

John Quintner, Rheumatologist

Dr Rodrigues, as Science appears to have left this room, I will sign off and leave you to worship at the Temple of the Trigger Point.

“incontrovertible that the needling of innocent tissues can be relegated to the dustbin, where ineffective and irrational therapies belong.”

As if you did not know that science has a starting point and that is in our thoughts and dreams, we test those ideas in the real world using what works and discarding what does not. That is the simplest of the science methods. Trials and errors are this life blood of ingenuity. Denial of another person’s ideas, practices and results that are validated in the office by hundreds in my patients and tens of thousands when you include all of us who use needles and hands on therapy is NOT scientific and borders on insanity. Since pain is so personal and individual you have to talk to each and every patient to make any conclusion. The journey of Real people should convince you.

Please my friend, people are not data points or numbers or widgets you must put a halt to your dissension. People need options now, don’t hate on Acupuncture or needles! Remember if left untreated some pain syndromes will metastasis into the vertebra zones to cause CSS or Spinal Segment Sensitization, I would not want that disease on anyone and I would even have mercy on Lucifer himself.

John Quintner, Rheumatologist

Dr Rodrigues, you already know the answer to your question. The so-called positive data of your predecessors has been exposed as without scientific foundation.

Far from being guilty of “malignant disregard,” a small group of us has taken the trouble to wade through much of the relevant literature of the 19th and 20th centuries and distil both the theories and practices that were being promulgated at these times. Moreover, we have, and are still, publishing our analyses in reputable journals.

The fact that you disagree with my opinions does not in any way lessen their impact. The evidence is incontrovertible that the needling of innocent tissues can be relegated to the dustbin, where ineffective and irrational therapies belong.

While you “professionals” argue this out to determine what is safe for us patients, do you need any human guinea pigs?

I’m sure due to restrictions we will not see this drug, if it is deemed good and safe, for many years but hopefully the point is taken. We are on fire! We are burning. We need water.

I wouldn’t want to stop regulation of these drugs, believe me, but if the point is well taken then you understand, if you were standing next to me on fire how would you feel if I told you the water I was holding might not be safe and maybe you can pour it on me in a few years? That’s the point. People who aren’t in pain deciding important, timely, critical issues for those of us who are in pain.

Can we hurry the process? Is anyone going to jump in and help Dr. Lyftgot with research and smoothing the road? Can we earmark certain pain drugs as “priority 1” and put them on a fast track? There are answers here, beyond politics. With 100 million people in pain, half of whom are in severe, constant pain requiring strong pain treatment, we are in an epidemic, no, a pandemic. Treating pain reminds me of how we treated Katrina. Let’s hope it isn’t up to Congress where it would take years to decide not to vote on it!

@ Quintner
I note that you are a researcher and scholar (not in active practice) who is attempting to uncover the mysteries of pain and all of the therapeutic options. Thanks! Why the profound disregard and disrespect for us on the front lines who use needles as tools in our quest to free folks from pain. All researchers should be investigative, curious and free thinking. Being a defeatist and rejecting all of the positive clinical data that our predecessors have collected and we continue to collect daily is discouraging to the readers.

Discouraging and confusing patients is tantamount to malignant disregard. I know beyond doubt that chronic pain will not disappear, can not be fixed with a pill or surgery and has the potential to metastasize into surrounding tissues. If the pain cancer invades the small rotators of the spinal column then it is called Central Sensitization Syndrome. Imagine Hellfired and Brimstone! So the longer one waits the longer and more intense the therapy will have to be to reverse the damaged tissues.

I know beyond a shadow of a doubt that chronic complex pain should be treated with a recipe of options based on the unique circumstance of each case at the patient’s request. Try not so use each discipline against the other; Acupuncture vs Gunn-IMS vs Sugar-Oil-Zinc-Traumeel Prolo-therapy vs Travell injections vs CBT vs Chiropractor adjustments vs massage vs medications. BUT in a recipe that the patient has control over and can dictate the intensity, frequency and modality so he/she can personally tailor make a therapy.

@Lyftogt
I see your work shops are a 1000 bucks, good price from a marketing standpoint. We need more injectors. I have use prolo and have decided that the needle is the active ingredient and that the substance is just about faith. The evidence is based on 5000 yrs of the use of needles in China and Travell use of trigger points with lidocaine.

John Quintner, Rheumatologist

Dr Lyftogt, as I see it, you launched your hypothesis in the public arena. In so doing, you exposed it to critical analysis. If it does not survive this process, a better hypothesis may be generated that explains the excellent outcomes you have observed. Your accusation of character deconstruction is without foundation. Whether we like it or not, furthering the cause of science is of necessity an adversarial pursuit for an elusive truth.

There are many wise men of science (and literature) who have outlined the paths for us to follow:

“What the experimenter is really trying to do is to learn whether facts can be established which will be recognized as facts by others and will support some theory that in imagination he has projected. But he must be ingenuously honest. He must face facts as they arise in the course of experimental procedure, whether they are favorable to his idea or not. In doing this he must be ready to surrender his theory at any time if the facts are adverse to it. From: The Way of an Investigator, Fitness for the Enterprise. Walter B Cannon [1871-1945]

In his The Doctor’s Dilemma, “Preface on Doctors,” George Bernard Shaw made a very telling observation: It does happen exceptionally that a practicing doctor makes a contribution to science … but it happens much oftener that he draws disastrous conclusions from his clinical experience because he has no conception of scientific method, and believes … that the handling of evidence and statistics needs no expertness.

Dr Rodrigues
Neural Prolotherapy is not an easy treatment to learn and I run 3-day introductory workshops, which are announced on my website: doctorliftoff.co.nz.
Dr Quintner
In this whole correspondence you have not once uttered any curiosity about my observations or acknowledged anything I have discovered. From the beginning you and Geoffrey Bove have embarked on a path of character deconstruction, which is all the more tragic, because what I have learned has benefitted some 6000 of my patients over the last 12 years. Overall my excellent outcomes with a variety of chronic painful conditions has been in the order of 80%. And I have documented a good number of these in high level Practice Based Evidence studies and one RCT published in the Br J of Sports Medicine. Good RCTs involving a minimum of 120 patients in two or three arms of a study usually have a budget in the order of $300.000. I do not have the funds for this, so I am dependent on excellent researchers like Professor Dean Reeves and Professor Michael Yelland for generating these funds. This is extremely difficult as no Pharmaceutical Company is interested in funding glucose, a substance that can not be patented. Despite all the hurdles we are progressing well with a number of RCTs. Your demands for RCTs and publications in peer reviewed journals will be responded to this year.
I have been a clinician for 40 years, my prime responsibility is to the patient in front of me, not to some rigid and blinkered ‘scientists’ whose sole objective it seems to be to be adversarial in the most vaguest of terms and claiming to know all science underlying pain. This is such a preposterous stance as there will always be more to find out than is known today in this most difficult field of medicine.

Interesting! Would you mind sending me your personal protocol? I have never used glucose, I follow Travell/Simons lidocaine recommendations.

It would be interesting to compare the beneficial effects of 5% glucose versus:
1% glucose
NO glucose
Only the needle insertion as a control.
An acupuncture needle as a control.
An entirely different solution like lidocaine 1% @ 50/50 which is my standard for wet needling.
The use of extraneous points.
I would exclude anyone on opiates and cholesterol meds; opiates disrupt sensation and neurotransmitters and Statins interfere with healing and peripheral nerves).

Notes:
The patient will know by sensation which concentrations are being used so I would suggest that this information is catalogued by sensation type and how long after the procedure the sensation lasted.

Keep track of proactive home and aftercare. I would suspect that an active person would fair better than a sedentary or one who loves to soak in a hot tub plus massage, meditation and use of supplements esp magnesium.

@Quintner, in the office the only scientific method that is valid is a “try and see” approach. All hands-on, personal, individual and unique for that particular day. Because this therapy ignites healing, rarely on follow-up is the patient the same. This would be an impossibility due to the innate ability of healing. (This is not a trial and error approach where the therapy can be toxic or do harm). After the procedure the patient tells you if the triggers have been targeted and in improved Range of Motion as in a frozen shoulder. I like to see 25-50% improvement in ROM.

John Quintner, Rheumatologist

Dr Lyftogt, it is your personal hypothesis that is being met with scepticism and derision. The responsibility rests with you to provide a more credible scientific explanation of the observed positive, but as yet unpublished, results of your treatment. Hopefully, this robust debate will now take place within the covers of reputable journals. But first you have to publish your results in one or more of these journals.

When I first heard about the use of Glucose as a treatment for chronic pain, like Dr Quintner and Geoffrey Bove PhD, I dismissed this out of hand as too alternative and bizarre. However when I heard Professor Michael Yelland from Brisbane, Australia give a presentation on a RCT on prolotherapy and chronic low back pain I decided to investigate this further. I experimented on myself for a considerable period of time, with subcutaneous hypertonic glucose injections treating my chronic Achilles tendon injuries. I found, much to my surprise, it resolved the chronic pain and swelling. The discovery that glucose can resolve chronic pain and disability was further tested in six Practice Based Evidence studies published in the Australasian Journal of Musculoskeletal Medicine. The results speak for themselves (doctorliftoff.co.nz) I further tested, initially on myself, which concentration of glucose may give the best clinical results and came to the conclusion that all tested concentrations (40-30-20-10- and 5%) produced similar clinical outcomes. A serendipitous observation in 2010, again through experimenting on myself showed that Glucose 5% in near nerve injections completely extinguishes chronic pain and with repeat treatments resolves disability. I have been teaching this treatment (NPT/PIT) worldwide to Doctors from 12 different nationalities with excellent clinical outcomes.
I have concluded that Glucose in near nerve injections with Isotonic (5%) concentration extinguishes, in a transient fashion, neuropathic pain and with repeat treatments restores tissue homeostasis or the nutritive state of tissues.
Glucose has been used in the treatment of chronic pain for over 60 years and its analgesic effect has been known for even longer. We have known for over 50 years about the existence of glucosensing nerves. My challenge to the scientists is: look into this glucose puzzle and give us an explanation!
My personal hypothesis is that glucose in isotonic concentrations targets C-fiber glucosensing neurons with TRPV1 expression. The clinical results demand an explanation from scientists, not denial and derision. The future wellbeing of patients with chronic pain could well depend on this.

@ Dr Rodrigues. You have just nailed it – “use basic scientific methods”. No more or no less is required of us.

@ Dennis Kinch. I hope that your prayers are speedily answered as they strike at the heart of the ethics of Pain Medicine and, dare I say it, at those of Medicine itself.

@quintner
“shadowy world of pseudo-science”
Interesting that you would call pseudo-science, “shadowy”, because all science begins as a shadowy idea, a thought, an observation, a problem, a barrier or insight! With the use of the basic scientific methods we are able to discern reproducibility some reasonable truth.

“Clinical experience and scientific endeavour are not incompatible bedfellows.”
Clinical experience is actually the CORE of scientific endeavours!

“scientific credibility of his hypothesis that has been questioned.”
His hypotheses (yes indeed) is the issue that has been in discussions and practice as far back as 1911 and 1930 when Lennander, K. G. and Leriche, R respectively used injections for the treatment of back pain. Then, 1953 Hackett, 1989 Pybus, Wyburn-Mason, 1990 Lyftogt and onto today where everyone is claiming a new twist on an old idea.

Again the tools are valid and vetted, we need to come together to “purify” the science and medicine.

Remind me again Quintner, What was your twist?

Far be it for me to stand in the way of progressive health care. But wait, aren’t there millions of us who can prove that the medical system has been spiraling downward since the advent of the HMO? Millions, and counting.

The stories are all the same, complete disbelief that we are in pain, mistrust that we know how to use meds, professionals with a money agenda, or a numbers agenda, sacrificing the patients and ultimately, their families. DEA agents watching everybody involved searching for more victims to put in jail.

While we suffer through “Protect and Prohibit” mentalities, we lose everything, end up homeless and yet, still in pain. I’ll say it again: “Put the prohibition on the back burner and turn your concentration to getting us pain relief, to saving us from agenda ridden insurance agents, to believing our pain is real. Protect us from pain, which all of us have, not from the small minority of “bad apples” who cheat the system or from the arguments over what works and what doesn’t.

Again, I’m not against what you say or do it’s just that my pain and the search for relief has my priorities. I wish it was everyone’s priority, that’s all.

John Quintner, Rheumatologist

@ Dr Kim. However it may seem to you, the author has been in contact with Dr Lyftogt. But I do take your point about 5% Dextrose in water.

Good and caring physicians will always be in demand. I do not see that this point is either arguable or relevant to my article, which does not cast any doubt upon Dr Lyftgot’s attributes as a physician. It is the scientific credibility of his hypothesis that has been questioned.

But let me make a final observation. Clinical experience and scientific endeavour are not incompatible bedfellows.

Dear Dr. Quintner,

My hats off to you for your efforts. Here are my 2 cents…

[“Dr. Lyftogt favors hypertonic sugar injections.”]

5% dextrose in water is isotonic, not hypertonic.

[“All we can do is hope that good science will triumph over its rival.”]

I hope that a good physician is not a warrior, but a gentle soul who actively seeks ways to bring comfort, and support healing in those who have suddenly found themselves in a lonely and disempowered state. Of course, I agree, science is the foundation, but healing, spirituality, and how life unfolds are some of the areas that are often beyond the current scope of science.

And if a doctor is concerned for the suffering patients, and is curious about a new technique that is beyond the current understanding, how about contacting the doctor himself who is reporting something new and exciting? It seems that you have contacted everyone except the man himself.

Upon such direct contact, perhaps with your science and his clinical experience, a new paradigm in pain medicine may emerge that can help thousands of patients. Otherwise, a good scientific endeavor may seem like an attack.

Just my 2 cents.

Respectfully,

Dr. Albert M. Kim ND
Burnaby, BC Canada

John Quintner, Physician in Pain Medicine

@ Dr Rodrigues. If only it was as simple as you make out. But because you have accused Medicine of holding a narrow dogmatic view regarding therapy, let me direct you to these wise words of Raymond Tallis:

“The contrast between the endless variety of ‘orthodox’ medicine – with a multitude of different remedies for the multitude of different diseases – and the monotony of the remedies offered by alternative practitioners, has never been sufficiently remarked upon … What is more, exponents of one particular brand of alternative therapy have little time for purveyors of other non-orthodox alternatives. The closed-mindedness orthodox practitioners are accused of is very much alive and well in the ranks of alternative practitioners.” (p. 304) from: Raymond Tallis. Hippocratic Oaths: Medicine and its Discontents, 2004.

The remedy for your discontent is to follow the well-trodden path of the Scientific Method. Although I cannot agree with Dr Lyftgot in this matter, his publications do at least allow for a critical analysis of his hypothesis.

Your hypothesis – igniting nature’s innate healing systems etc. – is of ancient (i.e. Hippocratic) lineage – Vis Medicatrix Naturae. Hippocrates taught that we must refrain from meddlesome interference. In my view, your use of needles falls into this category. I am always happy to be proven wrong in this matter.

@ Dennis Kinch. I do agree with you in so far as all methods of treatment should be the subject of double-blind controlled clinical trials. This holds both for orthodox and heterodox methods. Yes, by all means “Educate and make Aware”. This is an important function of the National Pain Report.

As for Protect and Prohibit, would you prefer to have a downward sliding health care system where “anything goes”? From my admittedly distant observations, I think you could well be on this slippery slope in North America.

@Quintner
You have fallen victim to a narrow dogmatic modern view of medicine that profess all therapy has to be screened by a “pure” scientific model. This pure methodology is a fallacy like the belief system back in the dark ages when humans thought the earth was flat. As I read more about this thought process, I assume it is fueled by the business of medicine based on profits and on the egos of scientist for fame.

Prolo-Therapy is good idea, over 50 yrs old and was introduced by Stuart Hackett, MD.. Prolo is a valid therapy based on a “truth” but is flawed in the concepts. The truth part is very valuable to a lot of patients with musculoskeletal pain problems and if his protocols are follow properly they are very safe. How do I know because I’ve read his book many times trying to understand his logic and I have used his protocols in hundreds of patients for over a decade and they work.

Igniting natures innate healing systems is the key that is being used under false pretenses. All injections use a needle so they all have a common thread in terms of the mechanism of action which is to stimulate the healing cascade and depolarize/relax muscles to ignite natural innate healing. Examples are Botox, Biopuncture, Prolo, Platelet Rich Plasma, Steroid injection, Lubricant injections, Minimal Invasive, keyhole, Arthroscopic, no-incision Surgery for back, knee, hip or wrist pain.

The complete story goes back to a simple idea … the problem is in the muscles as in myofascial pain and dysfunction. Treated with massage, adjustments, yoga, Acupuncture and dry/wet needling, Travell trigger point injections and wellness + minerals. See my notes.

Are there any numbers supporting either side of the claim? How long has this treatment been going on? What studies were done for it to come to the practice level? And by the way…I’d volunteer to be a guinea pig right now, because even the dangers are better than my prognosis. And the way opioids are going I’m going to be in a lot more pain as time goes by, not less. As much as I’m all for testing and more testing and testing again, I’m in severe pain every single day of my life.

As my life becomes more painful due to lack of proper meds, disease degeneration and undue pressure on my doctor to help me, I am left wondering why I had to be born in a time where “prohibition” is the way of life, fear runs the rules. Medicine is saving more lives than ever before in history – except in pain medicine and money rules the decisions made by everyone who has weight in the field. So while this debate goes on and everyone weighs in, what does the person in pain do while we’re waiting for some relief to come down the pike? If you were on fire would you want water or would you wait until someone tested it first? I’m all for everything you said in your article except where the waiting patient is concerned. Everyone has already decided that it’s OK if our lives are more painful as long as we are protected from the evil drugs and procedures that relieve pain. They should try living with constant pain and see if they still feel that way after a month, or 15 years!

I’ve tried a lot of AMA approved procedures that cost a fortune and did nothing to help, and I’d do a hundred more if there was one shred of hope in it. I’m in pain. My life is shrouded with pain but all I ever hear is “Protect and Prohibit!” How about if we put some time and money into the only thing that’s helped me so far (besides neurontin and morphine), Education and Awareness.

I’ve seen it help more patients than any meds or procedures. It definitely has a bigger impact numbers-wise. The only reason I’m even talking like this is because I’m in pain, hard, terrible pain, all the time.Forget “Protect and Prohibit” and try “Educate and make Aware!”

And let the meds and procedures flow. Let the patients be the test! I’d try it right now! (except my pain is spinal) Sign us up. I bet out of 75 million patients, you’d find 70 million guinea pigs! Just something to think about.