A Sweet Solution to Chronic Pain

A Sweet Solution to Chronic Pain

Dr. John Lyftogt

Dr. John Lyftogt

(Editor’s note: John Lyftogt, MD, recently retired from clinical practice in Christchurch, New Zealand. He has published several articles on chronic pain and has conducted workshops around the world about neural prolotherapy, which involves the injection of a glucose/dextrose solution under the skin to control pain.

Dr. Lyftogt is responding to a recent column in National Pain Report by Dr. John Quintner (“Sugar Coated Nerves: The Pseudo Science of Neural Prolotherapy”), which questioned his advocacy of neural prolotherapy.)

Is neural prolotherapy just another fad from the “shadowy world of pseudo-science” or does it have an analgesic effect that could help millions of chronic pain patients around the world?

For millennia Jewish males have had circumcision under oral glucose/dextrose anaesthesia. Many painful neonatal procedures are commonly conducted under glucose anaesthesia and a systematic review of 14 controlled trials confirms the effectiveness of glucose as an analgesic agent.

Unfortunately, no scientist to date has investigated this common phenomenon — not even Professor Douglas Zochodne, who published a study on subcutaneous near nerve injections with low dose morphine.

It would be easy to repeat the same study with glucose in sterile water as a control. There are probably two reasons why scientists are not interested in this curious effect of glucose:

  1. Funding could be difficult without Big Pharma support.
  2. Finding a solution to chronic pain is not conducive to an academic career.

For over 50 years diabetes researchers have known about glucose-sensing neurons, which are specialized neurons that use glucose as a signalling molecule to alter their action. Glucose is increasingly viewed by scientists as a molecule with a metabolic and an inter-neuronal signalling function. Glucose-sensing neurons have already been identified in the brain, heart and enteric nervous system.

Meaningful chance observations in clinical practice have a long history of opposition from funding and regulating bodies in medicine. A doctor’s advocacy of washing hands in a labor ward in the 1830’s reduced maternal deaths there by 90%, but also lead to the doctor’s dismissal, eventual committal to an asylum, and death from a clobbered skull.

More recently, Barry Marshall’s observation in 1982 that peptic ulcers were caused by a bacterium led to his dismissal from the Royal Perth Hospital. In 2005, Marshall was awarded the Nobel Prize for Medicine.

All this happened in Dr. Quintner’s hometown. He should be well familiar with mainstream medicine’s kneejerk denial of innovation, as has been happening with glucose analgesia over the last fifty years.

bigstock-needle injectionDr. George Hackett was the founder and a prolific author on prolotherapy in the 1940-1960’s. He published his 19th paper on prolotherapy for headaches in 1962. Dr. Hackett reported on 82 patients with occipito-cervical disability who were treated with prolotherapy over a four year period. Good to excellent results were reported by 90% of them, with lasting success.

In the article’s introduction Dr. Hackett comments that, “Recent scientific interpretation of the devastating effects of excessive antidromic impulses and their clinical application are described.”

Here is the first description of an effective treatment with hypertonic glucose for conditions now known as neuropathic pain due to neurogenic inflammation.  Despite more than 50 years of continued success with prolotherapy and an increasing number of clinical trials confirming this, scientists refuse to have even a modicum of curiosity into the analgesic and trophic effects of glucose.

Mainstream medicine with its emphasis on central nervous system sensitisation and pain management can only offer relief to, at most, 30% of those who suffer chronic pain. This dismal track record in relieving pain and suffering should be a potent stimulus for investigation. As Hackett said in his 1962 paper, we should be “scrutinizing every fact, theory or idea that might enlighten us to the pathology, pathophysiology and treatment of these patients.”

Neural prolotherapy (NPT) is the application of isotonic glucose/dextrose to sensitized peripheral nerve trunks by way of subcutaneous (under the skin) near nerve micro-injections. It results in an immediate, profound and quantifiable reduction of mechanical allodynia.

Repeat treatments reverse the underlying neurogenic inflammation that causes neuropathic pain and leads to restoration of tissue homeostasis. Treatment with NPT allows for normal physiological repair of the nerve trunk and surrounding tissues. This has been documented in tens of thousands of patients and large numbers of ultra sound examinations before and after treatment.

NPT therapy is now available in 12 different countries by doctors who have been trained in neural prolotherapy. Ongoing ridicule of neural prolotherapy by specialists like Dr. Quintner, who has never witnessed a neural prolotherapy treatment or discussed the outcomes with patients whose lives have been transformed by NPT, is gratuitously offensive.

Cynical put downs of “anecdotal evidence” does nothing to enhance the reputation of mainstream medicine as it merely results in diminishing the validity of patients experiences in their battle with unendurable pain.

Several studies of NPT will be published this year in reputable journals, all confirming the above. More than fifty years of denial of the analgesic effect of glucose/dextrose by doctors is further evidence that they do not have the slightest interest in the care of chronic pain patients.

NPT is an effective, safe and economical treatment for chronic pain and mainstream medicine exponents like Dr. Quintner merely require an open mind.

References:

Harrison D. Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Arch Dis Child 2010; 95:406-413 CONCLUSION: Glucose sublingual is and effective analgesic in infants between 1 and 12 months of age

Barry E. Levin,1,2 Vanessa H. Routh,3 Ling Kang,2 Nicole M. Sanders,4 and Ambrose A. Dunn-Meynell1,2. Neuronal Glucosensing. What Do We Know After 50 Years? DIABETES, VOL. 53, OCTOBER 2004

Min-tsai Liu1, 2, Susumu Seino3, and Annette L. Kirchgessner1, 2 Identification and Characterization of Glucoresponsive Neurons in the Enteric Nervous System. The Journal of Neuroscience, December 1, 1999, 19(23):10305-10317

J. Antonio Gonzàlez1, Frank Reimann2 and Denis Burdakov1.Dissociation between sensing and metabolism of glucose in sugar sensing neurones. Department of Pharmacology, University of Cambridge, Cambridge CB2 1PD, UK.

Hackett G S, Raftery A, Prolotherapy for Headache. Pain in the Head and Neck, and Neuritis. HEADACHE, April 62

Authored by: Dr. John Lyftogt

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Michael

The best insight into this issue is the paragraph

Funding could be difficult without Big Pharma support.

Finding a solution to chronic pain is not conducive to an academic career.

It reminds us of the interest in monetising symptom management. There isn’t strong interest in addressing the cause which would result in reduction in the ability of the industry to rob patients of their life and savings.

dave

@ John- I am not that familiar with the work of Dr. Loeser. I agree with him, of course, as to what needs more attention in pain care and he deserves praise for founding the IASP that has brought attention to so many about the problems in pain care and attracts some of the most dedicated specialists in pain care.

John Quintner, Physician in Pain Medicine

@ Dave. You may already know that Professor John Loeser, a founding member of the International Study for Pain (IASP), has identified five crises in contemporary pain management that require urgent attention: (i) lack of evidence for treatment outcomes; (ii) inadequate education of primary health care providers; (iii) the largely unknown value of opioid treatment for patients with chronic non-malignant pain; (iv) funding availability for health care providers; and (v) access to multidisciplinary pain centres.

Reference: Loeser JD. Five crises in pain management. Pain: Clinical Updates, IASP, 20 (1), Jan 2012.

dave

Dr. Rodrigues- I agree with a number of your ideas and share your concerns about inclusiveness and the need for a civil rights approach to improve pain care.
Cultural transformation is needed in the “pain care system” in the United States and other Nations.
My belief is that it is largely up to people in pain to call for such change. Nonetheless, I recognize the contribution professionals like Dr. Bennett, Dr. Quintner, Dr. Moseley, Dr. Fishman, Michael Schatman, Ph.D., Dr. Giordano, and yourself( to name a few) are making to change pain care. I hope there is a way to set a side differences and work together in common cause to advance pain care.

John Quintner

Dave, prolotherapy has undergone scientific scrutiny and, at least for people with chronic low back pain, it does not produce outcomes that are any better than placebo injections. Consequently it cannot be recommended as a sole method of treatment. This is not surprising, given that the treatment is based upon the hypothesis that lax or damaged spinal ligaments can be a cause of chronic low back pain. Injecting irritant solutions around these suspect ligaments is supposed to make them stronger, with the result that both pain and disability are reduced. The hypothesis lacks supporting evidence. Thus, all one can conclude at this stage is that it may be “prolo” but is it “therapy”?

We all have flaws in our logic PERIOD. It is flawed logic to think that the same groups of people who got us in this situation will get us out! They are too busy confirming and promoting this maze of deceptions. It’s also human nature to believe what we are told without doubt.

Yes, I have my own confirmation biases but my knowledge AND experience base seems to be a little broader and more inclusive. Any rejection of a therapy is based on the failures that I see in the office. Pharmacology has too many failure so without inclusion of alternatives, patients are neglected and harmed due to a closed minded paradigm. Spinal, knee and hip surgeries have too many failures and patients are not given any other options and this does a lot of harm.

One major issue is the definition of “Pain” it is not what I thought it was and not what you think it is! Pain has too many variables and components to be sanctioned to a set standard treatment.
Knee pain is assumed to be in the knee joint proper. So all the attention is given to the “knee joint,” with X-rays, MRIs, injections caustic and disruptive substances like steroids and “the juice of chicken combs”, scopes, all in preparation for the ultimate high tech procedure which is a customized artificial joint replacement.

I’m disappointed that a Chiropractor would not be able to see the thin thread that links all of these chronic pain issues and that is the muscle/neuromuscular units which generate and propagate pain. This makes me aware of an additional issue and that it the “box.” You assumed that I was a Chiropractor without doing a simple investigation.

You are correct that I perform massage, adjustments, use Cold Laser, spray and stretch, use heat, E-stim and take in pre and post exam readings to see if there is improvement and if the therapy is working. All of which are the tools needed to treat chronic pain and what are missing in most therapies. Patient are not getting well rounded care and are subjected to piecemeal, crappy, poorly conceived care.

These patients should joint forces and rally a class action lawsuit because their civil rights are being violated by this ruse. Being free from treatable pain should be a Civil Right! This debate will continue until a powerful grassroots organization forces in this biased mechanical material science-based healthcare system. Having an all inclusive array of therapy options old and new is reasonable, attainable and humane.

dave

@ John In his book: Do You Believe in Magic, Dr. Offit, inidcates alternative treatments should be the subject of rigorous scientific testing.
In fact prolotherapy has been the subject of RCT’s for different pain conditions. SO it is clear “the untestable” is tested, and in the case of prolotherapy seems to have fared well under scientific scrutiny.
As conventional treatments for pain have high rates of failure, it only makes sense for society to investigate treatments that have some following but has yet to be put through the rigors of science.

dave

Dr. Bove- I appreciate your candor and your noble gesture to do research on neural prolotherapy. I am certainly willing to make an effort to make such research a reality. Ideally, researchers and the public should work together for the greater good of society.

John Quintner

@ Dave. You argue that “NIH should focus on other treatments such as electrotherapies, magnetic therapies, and allow treatments that have a decent following to have their day and receive fair and unbiased scientific testing.”

Why should the NIH waste precious research dollars on testing the untestable? The popular treatments that you mention (and all the others that you have not mentioned) rely for their credibility more upon the nebulous views of their proponents than upon hard science.

Dave

Ms. Schulkin- I know there is a Dr. Clifford Stark, an osteopath, in the Chelsea section of Manhattan that does neural therapy and prolotherapy. I do not know if the prolotherapy Dr. Stark practices is the same as the “neural prolotherapy” of Dr. Lyftogt.

Geoffrey Bove, DC, PhD

Dr. Rodrigues,
Yes! I agree with you; I did not know you were a chiropractor! So I can do the exact same thing by rubbing tissue without the need for any insertion/injection, any trigger point, etc.

NONE of the hypotheses/theories are “valid or vetted,” they are typically fallacious from the start. One of my colleagues said that a mutual colleague “didn’t let the facts get in the way of his opinion.” This is what’s going on here. John Q. and I have pointed out the flaws, but you all choose to ignore the facts. You have to read primary literature, not distilled and usually cherry-picked reviews and opinion.

RE: research, the only issue is money. Research is a luxury of a rich society, and the US is not so rich any longer. Even so, other countries don’t support more than a smattering of research in comparison. “Big Pharma” can be excused, really, much as it pains me to say it, as they are in the business of making money, and the only problem there is it is at our collective suffering. At least they develop drugs. But it is in the hands of governments and individuals to do research related to treatments that have little profit. My entire career has been hampered by this issue.

I will be happy to design and implement a clinical trial of neural prolotherapy. If there is a specific response, I will be more than happy to design studies to optimize conditions and understand the mechanism of action. The funding for this will have to come from those who espouse the treatment. Bottom line: the clinical trial would be an exploratory study, no doubt, which would qualify for an “R21” mechanism. Were I to ask NIH to fund this study, it would reasonably cost 175-200,000 USD over 2 years, plus the indirects to the university for facilities and administration (add ~$60,000). But NIH study sections would not likely look favorably on this application — it would be considered wildly speculative at this point in time, and there is no reasonable hypothesis to suggest a mechanism. There are only anecdotes, and not many of them (yet) either. Still, if you collectively come up with the funds I’ll do the study.

Ester schulkin

Are there Physicians in the NY , CT are doing this for nerve Pain-? Please forward names . Thankyou

The truth as to why all these “metallic stainless steel tools” like a needle or a scalpel works to help treat pain is based on two factors; Re-Injury which ignites the healing cascade and the metallic tool depolarizing muscle bundles simultaneously to invite complete repair.

Everyone is distracted by the ideology, concepts, intent or theory of what the substances (sugar, alcohol, platelet rich plasma, botox, saline) are doing. The most profound element in any therapy is the innate natural healing process of the human body, something that is overlooked. Yes! God and time heals all wounds both of which humans have no absolute control over but can use to our benefit. Try to play God or alter the time of healing and we will fail.

A surgeon will say, “I’m removing your disc to treat your pain.” That is almost true but NOT the entire truth! He is mucking around with the spine and God will make up for his arrogance to heal and repair despite his intent.

A physician will attempt to treat lower back pain with an injection of steroids, “I’m placing a powerful medicine around your spine and spinal nerves and this will treat your pain.” That is almost true but NOT the entire truth! He is using a stainless steel probe to muck around the spine and God will make up for his arrogance and flawed logic.

Travell and Simons are missing in all of the books and studies I have read published in the past 20 yrs. It seems as if someone is trying to alter history with a new paradigm. Travell/Simons, Edwards and Gunn believes the pain generators are in the muscle or neuromuscular unit. I really don’t care much about the science anymore but the theory is valid, vetted and yet disavowed. Many people are suffering as a result. I hope all of you will do your own homework on this matter because your providers are completely distracted.

@Dave, I will not hold my breath with researchers because modern scientist are suffering from “groupthink” searching for quick and easy fixes with a pill or high-technology that have a good financial return. Oh and good ego boosting potential.

Dave

Dr. Bove- The fact that 50% of medical research is unpublished coupled with the recent statements by Dr.. Collins about “hobbled” research are a counterpoint to what you assert regarding research. When Senator Specter was alive he found that there were “roadblocks” to cures for medical conditions and sought to change that. Senator Harkin, sent a letter to the Director of NCCAM last year stating disappointment that certain treatments weren’t being tested by NCCAM- an agency he helped to create.
As I stated before- which anyone can verify-there are few “commoners” in NIH advisory committees. Many treatments are not funded because of clear “anchoring bias” which your comments represent. In other words, Dr. Bove, your comments are mere opinion that cannot be squared with the facts about medical research in the United States. You have provided the readers here the “received view” that serves special interest groups and has done all too little for people in pain.
Anyone who reads medical research, as I do, can plainly see for every pain condition there is lack of adequate research and treatment.

Dave

@ John- You’re causing my basolateral amygdala to hypertrophy on this issue! I agree that science- when done properly and without bias, is the most reliable means to test treatments.
Given that the NIH Director has recently stated essentially that medical research is “hobbled” it seems reasonable that fair consideration in the form of scientific research should be paid by NIH to investigate treatments like neural prolotherapy.
Dr. Collins also mentioned the great cost and time of bringing pills to market. From what I read the average time is 10 years and $1.4 billion to bring a new pill to market-and 8% of pills are removed by the FDA every year. It is well known that compared to the EU, the FDA is slow to consider medical devices.
Dr. Osler indicated a profession can be judged by the amount of effective tools it develops and uses. In the 1840’s a prominent doctor from Massachussetts General Hospital indicated that nothing was more well established in medicine then bloodletting. Today biomedical pills for pain is well established-and for all we know biomedical phenomena maybe just an epiphenomena of photophysical events. After all we know DNA absorbs and transmits photons- and cells emit 100,000 photons per second. So 50 years from now medicine might look back at “pills for pain” disparagingly as we look back disparagingly at bloodletting.
Based on the aforementioned, instead of continuing the profitable, misguided, and failing “pills for pain campaign”, NIH should focus on other treatments such as electrotherapies, magnetic therapies, and allow treatments that have a decent following to have their day and receive fair and unbiased scientific testing.

Geoffrey Bove, DC, PhD

As this discourse was initiated secondary to a personal contact to me from Dr. Lyftogt, since his concepts include data from my laboratory, I feel like I must respond. Lots of things “work,” at least until tested well, so we can give the benefit of the doubt at this point. However, the concepts are about as miserably twisted an inaccurate as can be, and not consistent with known scientific data (again, I designed, performed, and published much of the data proposed to be involved in the mechanism of the proposed action).

But one has to look no further than the comments related to sugar being analgesic for infants to see the level of logic that Dr. Lytogt uses. Oral sugar is in fact used to help during neonatal procedures. In most of us, the mouth is a long way from the penis or foot (the distraction method is used for circumcision and heel sticks), and oral sugar certainly does not increase blood sugar to leading to pain relief. If it did, we could all treat our pain patients like Mary Poppins, with a spoonful of sugar. Or hook them up to an i.v. of ringer’s with dextrose (don’t people get that post-surgically?). Relating oral sugar to presumed-near-nerve dextrose injections is ludicrous.

I have been a NIH supported scientist for close to 20 years, in the pain field. There is no conspiracy to prevent research findings from being published or to inhibit research to treat pain. However, funding bodies are loathe to fund studies that have no hypothetical support. The reason neural prolotherapy will not likely ever be studied is because not only do the proposed mechanisms make no sense, they also contradict known physiology. This does not preclude performing a clinical trial however; a pilot study could readily be performed in a clinic at almost no cost.

A few prolotherapy studies are being funded by NIH, because the applications were deemed to have reasonable rationale. This week I took another look at the studies, and found something quite interesting. Peter Amadio developed a model of prolotherapy-induced carpal tunnel syndrome!
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509200/
So, perineural injections of 5% dextrose cause perineural fibrosis.

Perineural fibrosis is something to be avoided, I think we all can agree on that. The fact that 5% dextrose injected perineurally causes perineural fibrosis should contraindicate this procedure.

I suspect that in the wash, this treatment approach will be found to have a strong contextual effect, like acupuncture and many other non-specific modalities.

John Quintner, Physician in Pain Medicine

@ Dave. In response, as it does have some relevance to this discussion, may I quote someone closer to our time than Albert Einstein:

“Litigation, fear, bias, and greed can interfere with scientific efforts to answer an important public health question. Perhaps most troubling of all, … in deciding about health risks, our courts and a substantial segment of the American public seem comfortable with methods that can only be described as antiscientific and irrational. Yet, like it or not, science and the rules of evidence and reason are the only reliable tools we have to investigate risks to human health.”

Marcia Angell. Evaluating the health risks of breast implants: the interplay of medical science, the law, and public opinion. New England Journal of Medicine 1996; 334: 1513-1518.

Dennis Kinch

A couple of things stand out in this report. 1. Finding a solution to chronic pain is not conducive to an academic career. Is this crazy or what? Some high-up mucky muck keeping someone else’s career path down and all at the expense of a patient in pain ! If it wasn’t so damn typical i’d think this was a wrong statement.
2. What about trigger point injections or Botox? This seems much more sane than the science behind Botox, or even steroid injections.
But here we go again. Protect and prohibit. Save me from the dangers of drugs. Why do they never ask the patient? I’ll bet, if the government allowed it in, they could find thousands of willing guinea pigs to test this medicine. After reading this article I want to sign up right now.
Doesn’t every treatment or cure start out like this? A seemingly crazy idea behind some crazy science and then, Bam!…Polio is cured! Ask any chronic pain patient who has suffered for any length of time and they’ll tell you; “I’m on fire and you guys hold the water!”

John Quintner, Physician in Pain Medicine

Dr Lyftogt, I am far from representing “main-stream medicine” (even if there is such a thing).

In any case, I have never questioned your results, but rather the theoretical foundations upon which you claim to have based your pioneering treatment.

When the studies you mention are published in reputable journals I will read them with great interest.

In the meantime, it is noteworthy that two experts in the field, Douglas Zochodne and Geoffrey Bove, have been most critical of the neuroscience that you have drawn upon to support your hypothesis.

The success of your invention may depend more upon who is at the other end of the needle than the substance being injected and where just it is being deposited.

In the words of the immortal Bard – To Needle or Not to Needle; That is the Question.

dave

The “iron triangle” in America wishes to limit pain care to that which serves corporate, government and medical interests- regardless of what impact it has on people in pain.
How telling it is that in the last month none other than NIH Director, Dr. Collins, confesses that efforts to ensure reproducibility in research are “hobbled” and that the efforts of government won’t be enough to fix problems in research. If that weren’t bad enough, he also admits to “high rates of failure” in medical treatments. This is the result of the iron triangles selfishness and greed and nescience when it comes to pain care. We all know NIH has underfunded pain care. NIH has guarded against democratic excesses by failing to have enough pain sufferers on advisory councils. And even Cochrane database reviews- that are sometimes done by researchers in the pharmaceutical industry question the reliability of research studies done by pharmaceutical companies.
When it comes to pain care, the “iron triangle” promotes their own occupational interests-and the result is, in part that too many treatments go uninvestigated or underinvestigated. And as Einstein said, condemnation without investigation is the height of ignorance. Government continues to be ignorant of the possibilities inherent in many treatments for pain because their focus is too support private profit rather than the public good. And so unless people in pain require real change their will be a continuing escalation of failure in pain care.

THIS IS THE FUTURE OF MEDICINE!!!! This is what I have been preaching about!

Modified versions of this therapy goes back to ancient China, Rome, Greek and Egypt!

Over the past half century this therapy has diverged into 3 disciplines that are all variations on the same mechanics of actions. 1. Ignite the healing cascade and 2. repolarizes contracted muscles. Which sound simple but is profound for the why we all need this therapy and that is the neuromuscular units.
1. Hackett, Bourne, Pybus, Wyburn, Blount, Leriche and Fabio aims at the nerve and ligaments with injections of hypertonic(sugar, salt, alcohols) solutions.
2. Travell and Edwards aims at the muscles, tendons, ligaments and bone with injections of lidocaine.
3. Gunn aims at the muscle unit with a thin filament needle.

Traditional doctors don’t aim put blindly inject high doses of steroids into the joints which has the opposite effect of igniting and really shuts-down healing and cause deterioration and atrophy.

The why is this therapy needed is in the neuromuscular units that get discombobulate and cause the muscular units to contract, spasm and compress onto nerves, joints and blood vessels to cause chronic stubborn pain, CRPS/RSD, POTS, Neuralgia, Arthritis, Bursitis, circulatory and lymphatic issues.

YEA!