(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:
- Funding could be difficult without Big Pharma support.
- 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.
Dr. 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.
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