What is neural prolotherapy?
Neural prolotherapy involves superficial injections with dextrose (aka glucose) to treat a wide range of pain conditions. It was developed by Dr. John Lyftogt, MD who specializes in sports medicine and uses dextrose injections as his sole tool for pain management in his practice.
How does it work?
Pain is a complex area of human health and researchers and clinicians only understand vague fragments of it. In the context of neural prolotherapy it is known that pain fibres express a protein channel called TRPV1. If TRPV1 levels are kept to a minimum pain is not an issue. In fact, if TRPV1 levels are kept in check it promotes healing and repair of the nervous system. However if pain fibres become sensitized (e.g. due to trauma, inflammation, etc) their TRPV1 expression skyrockets and pain follows suit. Pain fibres overexpressing TRPV1 release excessive amounts of calcitonin gene related peptide (CGRP) and substance P (sub P) which lead to pain, increased blood flow, and possible swelling in the affected area.
Dextrose is a TRPV1 inhibitor, meaning that if TRPV1 is overexpressed on pain fibres the dextrose stops their function. When the TRPV1 function is arrested, pain is decreased (important for immediate relief) and tissue repair is allowed to occur (important for sustained relief and healing).
What conditions does it treat?
Neural prolotherapy 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 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%)
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?
The average number of treatments is 6-8, with 1 week apart between treatments (please note, for patients who are travelling from a distance for treatment, the treatment schedule can be condensed if needed. Indeed, it appears that the number of treatments ultimately affects the end result, rather than the timing). Patients typically report a 10-20% cumulative pain improvement with each session.
Is the treatment safe?
Superficial dextrose injections are safe. Indeed, neural prolotherapists have not seen a negative reaction to date. This makes sense as dextrose is a benign substance and is not accompanied by preservatives. One theoretical contraindication would be a severe allergy to corn (dextrose is commonly derived from corn). In such cases, a sugar beet extract could be obtained instead.