PERINEURAL THERAPY OR NEURAL PROLOTHERAPY (NPT) IS AN EXCITING AND INNOVATIVE ADVANCEMENT IN THE FIELD OF REGENERATIVE MEDICINE. IT IS USED TO TREAT NEUROPATHIC PAIN IN A VARIETY OF MUSCULOSKELETAL INJURIES AND CONDITIONS.
Neural Prolotherapy is also known as Neurofascial Prolotherapy, Subcutaneous Prolotherapy or the Lyftogt Perineural Injection Technique. This therapy involves the injection of a medical-grade 5% Dextrose solution. This solution is administered with a very small needle just below the skin at anatomical sites where nerves pierce the deep fascia layers of muscles. The dextrose solution promotes healing of injured nerves and restoration of tissue function.
Neural Prolotherapy was developed by a New Zealand Sports Physician, Dr. John Lyftogt, who has been using this method to treat musculoskeletal injuries and various pain conditions over the last decade with outstanding results.
The theory behind Neural Prolotherapy is based on “Hilton’s Law”, named after British surgeon Dr. John Hilton. An extraordinary anatomist, Dr. Hilton noted that the nerves that innervate a joint also innervate the skin overlying that joint and the muscles that move that joint. Using this simple model, Dr. Lyftogt hypothesized that irritation to a nerve that supplies sensation to the skin over a joint may also cause dysfunction and pain to the muscles and tissue around that joint.
It has long been known that dextrose in traditional prolotherapy promotes healing in connective tissues such as ligaments and tendons. Because nerves also contain connective tissue, Dr. Lyftogt postulated that dextrose could allow for the same healing in nerves. He injected small amounts of dextrose under the skin which resulted in decreased swelling, reduced pain, and improvement of function in many musculoskeletal conditions.
Dr. Lyftogt postulated that restoration of subcutaneous nerve function (those just beneath the surface of the skin) will lead to healing of deeper structures and reduction in pain. This method to treat musculoskeletal injuries and neuropathic pain has been achieving remarkable results.
HOW DOES NEURAL PROLOTHERAPY WORK?
Injured tissues cause the release of pro-inflammatory substances (e.g. Bradykinin, Prostaglandins) that activate a channel on nerves called the “Transient receptor potential V1” (TRPV-1) cation channel, also known as the capsacin receptor. When activated, this channel results in the nerve releasing substances that cause inflammation (substance P and calcitonin gene related peptide (CGRP)) leading to leaky blood vessels (swelling), hypersensitivity, and painful sensations. It is thought that the dextrose used in the injections for Neural Prolotherapy bind to and inhibit the TRPV-1 nerve receptors, preventing this inflammatory process and restoring normal nerve function.
WILL THE TREATMENT BE PAINFUL?
Neural Prolotherapy is very well tolerated as the injections are administered with very small and short needles just beneath the surface of the skin. Multiple injections may be required along the course of the subcutaneous nerves. Some points may result in mild discomfort.
WHAT CAN I EXPECT AFTER NEURAL PROLOTHERAPY TREATMENT?
An immediate reduction in pain immediately after the first injection is experienced by most patients, which may last anywhere between hours to days. Pain is generally reduced by 10-20% with each subsequent treatment as the tissue progressively heals.
HOW MANY TREATMENTS WILL I NEED?
Most patients respond to 5-8 treatments, however, further treatments may be necessary depending on how long the injury has been present as well as the degree of the damage. Each case is unique and treated on an individual basis. Treatments are typically spaced 1-2 weeks apart.
IS NEURAL PROLOTHERAPY SAFE?
Neural Prolotherapy is considered extremely safe when administered by a trained physician. The solution (D5W) is the same solution used in IV bags in emergency rooms and hospitals. While uncommon, possible adverse effects include local swelling, bruising and mild temporary pain.
WHAT CONDITIONS CAN BE TREATED WITH NEURAL PROLOTHERAPY?
Neural Prolotherapy is an effective treatment for neuropathic pain associated with injuries to joints, muscles, tendons, and ligaments. Neural Prolotherapy is also an excellent therapy when used in conjunction with our other treatment modalities. Furthermore, we have achieved fantastic results using this treatment for Achilles Tendinopathy and Subacromial/Subdeltoid Bursitis. Neural Prolotherapy has also been shown to be effective with chronic pain after surgical procedures such as total knee replacements.
It may the below website helpful with further information on this treatment.