Neural Prolotherapy at Gershon Pain Specialists

Neural Prolotherapy (NPT) was developed by New Zealander Dr John Lyftogt (click HERE for his website). It is a safe and effective treatment for painful conditions arising from the musculoskeletal system. Neural Prolotherapy is sometimes referred to as Perineural Injection Treatment. It involves first making an accurate diagnosis of the cause of pain. This type of pain is typically due to an injured and non-healing sensory nerve causing pain, inflammation and delayed healing. needleandsyringe1

The treatment consists of a series of small injections immediately under the skin targeting painful and sensitive nerves with simple and natural substances. The substances injected are largely made of a glucose based solution. The goal of this treatment is to completely eliminate the patient’s pain.

After the first treatment session pain relief may last for a period of four hours to four days. After this the pain will return, but usually in to a lesser extent. Repeat weekly treatments will steadily reduce the overall pain and allow return of full function. The average number of treatments required for most conditions is 6-8 and success rates vary between 80-85% depending on the underlying condition. Some patients with acute pain may only require 2-4 sessions. Patients with chronic pain typically require 8 or more sessions.

A similarly named procedure, but very different in terms of injection technique, is classical Prolotherapy. This was developed in the 1940s by American trauma surgeon Dr George Hackett. He introduced deep Glucose (Dextrose) injections in concentrations of up to 25% combined with local anesthetics. This has been proven to be an effective treatment for chronically painful conditions, attributed to ‘weak’ or ‘lax’ ligaments and tendons.

Dr Hackett reasoned that ‘lax’ or ‘weak’ ligaments were the cause of most joint and ligament pain. He targeted these structures with high Glucose concentrations to stimulate inflammation. He proposed this inflammation would eventually lead to normal repair and make tendons and ligaments stronger. Strengthening these tendons and ligaments would resolve the pain. Dr Hackett was successful in treating chronic pain and published 16 articles and a textbook on this procedure. He had an 80% success rate for the treatment of conditions like chronic low back pain and many other painful conditions. A growing number of classical Prolotherapy studies over the last 40 years have indicated very good to excellent results from high concentration Glucose (Dextrose) treatments of joints, ligaments and tendons.

Neural Prolotherapy (NPT) is a distinct and separate treatment modality and has been developed by Dr John Lyftogt in

knee injection2002. NPT targets superficial nerve trunks immediately under the skin with low concentration Glucose injections. Dr Lyftogt surprisingly and unexpectedly observed that low concentrations of Glucose (Dextrose) 5% in sterile water injected near superficial nerves extinguish chronic pain and inflammation for up to 4 days. Repeating these NPT treatments on a weekly basis resulted in resolution of persistent pain and inflammation.

Neural Prolotherapy was initially developed for the treatment of Achilles tendonitis and differs from Classical Prolotherapy in that the injections are given immediately under the skin while taking great care avoiding needle contact with the exquisitely sensitive tendon. This ‘subcutaneous’ or ‘neural Prolotherapy’ protocol was successfully extended to the treatment of tennis elbow, painful knees, shoulders, wrist, neck, hips, ankles, low back pain and compartment syndrome. Results are consistent and two year follow up studies have shown success rates between 80-85%.

Because Neural Prolotherapy does not target tendons, ligaments or joints the question had to be asked what causes the sometimes dramatic decline in pain levels after even a few treatments. A working hypothesis was developed that glucose targets glucose sensitive pain nerves called nociceptors located in nerve trunks immediately under the skin. These nerve trunks may contain up to 30,000 small nerve fibers per mm2.  Half of these small nerve fibers are a variety of ‘pain nerves fibers’, technically known as sensocrine nociceptors. When injured these sensocrine nociceptors are thought to be responsible for painful conditions described as ‘neuralgias’ or ‘neuropathic pain’ or more commonly known as ‘chronic pain’.

The protective sheath of the nerve trunk is structurally very similar to tendons and ligaments. It protects small nerve fibers inside the nerve trunks from injury, friction and pressure. Nerve trunks have their own nervous innervation, called ‘Nervi Nervorum’.

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

It is also known that this “neurogenic inflammation” differs from other forms of inflammation in that it does not respond to anti-inflammatory drugs or cortisone injections and this is the reason why these commonly used drugs are proving to be ineffective in many painful conditions. In addition, there is a growing awareness that cortisone and anti-inflammatory drugs are associated with a variety of harmful side effects.

It is clear from clinical observations on more than five thousand patients and large case series that Neural Prolotheapy effectively reverses ‘neurogenic inflammation’ and resolves ‘neuralgia’ and ‘neuropathic’ or chronic pain.

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 and painful superficial nerves with micro- injections with low dose Glucose.

More recently Dr Lyftogt has developed effective Neural Prolotherapy treatment protocols for Migraine, ‘Fibromyalgia’, CRPS (Complex Regional Pain Syndrome), compartment syndrome and other difficult to treat persistent painful conditions. Dr Gershon has incorporated NPT into varies aspects of his practice.

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

For a practitioner to be effective in treating persistent pain the first requirement is the ability to make an accurate neuro-anatomical diagnosis and secondly combining this diagnosis with training in specialized clinical skills. This knowledge and skill can only be obtained by attending specific workshops in Neural Prolotherapy. There are currently three levels of courses that Dr. Lyftogt teaches. Basic, advanced and a Master level course. Dr. Steven Gershon has successfully completed all of these courses. He routinely is in contact with Dr. Lyftogt.

FAQ’s on Neural Prolotherapy

What is Neural Prolotherapy (NPT)?

Neural Prolotherapy (NPT) is one of the newest exciting advances in Regenerative Medicine used to treat neuropathic pain in a variety of musculoskeletal injuries and various pain conditions.  Neural Prolotherapy is the injection of a medical-grade sugar (dextrose) just below the skin to promote healing of injured nerves and restoration of tissue function.

What are the origins of Neural Prolotherapy?

Neural Prolotherapy was developed by New Zealand 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. Dr. Hilton noted that the nerve that innervates a joint also innervates 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 that surround 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.

Dr. Lyftogt postulated that restoration of subcutaneous nerve function (those just beneath the surface of the skin) will lead to healing in deeper structures and reduction in pain. This method to treat musculoskeletal injuries and pain conditions has been used over the last decade with outstanding results, and Neural Prolotherapy is now being taught around the world.

What is the solution that is injected?

Neural Prolotherapy solution contains 5% Dextrose in sterile water (D5W). Dextrose is a sugar originally derived from a plant source.

How does Neural Prolotherapy work?

When tissue is injured, it causes a release of pro-inflammatory substances (e.g. Bradykinin, Prostaglandins) that activate a channel on nerves called the “Transient Receptor Potential Vanilloid1” (TRPV1) cation channel, also known as the capsaicin receptor. When this channel is turned on, it results in nerve release of substances that cause inflammation (substance P and calcitonin gene related peptide (CGRP)) leading to leaky blood vessels (swelling), hypersensitivity, and painful sensations.

It is postulated that dextrose, the active ingredient of Neural Prolotherapy, binds to and inhibits the TRPV1 nerve receptors, preventing this cascade and restoring normal nerve function.

Are these treatments painful?

Nobody likes injections, but Neural Prolotherapy treatment is not like having normal injections. Neural Prolotherapy is generally very well tolerated. The treatment consists of micro-injections just under the skin. The needle that we use is the smallest on the market. It is finer than a hair on your head. Once the procedure is completed, any injection pain disappears almost immediately. The aim of each treatment is to have you walk out of the consultation room pain free.

How will I feel after a Neural Prolotherapy treatment?

Most patients notice an immediate reduction of pain immediately after the first injection.  This initial analgesic effect may last anywhere between four hours to four days. Pain is generally reduced by 10-20% with each subsequent treatment as the tissue is progressively healed.

How successful is this treatment?

Depending upon the body part, how long you have had the injury/pain for, and the individual circumstances, the “rule of thumb” is that 85% of people resolve their pain completely, with many more experiencing a significant improvement.

Is This a Cure for Chronic Pain?

NPT is a very effective treatment for chronic pain. With an experienced practitioner, many people find that once they have completed a course of treatment their symptoms disappear and don’t return.

Can I expect to become pain free?

Many people do become free of pain in the long term. The aim of each treatment session is to get you pain-free. This is how we know if we are targeting the correct nerves. Following each session you should be pain free for anywhere from four hours to four days. With every session, you remain pain-free afterwards for longer and longer periods until your pain doesn’t come back, which is why you need multiple treatments.

How many treatments will I need? How frequently?

While each case is unique and treated on an individual basis, most patients respond to 6-8 treatments depending on how long the injury has been present as well as the degree of the damage. These are spaced one week apart. In certain circumstances your practitioner may suggest more or less frequent treatments.

Is it safe? Are there any side effects?

Neural Prolotherapy is considered safe when administered by a properly trained physician.  In fact, the solution (D5W) is the same solution used in IV bags in emergency rooms and hospitals as well as in newborn babies. Injections are done under sterile conditions with minimal risk of infection. It has been estimated that one in 300,000 injections may result in infection – in other words, an extremely low risk. No allergic reactions have ever been observed. While uncommon, possible adverse effects include: local swelling, bruising and mild temporary pain.

How is Neural Prolotherapy different than traditional Prolotherapy?

Neural Prolotherapy and Traditional Prolotherapy share many similarities, but also some key differences.  Both treatments promote healing and result in pain relief and functional restoration, but each uses different concentrations of dextrose as well as a different technique for injections.

Traditional Prolotherapy uses a higher concentration of dextrose along with an anesthetic, and is injected deeper in the affected area to promote healing and repair of connective tissues such as ligaments and tendons. Neural Prolotherapy uses a much lower concentration of dextrose and is injected at multiple points just below the surface of the skin to target subcutaneous nerves to reduce neurogenic inflammation.  Because it is injected just under the skin, Neural Prolotherapy is less invasive than traditional Prolotherapy.

Will my insurance cover Neural Prolotherapy?

No. Neural Prolotherapy is not covered by insurance companies at this time.

What conditions can Neural Prolotherapy treat?

Neural Prolotherapy is effective in treating nerve pain associated with injuries to joints, muscles, tendons, and ligaments.  Treatment areas include the neck, back, knee, shoulder, hip, elbow, wrist, hand, foot, and ankle.

Neural Prolotherapy has also been shown to be effective with chronic pain after surgical procedures such as total knee replacements and Failed Back Surgery Syndrome.  These patients often find relief when other traditional treatment options have failed.

Who performs this treatment?

Dr. Steven Gershon has successfully completed all 3 levels of Dr. Lyftogt courses, including the elite Master’s level class. He and Dr. Lyftogt frequently are in contact with one another. Dr. Gershon has successfully taught all of his mid-levels to perform this treatment. Dr. Gershon has now begun lecturing on the topic of Neural Prolotherapy.