Howard Rosen, MD
In this article, Howard Rosen MD, explains Prolotherapy as a Peripheral nerve pain treatment.
The peripheral nervous system is located subcutaneously. It is not widely known today but painful peripheral nerves are probably the most common source of chronic pain.
The peripheral nerve system has been used for thousands of years to produce pain relief. The first known use of the peripheral nerve system is seen in Egyptian hieroglyphics. At that time, the Egyptians applied pressure to the peripheral nerves in order to try and reduce the pain of their surgeries.
A mechanism on the etiology of peripheral pain was demonstrated in the May 2013 Journal of Neuron. In this study, it was learned problems would occur when energy is lowered in the part of the nerve called the Schwann cell. In this scenario, the Schwann cells break down fatty acids for energy. This breakdown of fatty acids results in a neurotoxin being produced. The neurotoxin leaks out and interrupts the conduction of the neurons. This interruption in conduction results symptoms of peripheral nerve pain.
peripheral nerve pain treatment – cellular energy dysfunction and replacement (Cedar) theory
It has been hypothesized supplying the peripheral nerve with energy helps reduce or eliminate this pain. This theory is called the cellular energy dysfunction and replacement (Cedar) theory. Common sources of energy are sugars such as dextrose or sugar alcohols such as glycerin.
peripheral nerve injections
Subcutaneous peripheral nerve injections were first performed by G.V, Lafargue in 1838. At that time, Dr. Lafargue treated his forearm neuralgia with 13 inoculation lancet injections with aqueous morphine. This one treatment provided him with permanent pain relief. In actuality, his morphine solution consisted of 2/3 glycerin. The glycerin was probably responsible for his permanent relief.
In 1850, Alexander Wood wrote an article in the British Medical Journal on peripheral nerve injections. As a result of this article, peripheral nerve injections became widely practiced throughout Europe.
More recently, Dr. John Lyftogt developed a system of treating the peripheral nervous system with dextrose. He named this system neuroprolotherapy.
In a quest, to develop a system of treating the peripheral nervous system with the least injections possible, I developed a system called the Minimal Injection Nerve Techniques (MINT).
In the MINT prolotherapy system, glycerin is used with dextrose. Glycerin and dextrose has been used for prolotherapy for years in the form of P2G. In order to make subcutaneous peripheral nerve injections safer and more comfortable phenol has been omitted.
The MINT system injections were often based on historical injections.
For example, Dr. Wood was able to treat patients with chronic arm pain with only one injection. This injection was performed just below the junction of the clavicle and the acromium.
However, there is a risk of pneumothorax at this injection point. The Mint system utilizes a point just below the spine of the scapula, which almost completely eliminates that risk. This one injection can treat the arm, forearm, shoulder and hand.
Many conditions such as failed neck surgery, carpal tunnel syndrome, and reflex sympathetic dystrophy have been treated by this one injection.
Many patients with neck pain actually hurt on the side of their neck. Their source of pain usually comes from a nerve complex named the superficial cervical plexus. The lesser occipital nerve goes from this plexus to the back of the head. The greater auricular nerve goes from the plexus to the area around the ear. The cervical cutaneous nerves go from this complex to innervate the front of the neck. The supraclavicular nerves also come from this complex and are divided into three branches. These branches innervate the front, side, and back of the shoulder.
The superficial cervical plexus can be injected with only one needle. This one injection can help treat a patient’s neck pain.
Many people with back pain will often hold the side of their lower back.
They are usually touching their painful superior cluneal nerves. One injection per superior cluneal nerve at its junction with the top edge of the iliac crest can provide most painful backs with pain relief.
In 1875, Dr. Halstead first developed the infiltration of cocaine just beneath the skin to anesthetize the local nerves. Local infiltration is used to treat chronic pain with the MINT system. Local infiltration can treat almost any peripheral nerve with just one injection.
Some examples of the nerves, which can be treated, are the anterior femoral nerves for knee pain and the auriculotemporal nerves for pain on the side of the head.
Many years ago, I popularized a vertical technique for the performance of a caudal epidural. This technique is both a safer and more comfortable approach than the traditional approach for the caudal epidural. A dextrose 5% caudal has been named the sweet caudal. It is used to treat back, leg and pelvic pain with just one needle.
Another component of the MINT system is the use of Prologel. Prologel is a topical cream; I invented to help lessen pain. It can be used just topically or with ultrasound. Ultrasound will help the absorption of Prologel. Prologel can be used to increase the effectiveness of prolotherapy injections and Prologel can be used to treat many painful conditions by itself.
To help others learn about the MINT methods, I have written a book named the Minimal Injection Nerve Techniques. Dr. Rosen can be contacted at firstname.lastname@example.org
You can learn more about Prolotherapy in our article Prolotherapy information for patients