Letters to the Editor

Townsend Letter for Doctors and Patients,  May, 2001  

• E-mail
• Print
• Link

On Injection Therapies for Pain and Chiropractic Manipulation

Editor:

In the November 2000 issue in the section "BookCorners," Jule Klotter reviews the book Arthritis by Anthony di Fabio, MA and Gus J. Prosch, Jr., MD. Ms. Klotter does a good job of reviewing this excellent information-laden book. One point may be a little confusing. She says "Under the heading of structural treatments, the authors explain reconstructive (a.k.a. neural) therapy and how that differs from intraneural injections. Reconstructive therapy strengthens. loose or torn ligaments or tendons. Intraneural injections reduce pain." Actually we have three quite different injection modalities here. Neural therapy, reconstructive therapy (a.k.a. prolotherapy, proliferative and sclerotherapy) and intraneural therapy. There is also Travell's trigger point injection therapy, making four quite different approaches.

Neural therapy, developed by two German physicians, Ferdinand and Walter Huenke. around sixty years ago, is defined by Louisa L. Williams, MS, DC, ND, in her workshop manual "Neural Therapy for Naturopaths and other Holistic Physicians" as "classically, neural therapy is the treatment of focal disturbances by injection of local anesthetic, to temporarily block the surrounding hyperirritable neuronal activity, and to restore normal cell membrane potential." Further in the book Arthritis states "...in Hueneke Neural Therapy, an anesthetic such as procaine or lidocaine is injected into nerve sites of the autonomic (independent) nervous system, acupuncture points, scars, glands, and other tissues. Through the pathways of the autonomic nervous system, energy to cells short circuits the disease or injury and serves to regulate biological energy" Neural Therapy is taught in the US by Dr. Deitrich Klinghardt and Dr. Louisa L. Williams through the American Academy of Neural Therapy.

Reconstructive, Prolo or sclerotherapy is the use of small amounts of an irritating agent injected into ligaments that are lax or weak. This method is outlined well in the article 'Overview of Orthopedic Medicine' by Dr. Gracer in the November 2000 Townsend Letter. In the book Arthritis, Reconstructive therapy is described as "Using natural substances injected in key positions, growth of connective tissue is stimulated in such a manner that weak or damaged tendons or ligaments are strengthened. By tightening up these structural defects pains often remotely located from the source of damage disappear."

Trigger Point Therapy as developed by Janet Travell, MD is another separate injection technique also using local anesthetics. Her work is fully described in her textbooks. Injection of trigger points can be an important part of solving musculoskeletal conditions. I was first introduced to these various local anesthetic injection techniques in the early 1980's by my friend Fred Shull, MD. He kindly allowed me to observe his work and also shared various articles from medical journals which I still have. One from JAMA 1978 is titled "Diagnosis and Therapy of Common Myofascial Syndromes." The therapy described is mostly the injection of 'trigger points' with a mixture of local anesthetic and steroid. Another from the Western Journal of Medicine 1982 titled "Treatment of the Chronic Iliolumbar Syndrome by infiltration of the Iliolumbar Ligament," describes the results achieved using a sclerosing agent, dextrose, as an outgrowth of the theory of musculoskeletal pain developed by Hackett.

In Jule Klotter's review intraneural therapy is mentioned as a way to reduce pain. Intraneural therapy is much more than this. Intraneural therapy was developed in South Africa by Paul K. Pybus, MD as a further development to the work of his mentor Roger Wyburn Mason, MD, PhD, in England. His work is fully described in his book Intraneural Injections for Rheumatoid Arthritis and Osteoarthritis. The book Arthritis says this also, "English Professor Roger Wyburn-Mason, MD, PhD, nerve specialist, demonstrated more than 50 years ago that the source causation of joint pain in both osteoarthritis and Rheumatoid arthritis began with, disturbances in the cells of nerve centers called "ganglia." South African Dr. Paul Pybus, surgeon and acupuncturist, demonstrated that these disturbed nerve ganglia. usually correspond to traditional acupuncture points. Further, Dr. Paul Pybus and one of us (Gus Prosch, Jr., MD) traced out a large number of these especially critical nerve centers throughout the body as related to bot h osteoarthritis and rheumatoid arthritis, as well as other forms of rheumatoid diseases such as alkylosing spondilitis, fibromyalgia, and so on. In almost every instance the center of joint disturbance follows known acupuncture points. The 'so on' here, in my experience includes a very wide range of musculoskeletal problems. While it's true that Prolotherapy is the only procedure that will correct weakened or damaged tendons or ligaments, the vast majority of patients presenting musculoskeletal pain problems do not have this problem. The 'Pyhus' intraneural injections will take care of the majority of problems, faster, safer and with less treatments than prolotherapy.