Relieving pain can transform your life!
Dr Hughes has spent his entire career researching and exploring various techniques and treatments that help people relieve pain and get their life back. He has chosen to focus his practice on the types of treatments that his patients get the most benefit from. A treatment called “Neural Prolotherapy” (NPT) is a perfect example of this type of innovative and highly effective type of treatment!
Neural Prolotherapy (NPT) is a breakthroughin the natural treatment of pain, involving multiple small injections just beneath the skin along painful tender regions that correspond to small nerves. This treatment was created by New Zealand Physician Dr John Lyftgoft MD. Dr Hughes has studied extensively with Dr Lyftgoft, having travelled to New Zealand to complete “Masters Level” training in this technique.
Generally there are 2 types of pain. 1) The pain we experience briefly like when a baby gets a shot & cries or when we quickly touch a hot stove. This pain can be intense but goes away. 2) The second type of pain is what brings patients into a doctor’s office: chronic pain. This is pain that lingers and is always there. It may vary in its features but is termed Neurogenic (or nerve) pain.
What does chronic nerve pain feel like?
Nerve pain can present in a number of ways including, burning, knife like, stabbing, hot, tight, swollen, deep/dull, tingling, creepy crawling, wet sensation, and electric. The pain can be anywhere from head to toe overlying a tendon, bone, or joint etc.
Often times patients report pain & limitations that are out of proportion to the structural damage. We can’t see these nerves on MRI or X-ray but they are real & often cause pain. Just beneath the skin surface exist hundreds of nerves that we now believe play a major role in controlling pain & inflammation. Often patients point to a region & say “it hurts here!” We tell them nothing is in that region & it is referred, but now we target this pain directly. With our knowledge of anatomy & the patient’s explanation of where the pain is we can find these nerves and treat them.
These nerves lie beneath the skin & were identified in 1771 & were used by top doctors in London to diagnose & treat pain. They did not have x-ray, MRI etc & relied on their hands, eyes, & ears. They described nerve swelling that occurs at common locations. This was completely forgotten in our medical school training!
How do these small nerves cause pain?
Following trauma or repetitive overuse, there is a surge of sodium & calcium which causes these nerves to develop swelling & increased pressure & then “dump” chemicals (peptides called Substance P & CGRP via sensocrine nervous system) that promotes neurogenic inflammation. This causes swelling, pain, tendon damage (loss of type I collagen), & triggers an immune response that leads to cartilage damage/arthritis. This also causes exhaustion, depression & increased stress response in the brain (amygdala).
What is injected?
A 5% dextrose or 5% mannitol solution in sterile water, just like the solution used in the Emergency Room for IV hydration, it is safe & relatively harmless. It was recently discovered by a doctor in New Zealand, Dr. John Lyftgoft to promote healing and immediately relieve pain generated from these nerves.
How does this treatment work?
We inject 5% Dextrose or Mannitol & pure saline (water) beneath the skin surface with a tiny needle over the commonly constricted regions of nerves. Patients with nerve pain (neurogenic pain) experience pain relief within seconds & often are shocked & look at you funny that their pain is gone without an anesthetic or cortisone etc. Immediately after the injection we will have them test their pain (grab an object for tennis elbow, squat for knee etc.). Importantly, this not only helps with pain but often facilitates structural healing (decreased calcification of a tendon & repair may occur).
Neural Prolotherapy works by immediately blocking the receptor in the nerve (TRPV-1 or Capsacin receptor) which is the principal regulator of pain and inflammation. This leads to healing beneath the nerve to deeper structures like tendon & joint (Hilton’s law). Other substances also can block this receptor like Magnesium & NaCl (Salt), which may explain why Epsom salt bath soaks are so popular. Also Vitamin D blocks this pain receptor & lots of research is pointing to Vitamin D for helping with pain.
In addition to treating the nerves to promote healing, it’s important to the address underlying cause. For example, re-educate biomechanics, posture muscle imbalances etc.
What conditions may benefit from NPT?
Fibromyalgia, headaches, migraines, neck, shoulder, elbow, wrist, hand, low back, hip, knee & foot & ankle pain. Generally, tendinitis, arthritis, bursitis, sciatica and muscle/ligament injuries are targeted. Dr Hughes nearly all conditions of pain improve with this therapy and is currently researching other ways of using this therapy to improve other aspects of health.
How many injections are needed?
Patients receive an initial treatment in office with anywhere from 3-30 small injections of ½ milliliter solution with a tiny needle depending on the nature of injury & region. They return weekly for repeated treatments generally from 2-8 times. If the initial injection provided no immediate profound relief we move on to different procedures to treat the problem at a deeper level.
Is the treatment permanent once it’s been administered?
Often times the treatment is permanent and patients “graduate.” However depending on the severity some return several months later for a brief “tune up.”
Is NPT painful?
There is very minor discomfort associated with the procedure. The injections are not deep and typically penetrate no more than 1/2 inch below the skin surface. Multiple injections are performed quickly along tender regions. There is no significant pain after the procedure. Generally patients of all ages tolerate the treatment very well.
Are there any activity restrictions post treatment?
There are no restrictions of activity. With this treatment we encourage activity, motion to increase blood flow. We like the patients to take a “test drive” & explore if their pain is gone. Of course assuming there is no dramatic structural injury (meniscus tear etc).
How long does each treatment provide relief for?
The relief form initial treatment lasts between 4 hours and 4 days & will not be permanent. It will require repetitive treatments for long term permanent relief. Generally patients return each week with fewer regions to inject & substantial improvement weekly.
How often are treatments?
Typically injections are done once weekly.
Can this treatment be used in sports medicine?
We use this on elite athletes to recover from injuries to allow them to heal faster & play without the downside of side effects!
Can this treatment be used after surgery?
Yes! We regularly treat pain following surgery. Often patients have large scars that cause pain. This provides a safe option to potentially reduce pain naturally, accelerate recovery, and improve range of motion.
If not treated, what can these pains lead to in the long run?
We believe that these nerves are on the front line of maintaining health of tendons & joints. If the nerve swelling continues, most likely tendon & joint damage will occur. So initially there may only be nerve like pain without structural damage but if it persists for many months structural damage can occur.
For example, if someone develops tight calf muscles, for 4-5 months, the pressure increases causing chronic constriction of the nerves (saphenous & sural) that leads to increased Substance P & CGRP (pro inflammatory peptides); then patients develop Achilles pain & tearing. This model explains how patients develop Achilles tendinitis or tearing. Also sick nerves overlying joints on the inside & outside of the knee can dump chemicals that trigger an immune response resulting in worsened arthritis and cartilage damage.
Are there any side effects of NPT?
Prolonged soreness at the injection site and temporary bruising are uncommon side effects. As with any injection into the body there are always potential risks of infection, fever, allergic reaction, or no relief, however these are very uncommon.