There are currently five published Randomised Control Trials (RCT's) and four case histories on Perineural Injection Treatment using 5% Dextrose. These can be found below, along with other relevant research articles.
Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial
Liza Maniquis-Smigel,Kenneth Dean Reeves, Howard Jeffrey Rosen, John Lyftogt, Cassie Graham-Coleman, An-Lin Cheng, and David Rabago
Anesth Pain Med. In press(In press):e42550. Published online 2016 December 6.
Background: Hypertonic dextrose injection (prolotherapy) is reported to reduce pain including non-surgical chronic low back pain (CLBP), and subcutaneous injection of 5% dextrose is reported to reduce neurogenic pain, hyperalgesia and allodynia. The mechanism in both cases is unclear, though a direct effect of dextrose on neurogenic pain has been proposed. This study assessed the short-term analgesic effects of epidural 5% dextrose injection compared with saline for non-surgical CLBP.
Methods: Randomized double-blind (injector, participant) controlled trial. Adults with moderate-to-severe non-surgical low back pain with radiation to gluteal or leg areas for at least 6 months received a single epidurogram-confirmed epidural injection of 10 mL of 5% dextrose or 0.9% saline using a published vertical caudal injection technique. The primary outcome was change in a numerical rating scale (NRS, 0 - 10 points) pain score between baseline and 15 minutes; and 2, 4, and 48 hours and 2 weeks post-injection. The secondary outcome was percentage of participants achieving 50% or more pain improvement at 4 hours.
Results and Conclusions: No baseline differences existed between groups; 35 participants (54 ± 10.7 years old; 11 female) with moderate-to-severe CLBP (6.7 ± 1.3 points) for 10.6 ± 10.5 years. Dextrose participants reported greater NRS pain score change at 15 minutes (4.4 ± 1.7 vs 2.4 ± 2.8 points; P = 0.015), 2 hours (4.6 ± 1.9 vs 1.8 ± 2.8 points; P = 0.001), 4 hours (4.6 ± 2.0 vs 1.4 ± 2.3 points; P < 0.001), and 48 hours (3.0 ± 2.3 vs 1.0 ± 2.1 points; P = 0.012), but not at 2 weeks (2.1 ± 2.9 vs 1.2 ± 2.4 points; P = 0.217). Eighty four percent (16/19) of dextrose recipients and 19% (3/16) of saline recipients reported 50% pain reduction at 4 hours (P < 0.001). These findings suggest a neurogenic effect of 5% dextrose on pain at the dorsal root level; waning pain control at 2 weeks suggests the need to assess the effect of serial dextrose epidural injections in a long-term study with robust outcome assessment.
Keywords: Analgesia, Epidural, Anesthesia, Caudal, Dextrose
Analgesic Effect and Potential Cumulative Benefit from Caudal Epidural D5W in Consequective Participants with Chronic Low Back Pain and Buttock/Leg Pain. Lisa Maniquis-Smigel, Kenneth Dean Reeves, Howard Jeffrey Rosen, John Lyftogt, Cassie Graham-Coleman, An-Lin Cheng and David Rabago.
JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE. VOL 00, NUMBER 00, 2018, pp. 1-8. DOI: 10.1089/acm.2018.0085
Objectives: Chronic low-back pain (CLBP) participants in a prior controlled study reported short-term pain relief after caudal epidural injection of 5% dextrose (D5W). This study assessed whether repeated caudal epidural injections of D5W results in serial short-term diminution of CLBP and progressive long-term decrease in pain and disability.
Results: Participants (n = 32, 55 ± 9.8 years old, nine female) had moderate-to-severe CLBP (6.5 ± 1.2 NRS points) for 11.1 ± 10.8 years. They received 5.5 ± 2.9 caudal D5W injections through 12 months of follow-up. The data capture rate for analysis was 94% at 12 months for NRS and ODI outcome measures, with 6% carried forward by intention to treat. A consistent pattern of analgesia was demonstrated after D5W injection. Compared with baseline status, NRS and ODI scores improved by 3.4 ± 2.3 (52%) and 18.2 ± 16.4% (42%) points, respectively. The fraction of participants with 50% reduction in NRS-based pain was 21/32 (66%).
Conclusion: Epidural D5W injection, in the absence of anesthetic, resulted in consistent postinjection analgesia and clinically significant improvement in pain and disability through 12 months for most participants. The consistent pattern postinjection analgesia suggests a potential sensorineural effect of dextrose on neurogenic pain. Link to article
Yung-Tsan Wu, et al: Six month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A prospective, Randomised, Double-Blind Controlled Trial. Mayo Clinic Proceedings, 2017
Objective: To assess the six-month effectiveness of ultrasounded perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild to moderate Carpal Tunnel Syndrome (CTS)
Results: Our study reveals that ultrasound guided PIT with D5W is an effective treatment for patinets with mild to moderate CTS Link to article
Editorial: Mayo Clinic Proceedings. August 2017, vol. 92,8. A Novel Treatment for Carpal Tunnel Syndrome? Link to editorial
Randomized Double-blinded Clinical Trial of 5% Dextrose versus Triamcinolone Injection for Carpal Tunnel Syndrome Patients.
Yung-Tsan Wu MD, Ming-Jen Ke MD, Tsung-Yen Ho MD, Tsung-Ying Li MD, Yu-Ping Shen MD, Liang-Cheng Chen MD, MS
September 2018, Annals of Neurology. DOI 10.1002/ana.25332
The treatment of trigger points (TRP), comparing D5W vs normal saline vs Lidocaine. ("Comparison On Treatment Effects of Dextrose Water, Saline, and Lidocaine for Trigger Point Injection") Min Young Kim, et al, 1997. J. of Korean Acad. of Rehab. Med. Vol 21, No. 5, October 1997
Abstract: Myofascial Trigger Point (TrP) is characterised as an impaired energy metabolism. We hypothesize that the use of dextrose as an energy supplement for TrP injections would be more effective than saline or lidocaine. 64 typical myofascial pain patients were treated with trigger point injections (TrP). Among them 23 were injected with 5% dextrose water (D5W group), 20 with normal saline (N/S group) and 21 with 0.5% lidocaine (Lidocaine Group). Visual analogue scale (VAS) and pressure threshold algometer (kg/cm2) were used as measuring tools before, immediatelt after, and 7 days after the injection therapies. Mean VAS scores were 6.78 before, 5.19 immediately after, and 3.39, seven days after the injections, and the treatment effects were greater after the second and third injections. Mean differences of pressure threshold were 0.37 before and immediatley after injections, and 0.42 before, and seven days after the injections. Significant elevations of threshold was noted after hte second and third injections. Mean VAS were not significantly different in 3 groups before and immediatley after injections. After seven days only D5W group showed significantly lower scores of 2.39 compared to 3.85 in the N/S group and 4.05 in Lidocaine Group (P < 0.01). Mean pressure threshold before and immediately after injections was not different in each group. After seven days the D5W group also showed significantly higher values of 2.49 compared with 1.91 in the N/S group and 2.27 in the Lidocaine Group (P < 0.05). We hvae concluded that 5% dextrose (D5W) would be the preferable choice for TrP injections.
LETTER TO THE EDITOR: Perineural Injection Therapy in the Management of Complex Regional Pain Syndrome: A Sweet Solution to Pain.
JU ANN THOR, MD, NOR HANIM MOHAMED HANAPI, MBBS, HAZWANI HALIL, BSC, AND ANWAR SUHAIMI, MBBS, MREHABMED Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Pain Medicine 2017; 0: 1–4 doi: 10.1093/pm/pnx063
2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Yung-Tsan Wu, et al: Ultrasound Guided Perineural Injection with dextrose for treatment of radial nerve palsy: a case report (June 2018)
Abstract: Rationale: Perineural injection with dextrose could be a novel intervention for peripheral entrapment neuropathy. However, this intervention has not been reported for treating radial nerve palsy (RNP). Here, we present a case with RNP having outstanding improvement after 2 sessions of ultrasound-guided perineural injection with 5% dextrose (D5W). Patient concerns: A 62-year-old woman presented with difficulty and weakness in extension of her left wrist and fingers after she slept with the arm compressed against her body. Diagnoses: On the basis of the findings of electrophysiological study and ultrasonography, the RNP with axonal injury was diagnosed. Interventions: Initially, the patient received 2-months conservative treatments without any improvement. Two sessions of ultrasound-guided perineural injection with total 15cc D5W with an interval of 1 month were performed 2 months after symptom onset. Outcomes: A noteworthy improvement in sensory and motor functions was observed after ultrasound-guided perineural injection with D5W. Lessons: This case shows that ultrasound-guided perineural injection with D5W may be an effective and novel intervention for RNP. Link to article
Case Report: Dextrose Treats Optic Neuritis. Dr Dina Soliman.
Journal of Medical Science and Clinical Research, Vol 06, issue 08, Page 179-183, August 2018
ABSTRACT: The sphenopalatine ganglion—also known as pterygopalatine ganglion, Meckel’s ganglion, Sluder’s ganglion and nasal ganglion—is the largest of the four parasympathetic ganglia associated with the trigeminal nerve. It is considered one of the largest neuron collection in the head outside of the brain, being exposed to the environment via the nasal mucosa. Classically, refractory head and face pain were treated with a series of ineffectual medications with intolerable side effects – cycling from one to the next based on trial and error. Although the sphenopalatine ganglion is a little-known region in the face, pain management specialists believe that it is very effective in the treatment of many conditions. It is a life changing, safe and established procedure that offers the pain sufferers an immediate relief from their pain. Dextrose 5% concentration in a neutral pH sterile water solution treats the neurogenic inflammation and stops the neuropathic pain by blocking the TRPV1 ion channels. In this paper, a 32 years old lady was suffering from severe headache, with an impaired vision of the left eye. The Visual Evoked Potential (VEP) showed an attack of optic neuritis. After 5 sessions of treatment with buffered dextrose in 5% concentration, the VEP showed a resolved attack of optic neuritis.
Conclusion: Buffered Dextrose in 5% concentration gave marvelous results in the treatment of headache and optic neuritis, and helped the patient to regain her vision. Link to article
Treatment of Trigeminal Neuralgia Utilizing Neural Prolotherapy: A Case Report. Alan Itkin. Journal of Prolotherapy. 2016;8:e961-e965
ABSTRACT: Neural prolotherapy, as developed by John Lyftogt, has been found to be an effective treatment for neurogenic pain syndromes. We report a case of trigeminal neuralgia successfully treated with neural prolotherapy. The patient is a 70-year-old man with a 15-year history of trigeminal neuralgia refractory to pharmacologic treatment. After one treatment of neural prolotherapy the patient reported 5 months of complete resolution of his symptoms. A second treatment was performed affording him another 10 months of relief. Neural prolotherapy may have an important role in treating trigeminal neuralgia. It can be a safe and effective treatment for those experiencing side effects from medications, contraindications to surgery, or less than favorable improvement from traditional treatments.
KEYWORDS: facial pain, allodynia, chronic constriction injury, lyftogt perineural injection treatment, tic douloureux, trigeminal neuralgia, neural prolotherapy, neuralgia, neurogenic inflammation, TRPV1, 5% dextrose.
OTHER RELEVANT DEXTROSE ARTICLES
Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Michael J Yelland, Kent R Sweeting, John A Lyftogt, Shu Kay Ng, Paul A Scuffham and Kerrie A Evans. Br J Sports Med. Published Online. 22 June 2009 and 22 April 2011
Objective: To compare the effectiveness and cost-effectiveness of eccentric loading exercises (ELE) with prolotherapy injections used singly and in combination for painful Achilles tendinosis.
Design: A single-blinded randomised clinical trial. The primary outcome measure was the VISA-A questionnaire with a minimum clinically important change (MCIC) of 20 points on a 100 point scale.
Setting: Five Australian private primary care centres.
Participants: 43 patients with painful mid-portion Achilles tendinosis commenced and 40 completed the treatment protocols.
Interventions: Participants were randomised to a 12 week programme of ELE (n=15), or prolotherapy injections of hypertonic glucose with lignocaine alongside the affected tendon (n=14) or combined treatment (n=14).
Main outcome measurements: VISA-A, pain, stiffness and limitation of activity scores and treatment costs were assessed prospectively over a period of 12 months.
Results: At 12 months, the proportions of participants achieving the MCIC for VISA-A scores were 73% for ELE, 79% for prolotherapy and 86% for combined treatment. Mean (95% CI) increases in VISA-A scores at 12 months were 23.7 (15.6 to 31.9) for ELE, 27.5 (12.8 to 42.2) for prolotherapy and 41.1 (29.3 to 52.9)for combined treatment. At 6 weeks and 12 months, these increases were significantly less for ELE than for combined treatment. Compared with ELE, reductions in stiffness and limitation of activity occurred earlier with prolotherapy and reductions in pain, stiffness and limitation of activity occurred earlier with combined treatment. Combined treatment had the lowest incrementalcost per additional responder (AU$1539) compared with ELE.
Conclusions: For Achilles tendinosis, prolotherapy and particularly ELE combined with prolotherapy give more rapid improvements in symptoms than ELE alone but long term VISA-A scores are similar. Link to article
Helene Bertrand, Marylene Kyriazis, K. Dean Reeves, John Lyftogt, David Rabago: Topical Mannitol reduces capsaicin-induced pain: results of a pilot level double-blind, randomised controlled trial. PM R May 12 2015
Capsaicin specifically activates, and then gradually exhausts, the transient receptor potential vanilloid type 1 (TRPV-1) receptor, a key receptor in neuropathic pain. Activation of the TRPV-1 receptor is accompanied by burning pain. A natural substance or medication that can reduce the burning pain resulting from capsaicin application may have therapeutic potential in neuropathic pain. Link to article
J Lyftogt. Prolotherapy and Achilles tendinopathy: A prospective pilot study of an old treatment, Australasian Musculoskeletal Medicine May 2005
Background: Prolotherapy has been successfully used for over 60 years in the treatment of a large variety of musculoskeletal conditions. No studies on prolotherapy and achilles tendinopathy have been published.
Conclusions: Prolotherapy is a safe, effective and inexpensive treatment for achilles tendinopathy in this pilot study.
Recovergrams are an effective clinical tool for monitoring progress, evaluating effect and predicting duration of treatment. Read this article
J Lyftogt. Chronic Exertional Compartment Syndrome and Prolotherapy. Australasian Musculoskeletal Medicine Nov 2006
Background: Chronic exertional compartment syndrome (CECS) is not uncommon. It affects mainly young, active people itis debilitating and intensely painful. Conservative treatment is not effective however surgery through fasciotomy offers hope.
Conclusions: This pilot study suggests that it is reasonable to offer patients with CECS a trial of prolotherapy. Recovergrams are an effective tool for monitoring effects of treatment and study recovergrams demonstrate the combined results readily in graphic format. Read this article
J Lyftogt. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Australasian Musculoskeletal Medicine Nov 2007
Abstract: In 2005, 127 patients were treated with subcutaneous prolotherapy: painful knees (74), shoulders (33) and lateral elbows (20). The mean length of symptoms was 23.9 months and mean length of treatment 7 weeks. The mean initial visual analogue scale (VAS) of 6.7 reduced at mean follow up of 21.4 months to VAS 0.76. Patient satisfaction rates at follow up were 91.7%. The treatment was well tolerated and safe. Read this article
J Lyftogt. Subcutaneous prolotherapy for Achilles tendinopathy: The best solution? Australasian Musculoskeletal Medicine Nov 2007
Abstract: Subcutaneous prolotherapy is an effective treatment for achilles tendinopathy in the primary care setting. Different glucose/local anesthetic concentrations were clinically trialled over a four-year period with long-term follow up of 132 achilles tendons. All 169 achilles were prospectively monitored with an evidence based Recovergram and 132 achilles were independently followed up after a mean period of 20 months. Mean follow up VAS was 0.4 and 90% of patients were satisfied with treatment.
All solutions were effective at follow up. Read this article
J Lyftogt. Prolotherapy for Recalcitrant Lumbago. Australasian Musculoskeletal Medicine May 2008
Abstract: Recalcitrant lumbago with a mean duration of 5.5 years in 41 consecutive patients presenting over a one-year period was treated effectively with a series of subcutaneous prolotherapy treatments. 90% improved by more than 50% from an initial mean Visual Analogue Score (VAS) of 7.6, with 29%, reaching VAS 0 at a mean treatment length of 8.3 weeks. Subcutaneous prolotherapy treatment has been shown to be highly effective in the treatment of a variety of peripheral neuropathic painful conditions. This clinical practice is founded on a proposed working hypothesis that subcutaneous prolotherapy is a suitable, effective and inexpensive treatment for prolonged pathological peripheral neurogenic inflammation. Read this article
J Lyftogt. Pain Conundrums: Which Hypothesis? Central Nervous System Sensitization versus Peripheral Nervous System Autonomy. Australasian Musculoskeletal Medicine Nov 2008
Abstract: The two hypotheses, central nervous system (CNS) sensitisation and peripheral nervous system (PNS) autonomy are at first glance irreconcilable. CNS sensitisation is the reigning paradigm in mainstream pain medicine. It is shared by most members of the medical scientific community. PNS autonomy is not recognised despite convincing scientific and clinical evidence. It has yet to establish a paradigm status and would require a scientific revolution or paradigm shift for it to gain acceptance, as predicted by Thomas Kuhn. Read this article
WALDMAN: PAIN MANAGEMENT. Prolotherapy. K. Dean Reeves. J Lyftogt. Section V. Chapter 139. Second Edition. 2011. ELSEVIER