In honour of open dialogue amongst people interested in chronic pain management, I am publishing Dr John Lyftogt’s response to the original post I published by Dr John Quintner “Sugar coated nerves”.
I want to make it clear that when guest authors are permitted to publish material on Healthskills, this is done to open dialogue and for calm and reasoned discussion. People with chronic pain, and those clinicians who provide interventions of any kind to alleviate the problems of chronic pain, have not yet arrived at any kind of “cure” or “fix” for the problem. We need to learn from one another – then we need to carry out good, systematic and scientific research to evaluate both the outcomes (eliminating as much bias as possible), and hypothesise about the mechanisms involved. I think we have a very long way to go.
REPLY TO SUGAR COATED NERVES (originally contributed by Doctor John Quintner) by Dr John Lyftogt.
The ‘latest fad in pseudo-science’ or does Glucose/Dextrose have an analgesic effect?
For millennia Jewish male neonates have had circumcision under oral Glucose/Dextrose anaesthesia. Many neonatal painful procedures are commonly conducted under Glucose anaesthesia and a systematic review of 14 RCTs confirms the effectiveness of Glucose as an analgesic agent. (Harrison).
Unfortunately no scientist to date has investigated this common phenomenon. Not even Professor Douglas Zochodne, although he has published a study on subcutaneous near nerve injections with low dose morphine.
It would be easy to repeat the same study with Glucose in sterile water as a control.
There are probably two reasons why scientists are not interested in this curious effect of Glucose:
- funding could be difficult without Big Pharma support
- finding a solution to chronic pain is not conducive to an academic career.
For over 50 years Diabetes scientists have known about Glucosensing neurones: “Glucosensing neurons are specialized neurons that use glucose as a signalling molecule to alter their action potential frequency in response to variations in ambient glucose levels” (Barry). Glucose is increasingly viewed by scientists as a molecule with two separate functions. A metabolic and an inter-neuronal signalling function (Gonzales). Glucose sensing neurones have already been identified in the Hypothalamus, Vena Cava and Enteric system. They are probably small peptidergic C-fibers.
Meaningful chance observations in clinical practice have a long history of opposition from funding and regulating bodies in Medicine. E.g. Semmelweis washing of hands in labour ward in the 1830s reduced maternal death by 90%, but lead to his dismissal, eventual committal to an Asylum and death from a clobbered skull. More recently Barry Marshall’s observation in 1982 that Peptic Ulcers were caused by a bacterium (HP) led to his dismissal from the Royal Perth Hospital. He was awarded the Nobel Prize for Medicine in 2005 however.
All this happened in Dr Quintner’s home town. He should be well familiar with mainstream medicine’s kneejerk denial of innovation as has been happening with ‘Glucose analgesia’ over the last fifty years.
Dr George Hackett was the founder and prolific author on Prolotherapy in the 1940-1960s. He published his 19th paper on Prolotherapy for Headaches in 1962. (Hackett) He reports on eighty-two consecutive patients with occipito-cervical disability treated with prolotherapy over a four year period. Good to excellent results were reported by 90%, with lasting success. In the article’s introduction he comments that “Recent scientific interpretation of the devastating effects of excessive antidromic impulses and their clinical application are described”. Here is the first description of an effective treatment with hypertonic Glucose for conditions now known as neuropathic pain due to neurogenic inflammation.
Despite more than 50 years of continued success with prolotherapy and an increasing number of RCT’s confirming this, scientists refuse to have even a modicum of curiosity into the analgesic and trophic effects of glucose. Mainstream medicine with its emphasis on Central Nervous System sensitisation and pain management can only offer relief to at most 30% of those who suffer chronic unendurable pain. This dismal track record in relieving pain and suffering should be a potent stimulus for investigation, and here I quote Hackett in his 1962 paper on headaches, “for scrutinizing every fact, theory or idea that might enlighten us to the pathology, pathophysiology and treatment of these patients”.
Neural prolotherapy (NPT) is the application of isotonic Glucose/Dextrose to sensitised peripheral nerve trunks by way of subcutaneous near nerve micro-injections. It results in an immediate, profound and quantifiable reduction of mechanical allodynia. Repeat treatments reverse the underlying neurogenic inflammation causing neuropathic pain and lead to restoration of tissue homeostasis. Treatment with NPT allows for normal physiological repair of the nerve trunk and surrounding tissues. This has been documented in tens of thousands of patients and large numbers of Ultra Sound examinations before and after treatment. The treatment is now available worldwide in twelve different countries by Doctors who have been trained in Neural Prolotherapy.
Ongoing ridicule of Neural Prolotherapy by specialists like Dr Quintner, who has never witnessed a Neural Prolotherapy treatment or discussed the outcomes with patients whose lives have been transformed by NPT, is gratuitously offensive. Cynical put downs of ‘anecdotal evidence’ does nothing to enhance the reputation of mainstream medicine as it merely results in diminishing the validity of patients experiences in their battle with unendurable pain. Several RCTs on NPT will be published this year in reputable journals all confirming the above. More than fifty years of denial of the analgesic effect of Glucose/Dextrose by scientists is further evidence that they do not have the slightest interest in the care of chronic pain patients. NPT is an effective, safe and economical treatment for chronic pain and mainstream medicine exponents like Dr Quintner merely require an open mind.
Harrison D. Efficacy of sweet solutions for analgesia in infants between 1 and 12 months of age: a systematic review. Arch Dis Child 2010; 95:406-413 CONCLUSION: Glucose sublingual is and effective analgesic in infants between 1 and 12 months of age
Barry E. Levin,1,2 Vanessa H. Routh,3 Ling Kang,2 Nicole M. Sanders,4 and Ambrose A. Dunn-Meynell1,2. Neuronal Glucosensing. What Do We Know After 50 Years? DIABETES, VOL. 53, OCTOBER 2004
Min-tsai Liu1, 2, Susumu Seino3, and Annette L. Kirchgessner1, 2 Identification and Characterization of Glucoresponsive Neurons in the Enteric Nervous System. The Journal of Neuroscience, December 1, 1999, 19(23):10305-10317
J. Antonio Gonzàlez1, Frank Reimann2 and Denis Burdakov1.Dissociation between sensing and metabolism of glucose in sugar sensing neurones. Department of Pharmacology, University of Cambridge, Cambridge CB2 1PD, UK.
Hackett G S, Raftery A, Prolotherapy for Headache. Pain in the Head and Neck, and Neuritis. HEADACHE, April 62