Long-term results of therapeutic local anesthesia (neural therapy) in 280 referred refractory chronic pain patients

Simon Egli, Mirjam Pfister, Sabina M Ludin, Katia Puente de la Vega, André Busato, Lorenz Fischer, Simon Egli, Mirjam Pfister, Sabina M Ludin, Katia Puente de la Vega, André Busato, Lorenz Fischer

Abstract

Background: Can the application of local anesthetics (Neural Therapy, NT) alone durably improve pain symptoms in referred patients with chronic and refractory pain? If the application of local anesthetics does lead to an improvement that far exceeds the duration of action of local anesthetics, we will postulate that a vicious circle of pain in the reflex arcs has been disrupted (hypothesis).

Methods: Case series design. We exclusively used procaine or lidocaine. The inclusion criteria were severe pain and chronic duration of more than three months, pain unresponsive to conventional medical measures, written referral from physicians or doctors of chiropractic explicitly to NT. Patients with improvement of pain who started on additional therapy during the study period for a reason other than pain were excluded in order to avoid a potential bias. Treatment success was measured after one year follow-up using the outcome measures of pain and analgesics intake.

Results: 280 chronic pain patients were included; the most common reason for referral was back pain. The average number of consultations per patient was 9.2 in the first year (median 8.0). After one year, in 60 patients pain was unchanged, 52 patients reported a slight improvement, 126 were considerably better, and 41 pain-free. At the same time, 74.1% of the patients who took analgesics before starting NT needed less or no more analgesics at all. No adverse effects or complications were observed.

Conclusions: The good long-term results of the targeted therapeutic local anesthesia (NT) in the most problematic group of chronic pain patients (unresponsive to all evidence based conventional treatment options) indicate that a vicious circle has been broken. The specific contribution of the intervention to these results cannot be determined. The low costs of local anesthetics, the small number of consultations needed, the reduced intake of analgesics, and the lack of adverse effects also suggest the practicality and cost-effectiveness of this kind of treatment. Controlled trials to evaluate the true effect of NT are needed.

Figures

Fig. 1
Fig. 1
Reflectory connections between skin, muscle and internal organ: a simplified schematic diagram. The arrows indicate possible sites of injection with local anesthetics. The injections can be combined

References

    1. WHO The burden of musculoskeletal conditions at the start of the new millennium. World Health Organ Tech Rep Ser. 2003;919:1–218.
    1. Smolen JS. Combating the burden of musculoskeletal conditions. Ann Rheum Dis. 2004;63:329. doi: 10.1136/ard.2004.022137.
    1. Oggier W. Volkswirtschaftliche Kosten chronischer Schmerzen in der Schweiz – eine erste Annäherung. Schweiz Aerztezeitung. 2007;88:1265–9.
    1. Fischer L, Barop H, Maxion Bergemann S. Health Technology Assessment (HTA) Neuraltherapie nach Huneke. Programm Evaluation Komplementärmedizin (PEK) des Schweizerischen Bundesamtes für Gesundheit. 2005.
    1. Fischer L, Ludin SM, Thommen D, Hausammann R. Antrag auf Kostenübernahme durch die obligatorische Krankenpflegeversicherung betreffend die Leistung Störfeld-Therapie (Neuraltherapie nach Huneke) an das Schweizerische Bundesamt für Gesundheit. 2010.
    1. Jänig W, Baron R. Pathophysiologie des Schmerzes. In: Fischer L, Peuker ET, editors. Lehrbuch Integrative Schmerztherapie. Stuttgart: Haug; 2011.
    1. Jänig W. The Integrative Action of the Autonomic Nervous System. New York: Cambridge University Press; 2006.
    1. Joos S, Musselmann B, Szecsenyi J. Integration of complementary and alternative medicine into family practices in Germany: results of a national survey. Evid Based Complement Alternat Med. 2011;2011:495813. doi: 10.1093/ecam/nep019.
    1. Barop H. Lehrbuch und Atlas der Neuraltherapie nach Huneke. Stuttgart: Hippokrates; 2011.
    1. Dosch P. Lehrbuch der Neuraltherapie nach Huneke. 14. Heidelberg: Haug; 1994.
    1. Fischer L. Neuraltherapie. Neurophysiologie, Injektionstechnik und Therapievorschläge. (4. Aufl.) Stuttgart: Haug; 2014.
    1. Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J. 2007;154:830–7. doi: 10.1016/j.ahj.2007.06.037.
    1. Cornelissen P, van Kleef M, Mekhail N, Day M, van Zundert J. Evidence-based interventional pain medicine according to clinical diagnoses. 3. Persistent idiopathic facial pain. Pain Pract. 2009;9:443–8. doi: 10.1111/j.1533-2500.2009.00332.x.
    1. Fukai K, Takiguchi T, Ando Y, Aoyama H, Miyakawa Y, Ito G, Inoue M, Sasaki H. Associations between functional tooth number and physical complaints of community-residing adults in a 15-year cohort study. Geriatr Gerontol Int. 2009;9:366–71. doi: 10.1111/j.1447-0594.2009.00547.x.
    1. Huneke F. Das Sekundenphänomen in der Neuraltherapie. 6. Heidelberg: Haug; 1989.
    1. Speranski AD. Grundlage einer Theorie der Medizin. Berlin, Sänger: Ins Deutsche übertragen von K.R. Roques; 1950.
    1. Schmid DU. Mikrochirurgie lumbaler Bandscheibenvorfälle. Nervenarzt. 2000;71:265–74. doi: 10.1007/s001150050556.
    1. Brügger A. Die Erkrankungen des Bewegungsapparates und seines Nervensystems. Stuttgart: Fischer; 1980.
    1. Fischer L. Myofasciale Triggerpunkte und Neuraltherapie nach Huneke. EHK. 1998;3:117–26.
    1. Fischer L. Pathophysiologie des Schmerzes und Neuraltherapie. Praxis. 2003;92:2051–9. doi: 10.1024/0369-8394.92.48.2051.
    1. Handwerker HO. Einführung in die Pathophysiologie des Schmerzes. Berlin: Heidelberg, New York, Springer; 1999.
    1. Baron R, Jänig W. Schmerzsyndrome mit kausaler Beteiligung des Sympathikus. Anästhesist. 1998;47:4–23. doi: 10.1007/s001010050517.
    1. Baron R, Jänig W. Sympathetically maintained pain. In: Bountra C, Muglani R, Schmidt W, editors. Pain. New York: Marcel Dekker Inc; 2003. pp. 309–20.
    1. Jänig W, Koltzenburg M. Possible ways of sympathetic interaction. In: Jänig W, Schmidt RF, editors. Reflex Sympathetic Dystrophia. Pathophysiological Mechanism and Clinical Implications. Weinheim, New York: VCH Verlagsgemeinde; 1992.
    1. Peterson-Felix S, Curatolo M. Neuroplasticity – an important factor in acute and chronic pain. Swiss Med Wkly. 2002;132:273–8.
    1. Cassuto D, Sinclair R, Bonderovic M. Anti-inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiol Scand. 2006;50:265–82. doi: 10.1111/j.1399-6576.2006.00936.x.
    1. Goadsby P, Edvinson L. The trigeminovascular system and migraine: studies characterizing cerebrovascular and neuropeptic changes seen in humans and cats. Ann Neurol. 1993;33:48–56. doi: 10.1002/ana.410330109.
    1. Gonzales R, Goldyne ME, Taiwo YO, Levine JD. Production of hyperalgesic prostaglandins by sympathetic postganglionic neurons. J Neurochem. 1989;53:1595–8. doi: 10.1111/j.1471-4159.1989.tb08557.x.
    1. Noble MD, Romac J, Wang Y, Hsu J, Humphrey JE, Liddle RA. Local disruption of the celiac ganglion inhibits substance P release and ameliorates coerulein-induced pancreatitis in rats. Am J Physiol Gastrointest Liver Physiol. 2006;291:G128–34. doi: 10.1152/ajpgi.00442.2005.
    1. Strittmatter M, Grauer MT, Fischer C, Hamann G, Hoffmann KH, Blaes F, Schimrigk K. Autonomic nervous system and neuroendocrine changes in patients with idiopathic trigeminal neuralgia. Cephalalgia. 1996;16:476–80. doi: 10.1046/j.1468-2982.1996.1607476.x.
    1. Strittmatter M, Hamann GF, Grauer M, Fischer C, Blaes F, Hoffmann KH, Schimrigk K. Altered activity of the sympathetic nervous system and changes in the balance of hypophyseal, pituitary and adrenal hormones in patients with cluster headache. Neuroreport. 1996;7:1229–34. doi: 10.1097/00001756-199605170-00001.
    1. Tracey KJ. The inflammatory reflex. Nature. 2002;420:853–9. doi: 10.1038/nature01321.
    1. Ricker G. Pathologie als Naturwissenschaft – Relationspathologie. Berlin: Springer; 1924.
    1. Pfister M, Fischer L. Die Behandlung des komplexen regionalen Schmerzsyndroms der oberen Extremität mit wiederholter Lokalanästhesie des Ganglion stellatum. Praxis. 2009;98:247–57. doi: 10.1024/1661-8157.98.5.247.
    1. Melzack R, Wall PD. Pain mechanisms. A new theory Science. 1965;150:971–9.
    1. Atalay NS, Sahin F, Atalay A, Akkaya N. Comparison of efficacy of neural therapy and physical therapy in chronic low back pain. Afr J Tradit Complement Altern Med. 2013;10:431–5. doi: 10.4314/ajtcam.v10i6.4.
    1. Fischer L, Pfister M. Wirksamkeit der Neuraltherapie bei überwiesenen Patienten mit therapieresistenten chronischen Schmerzen. Schweiz Zeitschr Ganzheitsmedizin. 2007;19:30–5. doi: 10.1159/000283620.
    1. Mermod J, Fischer L, Staub L, Busato A. Patient satisfaction of primary care for musculoskeletal diseases. BMC. 2008;8:33. doi: 10.1186/1471-2210-8-S1-A33.
    1. Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve – an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev. 2000;52:595–638.
    1. Levick SP, Murray DB, Janicki JS, Brower GL. Sympathetic nervous system modulation of inflammation and remodeling in the hypertensive heart. Hypertension. 2010;55:270–6. doi: 10.1161/HYPERTENSIONAHA.109.142042.
    1. Straub RH, Wiest R, Strauch UG, Härle P, Schölmerich J. The role of the sympathetic nervous system in intestinal inflammation. Gut. 2006;55:1640–9. doi: 10.1136/gut.2006.091322.
    1. Watkins LR, Hutchinson MR, Milligan ED, Maier SF. “Listening” and “talking” to neurons: Implications of immune activation for pain control and increasing the efficacy of opioids. Brain Res Rev. 2007;56:148–69. doi: 10.1016/j.brainresrev.2007.06.006.
    1. Bissig P, Schöni-Affolter F, Fischer L, Busato A: Is Neural Therapy Cheaper than Conventional Medicine? A Comparison of Cost Structure in Swiss Primary Care Providers – An Observational Study. Doctoral thesis. University of Bern, Switzerland, Medical Faculty; 2008. In publication.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever