Liza Maniquis-Smigel, MD

I am returning from the AAOM Annual Workshop that was held in Denver, Colorado August 5 and 6, 2011.  I lectured on “Neural Prolotherapy in the Clinical Setting” It was well accepted by the attendees, and many volunteered to get NPT treatment during the Treatment Workshop.  They were amazed at the instant relief of their pain, as well as the improved motion of the joints after the treatment.  I am happy to continue to spread the word about this mind-blowing treatment!
    

We left Hawaii June 22nd and flew into Barcelona and rented a car immediately.  After a one amazing week on  the road through Catalonia and Basque provinces of Spain and Southern France, we spent a few days in Barcelona then left for a   12 day Mediterrean Cruise,visiting places in Italy, France, Monte Carlo, Greece and Turkey, ending in Venice.

It was great cruising with many of our friends.  While on the ship, I treated many staff and friends with NPT for their chronic pain.   After the cruise, we visited a very dear friend and fellow prolotherapist, Steve Cavallino, and enjoyed his hospitality at  his beach villa in Ferrara.

We also round de voued with our friends, the Crawfords there and then and travelled overland thru the Dolomites and Italian Alps, towards Germany. We spent time in Frankfurt and Berlin.

I managed to fly to Dublin for a day for a prolo clinic that Pat and Niall McDonagh organized.  We flew to Chicago for a very quick and fun Family reunion yesterday. 

Again, I treated family members with prolotherapy.

This has been a great and wonderful and memorable holiday! 

In a way, it  also became a working vacation,  treating patients with prolotherapy. It is so gratifying to be able to help people with their pain and to help spread the word about Neural Prolotherapy.

Last May 2011,  a 3 day Neural Prolotherapy Workshop was held in Los Angeles led by Dr. John Lyftogt.   The Science of  Neural Prolotherapy and Neurogenic Inflammation is now clear. How can severe chronic   pain be relieved immediately with injections under the skin of 5% dextrose, the same fluid contained in ordinary Intravenous solution?

Dr. Lyftogt expounded on the science of Neurogenic Inflammation and emphasized   the Concept of Nociceptors and the role of TRPV1, the molecule responsible for neurogenic inflammation and pain. Dextrose is now postulated to be a TRPV1 antagonist, relieving neurogenic inflammation and reversing pain.

The main role of the unmyelinated C fiber nerve cells with TRPV expression is to make   sure every cell is functioning optimally. In normal physiological circumstances, these nociceptor  is silent  and does not produce pain. When part of the body is injured, the role of these nerve cells is to kick start the repair mechanism and to help bring back normal function to   the injured body part.    They do this by activating their TRPV1 receptor, which transmits sodium and calcium influx and releases two neuropeptides.         The first peptide released is called substance P, as in pain. It signals the brain that there is pain and limits you from moving, thus allow healing of scar formation.    CGRP also causes cells to become engorged with calcium, which may lead   to calcium deposits in chronically inflamed areas.    A blow, a burn, or a cut, are not the only ways the body can be injured .  If the fascia is suddenly stretched out of shape, these   holes where these nerve crosses thru fascia or muscles. They are no longer able to conduct nerve impulses or even   repair themselves.      Inside the nerve, the injured, swollen C fibers now have   activated TRPV1 receptors, which will remain activated as long as the C   fibers are swollen. 

If the TRPV1 receptors remain activated, there is persistent neurogenic inflammation and interruption of axonal flow.  This in turn does not allow nerve growth factors and other neural ingredients for healing to reach the injured nerve.  There is subsequent degeneration of tissues, as tissues do not heal.  This may help explain why people who suffer whiplash   injuries have such persistent pain. Blocking the TRPV1 receptor is the best way to   block the release of substance P and CGRP, and the transmission of pain   signals by the C fibers.      Sugar  (dextrose) has been shown to block the   TRPV1 receptor almost instantly.   Once the TRPV1 receptor is blocked, CGRP and substance P stop being   produced and the painful message which substance P transmits to the brain   disappears in a few seconds.      The nerve is no longer swollen and easily   crosses the small opening in the fascia.      It regains its normal function, which is to maintain cell health.      It is no longer a source of pain.  This is the most exciting development in chronic pain management in over 50 years.  That a simple dextrose in sterile water solution can relieve pain instantly and completely?

Because of low side effect and safety of D5W, Dr. Howard Rosen and I experimented on other applications using 5% dextrose with sterile water to relieve pain syndromes and other conditions.    These applications include 1. The Sweet Caudal Epidural and 2.  Prologel.  We introduced our early findings of these applications during this workshop.

The Sweet Caudal Epidural.    Because unmyelinated C fibers are also found at the nerve root/ spinal level, and the nerve root can also suffer with compression injury,  Dr. Howard Rosen and I experimented on injecting D5W into the spinal canal via caudal epidural approach to see if it would relieve low back pain. We found that it does in fact, produce relief of low back and leg pains instantly and completely! Amazingly, it also helps  to relieve pain in patients with nonspecific low back pain and ones with  peripheral polyneuropathy.   Dr. Howard Rosen and I, along with Dr. Dean Reeves, are currently conducting a prospective multicentered study on Sweet Caudal epidural cases and seeing the long-term outcomes of this amazing discovery.  A Prologel transdermal dextrose application for penetration into the subcutaneous tissues without a needle has been introduced by Dr. Howard Rosen, with promising results for treatment of Neuropathic pain. This application continues to evolve.

Also, Vitamin D cream, a steroid hormone that has neuroprotective effects, has consistently relieved many peripheral painful syndromes in my personal experience.

Neural prolotherapy and the science of neurogenic inflammation is the paradigm shift that is changing the world of pain. I think this is the most exciting development in pain management in the last 50 years.  I think we are sitting in a movement that is just beginning and it continues to evolve daily.  I hope that you will join in the search for answers and better outcomes for our patients.

I will again  assist as clinical instructor for  Dr Lyftogt's Neural Prolotherapy Workshop  in Los Angeles Califorina, May, 6-8, 2011. Attending Dr John Lyftogt's Neural Prolotherapy workshops, in New Zealand last year and in Italy this year, has been one of the most rewarding and exciting experience, in my quest to find the cure for Chronic Pain.  As a physiatrist and prolotherapist, I have been successful in treating musculoskeletal pain, but neuropathic pain has been  frustrating as very few treatment options are available - with no cure.     I went to New Zealand last year for his first ever  International  Neural Prolotherapy workshop that he and his wife Maria organized themselves. There were only 12 medical doctors that attended.  We were  all blown away by his  work  and impressed  by the immediate relief of pain we witnessed when he treated  his  own patients.   Impressed but still skeptical,  I returned home and tried it on my own patients and have  been amazed with the results, leading to pain relief in almost all musculoskeletal and neuropathic cases.  I was excited to tell many of my colleagues about Dr Lygtoft's technique.     I was invited to  attend his second workshop held in Italy, to assist  as one of his clinical instructors, attended by 27  doctors from around the world.  There, I was able to  understand more deeply  the pathophysiology of neurogenic inflammation and of the anatomy of  peptidergic sensory C-fibers and how it applies to the basic  principles of how neural prolotherapy with near nerve injections of dextrose can relieve pain instantly.      I feel honored and blessed to be one of the pioneers in spreading the word about neural prolotherapy.  The whole paradigm of pain  has changed for me and I have discovered, thanks to Dr Lyftogt, a minimally invasive treatment, that if done correctly,  can  relieve pain  without the  expensive and ill effects of many medications used for  pain. I am also  currently involved in exciting research, studying the potential analgesic  effects of dextrose on nerve roots,  via epidural approach.

I  returned from an amazing conference  in Italy that was held in  Ferrara, Italy October 8-10, 2010,  the 2nd international  Neural Prolotherapy Workshop.  The importance of this  conference is reflected by the large number   of countries  that were represented, with  27 doctors enrolled that  came from Australia, USA, Mexico, New Zealand, Korea, Spain, Canada, Germany, India and Italy. The speaker, Dr. John Lyftogt presented the results of his research and taught the members the way he treats patients. I participated as one of his instructors.    Neural Prolotherapy  is a new therapeutic approach to chronic neuropathic pain, which until now has always  been very difficult to treat with limited treatment options.    Neuropathic pain is described as a debilitating pain that renders patients unable to walk, work, sleep and enjoy life. The other clinical features of neuropathic pain are hyperalgesia,  allodynia and dysesthesia. Other important signs of neurogenic inflammation are the expansion of nerves and a degree of swelling and to a much lesser degree, heat and  redness. Basically, neuropathic pain is due to  neurogenic inflammation.  The neurogenic inflammation is caused by the depletion  or abnormal release of neuropeptides accumulated in the unmyelinated C fibers and A delta myelinated fibers in response to neuronal injury of these peptidergic sensory nerves.  The abnormal regeneration of peptidergic sensory nerves results in neurogenic inflammation and chronic or neuropathic pain.  Dr. John Lyftogt  and his instructors showed that subcutaneous near  nerve injections of dextrose can cause a instant analgesia   with a reduction of neurogenic inflammation and improvement of neuropathic pain.