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The following pathophysiologic models have been proposed over the years to explain the remarkable effectiveness of NT:5
- Nervous System Theory: Illness leads to changes in membrane potential of nerve cells and their conductivity, leading to disorganized/chaotic signaling of the afferent and efferent nerves. Loss of polarization of the membrane leads to abnormal cell metabolism and subsequent accumulation of metabolic waste and acidosis further disrupting the membrane potential. Local anesthetic restores resting cell membrane potential and ion pump function leading to normal cellular function.
- Fascial Continuity System: The fascial system has long been accepted as a layer of tissue surrounding organs, muscles, joints, ligaments, and tendons in a continuous fashion. A scar could cause a defect in the fascia in addition to the electrical conductivity. This, in turn, produces a disruption further along the fascial plane. By re-establishing cell membrane potentials with local anesthetic, traction on the fascia is reduced.
- Ground System (Matrix) Theory is based on Pischinger's work in which a complex system of proteoglycans and glycosaminoglycans exist within the matrix or extracellular space. This complex network of connectivity is responsible for regulation throughout the entire system. Changes in the chemical, physical, or ionic milieu due to an interference in the system such as a scar will lead to immediate disruption throughout the system. Local anesthetic can electrically neutralize an interference within a small part of the matrix leading to an immediate regulation of the entire matrix thus healing chronic pain or illness. This particular model is emerging as the most popular explanation among experts in the field.
- Lymphatic System Theory: In the 1970s, Fleckenstein's work revealed a lymphatic dilatory effect secondary to procaine.2 Chronic illness leading to chronic lymphatic spasm could be treated by dilating the lymphatics through local anesthetics. The subsequent increase in flow restores the entire lymphatic system.
Identification of Interference Fields
In attempting to decide which interference fields are responsible for a given symptom, several different fields of study within the genre of energy medicine can help elucidate the association. Acupuncture physiology dictates that anatomic highways of energy or Qi flow within channels known as meridians. Therefore, if an interference field lies within a given acupuncture meridian, it would be logical to expect the patient to be symptomatic in an organ or location within the sphere of influence of that meridian even if that might be much further away than where the interference field is located.17 Any scar that is inflamed, tender, burns, itches, or tingles is likely to be abnormal and is stressing the body in some way.18 Scars that are in the same spinal segmental region where there is pain should be suspected.
A form of muscle testing called applied kinesiology can be used to identify an interference field. Although several forms of applied kinesiology are in use today, almost all methods make use of muscle contractility. Those interference fields which solicit a sympathetic nervous response from the patient will, in turn, affect contractility when the muscle is tested thereby identifying a blockage.5 In our center we use autonomic response testing (ART) to determine whether a scar is causing the problem. As mentioned earlier, this method was developed by Dietrich Klinghardt, MD, PhD, and Louisa Williams, DC, ND. In brief, ART is a refinement of other forms of applied kinesiology, which uses changes in muscle strength to determine an area of abnormality.8,9 In skilled hands, it can be a tremendously useful tool. With this technique, one can often determine whether a scar is abnormal and whether it is the cause of the problem or merely contributes to it.10 Naturally, no medical assessment technique is accurate 100% of the time. All medical tests have different sensitivities and specificities along with different predictive positive and predictive negative values.
Finally, there are empiric associations that are well recognized within the neural therapy community whereby the location of a given interference field has been clinically associated with a certain anatomic location. For instance, tonsils are often associated with knee joints; abdominal scars with low back pain and large joints; leg scars with sciatica; tonsils and teeth with migraines; cholecystectomy with shoulder, hip or ankle pain; and pelvic scars with premenstrual syndrome and depression.5 In our practice, we have noted an association between hernia scars and groin pain.
Several different responses to treatment have been documented:5
- Huneke Phenomenon – lightening reaction where there is immediate, complete relief of symptoms for over 20 hours.
- "Knallkopf" or "Exploding Head" whereby there is a self-limited sensation of heat exploding in the head of several minutes duration following injection.
- Emotional euphoria whereby an emotional catharsis follows injection. Response may be weeping, sobbing, anger, or fear. It is generally associated with a scar that has an emotional attachment for the patient.
- Delayed reaction whereby symptoms resolved after 16-20 hours. Especially common in reactions involving asthma.
- Reversal phenomenon whereby symptoms worsen for about 24-48 hours and then resolve.
- Reaction phenomenon whereby the patient's symptoms are aggravated for several hours or days followed by return of original symptoms, which indicates that there are other active interference fields that need to be identified and treated.
In our practice, we use simple preservative free 0.5% procaine without epinephrine which can be obtained through a compounding pharmacy. We have seen frequent side effects with procaine that contains preservative and therefore do not recommend it. Preservative-free and epinephrine-free lidocaine 0.5 to 1% can be a substitute for procaine. Some have claimed lidocaine has carcinogenic potential so we prefer not to use it although it is considerably cheaper. Long-acting local anesthetics are discouraged as they tend to be neurotoxic.
Scars should be infiltrated intradermally at the junction of the dermis and the subcutaneous tissue. A bleb or wheal should form. Deeper subcutaneous injections are less painful but usually work less well. In order to maintain the needle in the intradermal space, it may be necessary to bend the needle to a 30 to 45 degree angle with the needle cap prior to the injection. This depends on where the scar is located and in what direction the practitioner approaches the patient. Approximately 0.7 ml of procaine per cm of scar is injected. A total procaine injectate of 20 ml of 1% procaine can be well tolerated by a 70 kilogram adult.5 It should be noted that scars may need to be injected on five or six different occasions before the interference field is permanently lifted.
Segmental therapy involves the creation of subcutaneous blebs (also known as quaddels) in the skin several inches apart over a specific area in order to remove an interference field over a given organ. Usually this is directly over the organ; however, it can on occasion be quite a distance away, for example, right upper shoulder for the liver and the left upper shoulder for the stomach.11
Ganglion injection technique requires formal training and falls outside the scope of this article. However, any physician who has infiltrated the skin with a local anesthetic can safely try injecting most scars on the skin depending on location.
Risks and Contraindications
Risks of NT are the same as those that would be present for any procedure involving the use of local anesthetic such as bleeding or infection. Local anesthetics can have neurotoxic and cardiotoxic effects. Early warning signs of toxicity are dizziness, orthostatic hypotension, tinnitus, and metallic taste.5,19 The risk of a vasovagal reaction to the anesthetic is a possibility; and depending on the location of the scar, other risks may exist, for example, possible perforation of a breast implant for a breast surgery scar; possible pneumothorax in the case of a scar or quaddels performed over the surface of the chest wall; or device interference for a scar located over a pacemaker. Scar or segmental infiltration can also be quite painful especially in areas that are particularly active with regard to dysautonomic interference.
Neural therapy may be contraindicated when some diseases are present. There is some concern in patients with active cancer that lymphatic flow may be enhanced as a result of neural therapy and therefore could increase risk for metastasis. Some physicians feel that there may be some increase in glucose lability in diabetics treated with neural therapy. Klinghardt considers active tuberculosis, psychiatric illness other than depression, and genetic illnesses as contraindications to neural therapy. Attention should also be paid to possible or existing allergies. Neural therapy may be ineffective in patients with severe nutritional deficits and end-stage illnesses.5 There have been rare reports of serious adverse reactions with injections into the deep ganglia and tonsils. Formal training is required to perform injections in higher risk anatomical locations.15
Case Vignettes from Our Practice
Vasectomy Scar: A 40-year-old male with longstanding severe neuropathic pain of his left lower extremity having failed conventional therapy presented to our office. His left lower leg had a dusky, somewhat mottled appearance. His ankle was stiff, and the entire foot was hypersensitive to the touch. We had been treating him for about a year with acupuncture which gave him partial temporary relief. One day upon re-inquiring about past scars, he mentioned that he had had a vasectomy 10 years prior. He was found to have a 1 cm scar on his scrotum from a vasectomy. This scar was injected superficially with 1 cc of 0.5% procaine. On his follow-up visit one week later, we were astonished to see that he not only had 80% pain reduction, his ankle was more supple and his skin color appeared more normal without the mottled appearance. After several weekly scar injections, he retained long-term improvement without needing continued maintenance acupuncture. He was even able to ski wearing heavy ski boots without pain, something he would not have dared to try before.
Tonsillectomy Scar: Upon injecting an old tonsillectomy scar (0.3 cc of 0.5% preservative-free procaine at a depth of 0.1-3 mm), a middle aged woman with chronic knee pain and stiffness noticed marked improvement in range of motion and complete reduction in pain within two minutes of the injection. After several weekly injections, her knee problem resolved. We have since seen over five cases where injecting the tonsillectomy scar was the key to the successful resolution of chronic knee pain.
Umbilical Scar: A pre-teen female athlete presented six weeks before her next competition complaining of pain in her hamstring area preventing her from running. Physical exam revealed tenderness over the attachment of her right biceps femoris muscle and pain and weakness with forced flexion of her lower leg. ART revealed that her umbilical scar (the original birth scar) was likely causing an interference field affecting her hamstring muscles. Within minutes of injecting her umbilicus with approximately 4 cc's of 0.5% procaine, she noticed complete resolution of her hamstring symptoms with resolution of pain and tenderness as well as return of full strength. The umbilicus was treated one more time one week later. Five weeks later, she placed first in her track meet.
Abdominal Scar: A 50-year-old female complained of constant aching daily pain in her shin of five-years duration ranging in pain intensity from 3 to 7 on a scale of 10. Past medical history was notable for bowel resection 11 years prior to the office visit. Within minutes of injecting the abdominal scar with 0.5% procaine, the patient noticed marked relief of her shin splint pain. At follow-up two weeks later, the patient reported moderate to marked relief of her shin paint. The patient's abdominal scar was injected again. She again noted immediate complete relief of her shin pain. She remained pain free for over two and a half years.
Pilonidal cyst and gallbladder scars: A 54-year-old female presented with an approximately 17-year history of bilateral foot pain diagnosed as plantar fasciitis. Her symptoms reached an excruciating level by end of the day (10/10). Her third and fourth toes of both feet would go numb. She also complained of chronic bilateral hip pain of over 10 years duration that reached a level of 9/10 severity by evening. Her past medical history was notable for a cholecystectomy 33 years prior and pilonidal cyst surgery 34 years prior. ART revealed that her pilonidal cyst was likely affecting her feet and the gallbladder scar was affecting her hips. Both scars were injected with 0.5% procaine. She noticed immediate reduction of pain in her feet after injection of her pilonidal cyst scar and immediate reduction of her bilateral hip pain following injection of her cholecystectomy scar. Simple trigger point injections were administered into her hip girdle muscles, but none to her feet. At the two-week follow-up, she reported 80% improvement of her feet and 90% improvement of her hip pains. The same scars were treated. One-month follow-up revealed 100% improvement. She has remained pain- and symptom-free for five years with no further treatment.
The above vignettes are some of the more astonishing cases that we have seen. They demonstrate the "lightening reaction" (dramatic improvement within minutes of the treatment) described by Dr. Huneke.
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