Tracy L. Brobyn, MD, FAAFP; Myung Kyu Chung, MD; and Patrick J. LaRiccia, MD, MSCE

Abstract

Today, the vast majority of medical treatments are for diseases of a chronic nature, in particular chronic pain. The treatment of chronic pain is costly not only in the United States but countries around the world adding up to billions of dollars for treatment costs as well as disability costs. There is an urgent need at this time to explore effective alternative treatments for chronic pain. A relatively unknown technique initially developed in Germany during the early 1900s known as neural therapy (NT) is emerging as a simple and effective treatment for chronic pain. NT is now gradually being adopted by medical communities throughout the world, and cases being described report many remarkable results.

Neural therapy technique primarily involves the injection of local anesthetic into scars, trigger points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, epidural space, and tissues. The mechanism of action calls upon the concept whereby each cell within the autonomic nervous system (ANS) is controlled via ubiquitous synapses occurring within the intracellular fluid (also known as the “matrix”). Chronic pain results from long-term disruption/irritation of this complex system. NT generally uses non-anesthetic properties of local anesthetics to re-establish homeostasis throughout the autonomic nervous system.

NT in its simplest form is intradermal injection of those scars, tattoos, or piercings which are believed to be causing an interference field or disruption of the autonomic nervous system. The local anesthetic is injected in such a way as to produce a linear wheal over the interference field of approx. 0.7 cc of solution per cm of scar. The location of the interference field can be in the vicinity of the patient’s pain or in an entirely different location, and the therapeutic benefits range from gradual improvement after repeated treatments versus immediate complete relief of symptoms. Our center has witnessed numerous cases where this technique has led to dramatic improvement and often complete cure of a patient’s long-term pain. 

Herein we present our updated and revised review “Neural Therapy (NT): An Overlooked Game Changer for Patients Suffering Chronic Pain?” The original article was published open access in the journal Pain & Relief.¹

Is it possible to completely cure a patient who has been suffering intractable pain for many years with a simple scar injection? (See case vignettes section below.) As physicians, we are called upon to examine the evidence, use our best judgment and, of course, heal if possible while doing no harm. As such, it is understandable that the average physician would look upon such a claim with a healthy degree of skepticism, and it’s likely that most physicians practicing NT today responded in kind the first time they had heard of this obscure therapy for pain. However, not only is it possible, it’s explainable on the basis of neurophysiology. In addition to being simple to perform, NT often produces dramatic results. The purpose of this article is to help bring to the forefront an often overlooked yet possibly outstanding therapy. 

Treatment of chronic pain with opioid medications has contributed significantly to the current public health problem of prescription drug-related morbidity and mortality.^2,3 Chronic pain is a significant contributor to morbidity, disability, and financial loss throughout the world.  In the adult population of Western nations, 15% of people will complain of pain when surveyed at any given point in time. Similar rates are found for the developing nations, e.g. in Asia 18.5% for back pain alone. In the US, 17% of patients seeing their primary care physician report persistent pain. In a national survey of pain specialists, an estimated 2.9 million Americans (1.1% of the population) annually are treated by physicians who specialize only in chronic pain.  The numbers of patients seeking care from primary doctors or other types of non-pain specialists must be at least comparable. Most patients with chronic pain do not have overt pathology that points to a specific disease but rather suffer from non-specific ailments such as low back pain or headaches. The statistics in the United States for back pain and migraine reveal that 13% of headache patients and 18% of back pain patients reported being unable to maintain full time work due to their pain.

Besides being incredibly common, chronic pain is incredibly costly, not just in terms of cost of care but also in terms of disability and lost revenue. Frymoyer and Durett projected the cost of treating chronic back pain to exceed $33.6 billion for health care; cost of disability to exceed $11 billion; and cost of lost productivity to be $4.6 billion. These estimates don’t get much better with less common causes of chronic pain. For example, rheumatoid arthritis is projected to cost $14 billion (year 2000 estimates) whereas costs for migraine come in at $13 billion (estimated 1993 dollars). Clearly, the need for safe and affordable pain treatments mandate our profession and the research community to be in active pursuit of such treatments.⁴

Historical Perspectives

At our practice, neural therapy has been a simple and effective treatment for chronic pain as well as other pathological processes. Although it has been practiced for decades in central Europe, it remains a relatively unknown modality throughout the rest of the world. Neural therapy has its roots in Germany as far back as 1892 when Schleich reported to a surgical congress that using a 0.1% to 0.2% cocaine solution could produce an infiltrative anesthesia. His theories were entirely rebuked until 10 years later when Mikulicz was finally able to convince the medical community of the utility of local anesthetics. By 1903, Cathelin reported on the usage of cocaine in epidural anesthesia; and shortly thereafter in 1905, Einhorn discovered procaine.

From 1906 to 1925, several researchers reported on the utility of locally applied procaine outside of the realm of pure anesthesia. Speiss, in 1906, reported on improved wound healing with regional infiltration of procaine. In 1906, Vichnevski reported on the anti-inflammatory effects of procaine; and in 1925, Leriche performed the first stellate ganglion block calling it the “surgeon’s bloodless knife.” It was not until 1926, however, that Ferdinand Huneke, the father of modern neural therapy, first reported using IV procaine in the treatment of chronic migraine headaches. Then in 1928, Huneke and his brother Walter published “Unfamiliar Remote Effects of Local Anesthetics,” thereby ushering in the now classic understanding of NT.^5,6   

Over the next 40 years, numerous other case reports were published regarding the effectiveness of this modality; and then, in 1965, Pischinger succeeded in providing objective evidence of the Huneke “lightening reaction” (discussed later in this article) through hematology and iodometry.⁵ This critical work states that the autonomic nervous system relies on a system of “ubiquitous synapses” whereby the extracellular fluid or “matrix” acts as a transmission medium for both capillaries and nerves as opposed to a classic synapse. The matrix provides the cells with information and keeps them healthy and in balance. A disruption in the environmental milieu will lead to inflammation, instability and, of course, chronic disease. The fact that there is a proven continuous and ongoing exchange of information between each and every cell of the human body through the neurovegetative network is the single most important concept in neural therapy and in our ability to find success in the treatment of chronic disease.⁷   

In 1964 Peter Dosch⁶ published the first manual on neural therapy based on Huneke’s work and this was translated into English in 1984. In 1991, German cellular physiologists Neher and Sakmann won the Nobel prize in medicine for their achievement in making the interstitial fluid (matrix) visible in addition to their measurement of its ion flow, a messaging relay between cells in regulating impulses, thereby further enhancing our understanding of the neurovegetative state.⁶  In the 1980s, German MD/PhD Dietrich Klinghardt emigrated to the United States and set up training for the first generation of North American physicians in NT. He brought much needed German knowledge and experience. Later, Klinghardt along with Louisa Williams DC, ND, developed a form of applied kinesiology called Autonomic Response Testing (ART) that can be used to identify those areas of dysautonomia most in need of treatment with NT.^8,9   In 2005, Canadian physician Robert Kidd published the first original English textbook on neural therapy designed for the busy clinician who requires a quick and relatively painless means of integrating the material into their practice.¹⁰

Actions of Local Anesthetics

NT technique primarily involves the injection of local anesthetic into scars, trigger points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, epidural space and tissues.  Local anesthetics have historically been used as a means of producing anesthesia through sodium channel blockade. Nevertheless, there remains a myriad of other properties of these drugs that may be responsible for the benefits observed in neural therapy up to and including neuroprotection of the CNS, reduction in intracranial hypertension, and protection against sympathetic sprouting in neuropathic pain.¹¹ Local anesthetics also appear to have a profound anti-inflammatory effect through polymorphonuclear neutrophil mediators and free radical release.¹² Although neural therapy is mostly a pain-relieving modality, there have been studies to support its use for other pathology such as secondary prevention of cancer, Alzheimer’s disease, and wound healing.¹¹

The Concept of Interference Fields

Neural therapy can be used to heal through local injections over the area of symptomatology as in the case of trigger points. Alternatively, injections can be given directly into a ganglion (the neurologic control center) of the limb or organ manifesting symptoms (known as regional therapy). Segmental therapy utilizes the concept of referred pain to achieve pain resolution. Examples might include occipital nerve injections in a patient with frontal headache, myofascial trigger point injection into the neck for shoulder pain^11,13 or local procaine injections in the form of subcutaneous blebs over the dermatome of a patient affected by post-herpetic neuralgia.¹⁴   Nevertheless, NT’s most common and powerful application is in the treatment of so called “interference fields” (Storfeld in German).    

Interference fields are blockages to healing that act either independently or as part of a constellation of insults. One can think of an interference field as a focus of erratic or dysfunctional (so called “dysautonomic”) excitation within a given location of the autonomic nervous system, leading to nervous irritation.¹⁰ Interference fields can include scars of any kind whether secondary to trauma or surgery, dental foci, intestinal dysbiosis, and any form of skin alteration including piercings,¹⁵ tattoos,¹⁶ and burns. Signs that a patient may be suffering as a result of an interference field include symptoms that present in an ipsilateral fashion, illness/pain recently following a trauma or surgery that cannot be logically attributed to that event, or symptom exacerbation/unresponsiveness following an accepted form of treatment for a given illness (known as a “reaction phenomenon”). The interference field may be close in proximity to the location of symptoms or a great distance away.⁵

The idea that the location of pathology may not be in the same location as the location of symptoms is not a new concept. Traditional Chinese medicine along with movement of Qi within acupuncture meridians clearly gives credence to the idea that symptoms can have their origin at any number of different points along an affected meridian, a highway of sorts facilitating the movement of Qi throughout the body. Osteopathy with its concept of a holistic fascial network controlling autonomic response embraces a similar philosophy.

In the case of acute pain as one would find with trauma, generally the location of the pain correlates with the pathologic location very much akin to X marks the spot. In contrast, chronic disease will rarely present with symptomatology in the same location as its cause.¹⁰ Several mechanisms found in the autonomic nervous system illustrate this phenomenon such as the previously mentioned referred pain (for example visceral pathology leading to back pain) or mechanical compensation (such as hip pain in someone with a limb length discrepancy). It is with these in mind that one can understand the mechanism of action in NT and why it is such a powerful means of treating chronic pain.     

The following pathophysiologic models have been proposed over the years to explain the remarkable effectiveness of NT:⁵

1. 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.
2. 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.
3. 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.  
4. 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

1. Huneke Phenomenon – lightening reaction where there is immediate, complete relief of symptoms for over 20 hours.
2. “Knallkopf” or “Exploding Head” whereby there is a self-limited sensation of heat exploding in the head of several minutes duration following injection. 
3. 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.
4. Delayed reaction whereby symptoms resolved after 16-20 hours. Especially common in reactions involving asthma. 
5. Reversal phenomenon whereby symptoms worsen for about 24-48 hours and then resolve.
6. 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. 

Technique

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.

Neural Therapy in the Medical Literature

• In a survey of 405 patients with musculoskeletal diseases treated by primary care physicians, those patients treated with NT (n=164) indicated higher treatment satisfaction and higher patient-care related satisfaction than those patients treated with conventional medical care (n=241).²⁰
• Fischer et al, reported a case of successful treatment of painful and progressive left-sided glossopharyngeal neuralgia, which had been unsuccessfully treated with standard medication therapy. The problem had been present for three years. After two NT treatments of the hypertrophic scar of the left tonsil, the patient’s problem resolved; and he was pain free for two and half years at the time the report was written.²¹
• Weinschenk et al, using NT successfully treated a woman with a 12-year history of conventional treatment-resistant vulvodynia. A total of 14 treatment were completed. The patient was pain free for three years at the time the report was written.²²
• Saha et al reported a case of a 39-year-old male with a rectal scar from a gunshot wound. The patient had suffered chronic pain for 10 years. He had not responded to conventional medical therapy. Nine days after one rectal endoscopic NT injection he was symptom free. He was then lost to follow-up.²³
• We (MKC, PJL) published three cases of chronic pain and chronic nausea refractory to standard medical therapy. NT resulted in total symptom resolution of, at minimum, two-years duration. Two of the cases had permanent resolution at the time of the report.^15,16 Also, we recently reported a case series of three patients in which breast scars were related to chronic neck and back pain. NT was instrumental in patient improvement.²⁴ NT’s ease of use, safety, low cost, and ability to ease suffering appears to be remarkable in our group practice experience.
• Haaks and Tackmann published a case series of 30 patients with post-stroke shoulder pain treated with NT. Seventy-five per cent of the patients were able to stop their analgesic medication.²⁵
• Fischer and Pfister reported a NT case series of 72 with chronic pain who were resistant to conventional medical, surgical,  and complementary/alternative  medicine therapies. Thirty-three per cent showed significant improvement and 60% were able to reduce their medication.²⁶
• Egli et al reported on a case series of 280 chronic pain (at least 3 months duration) patients who were unresponsive  to conventional medical therapy. All received NT. At one year follow-up, 60 were unchanged; 52 were slightly improved; 126 were considerably better; 41 were pain free; and 74% had reduced or eliminated their medication intake. There were no adverse events.²⁷
• Hui et al reported a randomized controlled trial of a multicomponent intervention of which NT was one of the components for chronic herpes zoster pain. Significant positive results occurred within three weeks and persisted in 78% of the subjects at one to two-year follow-up.¹⁴

Conclusion

In light of the preliminary evidence of the value and safety of NT for the treatment of chronic pain, NT’s history in Western medicine as far back as 1926, and the major public health problems associated with the use of opioid medication^2,3 in the treatment of chronic pain, it is time for further research into NT and for consideration of NT in the treatment of chronic pain. The authors are open to collaboration with others to further research.

This article was originally published in Townsend Letter (November 2017).

References

1. Brobyn TL, et al. Neural Therapy: An Overlooked Game Changer for Patients Suffering Chronic Pain? Pain Relief. 2015; 4(3):1-4.
2. Gaither JR, et al. National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012. JAMA Pediatr. 2016;170(12):1195-1201.
3. Rudd RA, et al. Increases in drug and opioid overdose deaths-United States, 2000-2014. MMWR. 2016;64(50-51):1378-1382.
4. Turk, D. Clinical effectiveness and cost-effectiveness of treatments for patients with chronic pain. Clinical Journal of Pain. 2002;18:355-365. 
5. Frank, B. Neural Therapy. Physical Medicine and Rehabilitation Clinics of North America. 1999;10(3):573-582.
6. Dosch P. Manual of Neural Therapy According to Huneke; 11th ed. Heidelberg, Germany: Karl Haug Publishers; 1984.
7. Pischinger A. The Extracellular Matrix and Ground Regulation: Basis for a Holistic Biological Medicine. Berkley,California, North Atlantic Books,2007.
8. Klinghardt D, Williams L. A.R.T., Autonomic Response Testing. Self-published; 1996. Updated ART manuals, videos and training course offerings at www.klinghardtacademy.com.
9. Klinghardt D. Video demonstration: Autonomic Response Testing versus Classical Kinesiology  http://www.klinghardtacademy.com/Videos/Autonomic-Response-Testing-vs-Classic-Kinesiology.html
10. Kidd RF. Neural Therapy: Applied Neurophysiology and Other Topics. Refrew. Custom Distribution, 2005.
11. Weinschenk S. Neural therapy—A review of the therapeutic use of local anesthetics.  Acupuncture and Related Therapies. 2012;1:5-9.
12. Hollmann MW, Durieux ME. Local anesthetics and the inflammatory response.  Anesthesiology. 2000; 93:858-875.
13. Travell, JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams and Wilkins; 1983.
14. Hui F, et al. A randomized controlled trial of a multifaceted integrated complementary-alternative therapy for chronic herpes zoster-related pain. Alternative Medicine Review. 2012;17(1):57–68.
15. Chung MK, et al. Tongue piercing and chronic abdominal pain with nausea and vomiting – two cases.Explore (NY). 2015;11(1):59-62.
16. Chung, MK, LaRiccia PJ. Successful treatment of chronic nausea and vomiting related to body piercing and tattooing with integrative medicine interventions. Holist Nurs Pract. 2015;29(1):33-6.
17. Strittmater, B. Identifying and Treating Blockages to Healing, New Approaches to Therapy-Resistant Patients. New York: Thieme Publishing; 2004.
18. Helms, JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley: Medical Acupuncture Publishers; 1995.
19. Schmittinger C, et al. Brainstem hemorrhage after neural therapy for decreased libido in a 31-year-old woman. J Neurol. 2011;258:1354–1355.
20. Mermod J, et al. Patient satisfaction of primary care for musculoskeletal diseases: A comparison between Neural Therapy and conventional medicine. BMC Complementary and Alternative Medicine.2008;8:33.
21. Fischer L, et al. Neuralgia of the Glossopharyngeal Nerve in a Patient with Posttonsillectomy Scarring: Recovery after Local Infiltration of Procaine—Case Report and Pathophysiologic Discussion. Case Reports in Neurological Medicine. 2015; Article ID 560546.
22. Weinschenk S, et al. Successful therapy of vulvodynia with local anesthetics. A case report. Forsch Komplementmed. 2013;20:138–143.
23. Sahaa FJ, et al. Successful Endoscopic Neural Therapy of a Patient with Chronic Pain Syndrome after Rectum Gunshot Injury. Forsch Komplementmed. 2014;21:310–313.
24. Chung MK, LaRiccia PJ. Successful Integrative Medicine Assessment and Treatment of Chronic Pain Associated with Breast Surgery: A Report of 3 Cases. Holist Nurs Pract. 2017;31(1):21-29.
25. Haaks T, Tackmann W. Neuraltherapeutishe behandlung der schmerzhaften hemiparetischen schulter. Biol Med. 1999;28(3):130-132.
26. Fischer L, Pfister M. Wirksamkeit der Neuraltherapie bei überwiesenen Patienten mit therapieresistenten chronischen Schmerzen. Schweiz. Zschr. GanzheitsMedizin. 2007;19(1)30–35.
27. Egli S, et al. Long-term results of therapeutic local anesthesia (neural therapy) in 280 referred refractory chronic pain patients. BMC Complementary and Alternative Medicine. 2015;15:200.

Published January 13, 2024

About the Authors

Tracy L Brobyn, MD, received her BA cum laude from Barnard College of Columbia University and her MD from the State University of New York at Buffalo. She completed a residency in family medicine at Mountainside Hospital in Montclair, NJ. Dr. Brobyn is board certified in family medicine and is a Fellow of the American Academy of Family Physicians. After serving in the United States Air Force, Dr. Brobyn served as assistant professor for the Robert Wood Johnson School of Medicine and attending physician at Cooper Hospital (Camden) in the Department of Family Medicine. Dr. Brobyn currently serves as assistant professor of family medicine at the Rowan University, School of Osteopathic Medicine. Dr. Brobyn is a Diplomat of the American Board of Medical Acupuncture and completed training in prolotherapy through the University of Wisconsin’s Hackett Hemwell Foundation. She has trained with the American Academy of Anti-Aging in the use of bio-identical hormone replacement. She is an advocate for increasing physical activity in the community. 

Myung Kyu Chung, MD. After serving as the chief of the department of family medicine at the Cooper University Hospital in Camden and vice-chair of the department of family medicine at Robert Wood Johnson Medical School for 13 years, Dr. Chung elected to pursue solely his clinical and research interest in integrative medicine. Dr. Chung is currently the Director and Founder of the Chung Institute of Integrative Medicine, Clinical Professor at Cooper Medical School of Rowan University, and President of the Won Sook Chung Foundation.

He graduated from the University of Washington School of Medicine (Seattle). Dr. Chung is board certified in family medicine and a Diplomate of the American Board of Medical Acupuncture. He has been named by the Philadelphia Magazine, South Jersey Magazine, and New Jersey Monthly as one of the “Top Doctors” and named as one of the best doctors in the Northeast. He has published peer-reviewed papers related to neural therapy, acupuncture, and autonomic response testing.

Patrick J. LaRiccia, MD, MSCE. Dr. LaRiccia’s background includes a Bachelor’s degree from Youngstown State University; Master’s degrees in psychology and clinical epidemiology from Temple University and the University of Pennsylvania School of Medicine; and MD from the University of Ghent in Ghent, Belgium. He is board certified in internal medicine and a licensed acupuncturist. Dr. LaRiccia is Research Director for the Won Sook Chung Foundation; a member of the medical staffs of Penn-Presbyterian Medical Center and of the Hospital of the University of Pennsylvania; and is an Adjunct Scholar at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania Perlman School of Medicine.

He has been active in professional organizations, serving as president of the Acupuncture Society of Pennsylvania and president of the New York Society of Acupuncture for Physicians and Dentists. He is the recipient of awards related to acupuncture and has been listed in Who’s Who in America and Who’s Who in Healthcare.