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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
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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 pain11,13 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.
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