Dear Colleagues:

A recent case in my office suggests it is time for another look.

A 33 year old man presented with pain in his head, neck and upper back for 6 years (as a result of a rear-end motor vehicle accident).  He also had developed lower back pain radiating into both legs, associated with gastrointestinal symptoms in the previous year.

The upper trunk symptoms were the result of soft tissue injuries and responded (to a degree) to physiotherapy, manipulation and exercise.  However improvement had plateaued and after five years the attending physician suggested a trial of prolotherapy.  The patient was referred to a very experienced prolotherapist who provided eight sessions of prolotherapy, four to the cervical region and four to the upper thoracic spine.

The patient experienced some post-injection pain and improvement in upper body mobility.  However, the post-injection pain worsened with time; pain gradually began to develop in his low back and legs; and constipation, anal itching and hemorrhoids appeared - entirely new symptoms. 

He ascribed the changes in gastrointestinal function to side effects of analgesics and underwent rubber band ligation (banding) of his hemorrhoids with some relief.   However this helped neither the constipation nor the lower body pain.

Musculoskeletal examination was unremarkable with good body symmetry and muscle balance.  Using autonomic response testing, an interference field was detected at the anus and treated with a Tenscam device.  (The classic neural therapy technique is injection of dilute procaine as "quaddles" into the skin in a circle about two inches from the center of the anus).

The result was immediate relief of all lower body pain and gastrointestinal symptoms for about five weeks.  Little or no change occurred in the upper body pain.

On re-examination at six weeks, autonomic response testing revealed a recurrence of the anal interference field.  This was treated and because of the persisting upper body symptoms, a closer examination of the upper body was undertaken.  A restriction of cranio-sacral motion and interference field was detected at the bridge of the nose (site of an old injury) and was treated with a cranial osteopathic technique. (An alternative treatment would have been neural therapy - either quaddles, Tenscam or possibly laser treatment).

Four weeks later the patient reported little change; the lower body pain had not returned, but the upper body pain persisted.  However a change in musculoskeletal balance had occurred and "arcing" (a subtle pulsation from a specific locus) could be felt in the upper thoracic region.  This was treated with an osteopathic unwinding technique and after 12 hours of increased pain, a significant physical and emotional release occurred.  The patient felt (for the first time) marked relief from the upper body pain and a change in upper body posture.  The patient described it as feeling "like before the accident".

So why did the prolotherapy trigger such an unusual response?  One can only speculate, but a few neural therapy principles may help explain it. 

Firstly, neural therapy and prolotherapy are more similar than generally recognized.  It puzzles me that in all the published research on prolotherapy, the role of procaine or other caine anesthetics has never (to my knowledge) been examined.  Yet a caine anesthetic is always part of the injection solution. 

Secondly experienced prolotherapists know that some patients respond very quickly to prolotherapy - immediately or within days.  This cannot be due to the proliferant effect which takes weeks or months for full benefit.  The procaine is the only possible explanation for this rapid response. 

Thirdly, occasionally neural therapy injections will temporarily worsen a patient's symptoms.  Experience has shown that this sort of response means that another important interference field is present.  It should be searched for vigorously as it is often the key to solving the patient's problem.

My interpretation of this man's unusual reaction to the prolotherapy was that the body was reacting as if the prolotherapy were neural therapy directed at the wrong place.  The worsening of symptoms suggested that an important interference field was somewhere present.  What is harder to explain is the persistence of the post-injection pain.  It would seem that the proliferant effect must have been playing a role, as the process is known to carry on for many months.

I am not entirely sure how this persisting pain can be explained and welcome readers' opinions (no matter how speculative) for a solution.  Whatever the mechanism, I think it worth reminding ourselves that whenever unusual pain is experienced during or after prolotherapy, it is worth looking for undetected interference fields.