Dear Colleagues:

This month I plan to discuss the subject "safety in neural therapy". This is not a topic that comes up often in neural therapy discussions, perhaps because in comparison to most mainstream medical treatments, it is so much safer. I would guess that one of the great satisfactions for most physicians practicing neural therapy is seeing patients give up their anti-inflammatory medications, their anti-depressants, their anti-convulsants, etc.

Much of this attitude is fueled by ignorance and fear: ignorance of the practices that they proscribe, and fear that these alternatives might expose the inadequacies of the practices that they support. This situation has come to a head recently in the jurisdiction where I practice (Ontario, Canada). A new policy on Complementary Medicine is requiring physicians to spend much of their time warning patients of the risks of the services that they provide, and of course documenting everything.

This is annoying to both patients and the physicians they consult. It is also condescending. Patients generally consult physicians practicing outside the mainstream for their own reasons and in my experience they are already well informed - certainly better informed than many mainstream physicians.

Nevertheless raising the question of risks in "alternative" medicine has its value.

The risks of neural therapy fall into two main categories:

1. Procaine (and other caine anaesthetics) allergy and toxicity.
2. Complications of injections into specific areas.

Knowledge of procaine toxicity comes from the anaesthesia literature. Anaesthetists use higher concentrations and larger doses than are generally used in neural therapy, so that if overdose reactions occur, anaesthetists are likely to be the first to encounter them. However dosage and concentrations are not the only factors to consider. The vascularity of the tissues injected and the period of time over which the injections are administered affect blood concentrations and the risk of reaching toxic levels. In classical neural therapy according to Huneke, many test injections may be given in one session, and attention needs to be paid to the cumulative amount being given.

Allergy to procaine is rare. Cases do occur, but I have never encountered one in my 24 years of neural therapy practice. The Dosch book discusses allergy in detail (pp. 277-79 in the most recent edition), giving advice on how to identify, to avoid and to treat allergic reactions.

Segmental therapy, scars and periodontal injections are virtually risk-free. However care needs to be taken with some of the deeper injections, especially those near arteries in the neck, the lungs and the spinal dura. Details of these are beyond the scope of this newsletter, but training should be obtained either from an experienced neural therapist or by consulting the Dosch manual when undertaking these injections.

Coagulation defects or anticoagulation therapy are not absolute contra-indications to neural therapy injections, but care must be taken especially when the INR is prolonged. Another circumstance involving clotting (or lack of it) is neural therapy treatment of varicose veins. This method, taught by German surgeon and neural therapist, Dr. Ulrike Aldag of Berlin, carries the small risk of dislodging venous thrombi and causing pulmonary embolism. However, with elementary precautions, this risk should be outweighed by the benefit of preventing pulmonary embolism, now the cause of death of 30,000 Germans per year.

Finally, a no-brainer: (I and my patient were caught by this many years ago.) Change your needle after injecting potentially infected tissue, like periodontal tissue. Using the same needle when injecting that small bolus of procaine intravenously can cause a septicemia. My patient developed pneumonia the day after I injected her infected tooth. No doubt it was the subsequent antecubital vein bolus using the same needle that caused it.