Neural Therapy and Its Role in the Effective Treatment of Chronic Pain
Neural therapy is a powerful treatment that can be quite effective in resolving autonomic nervous system dysfunction and pain, especially in the complex pain patient.
Harris G. Neural Therapy and Its Role in the Effective Treatment of Chronic Pain. Pract Pain Manag. 2009;9(6).
Chronic pain is a major problem in our society not just because of its prevalence, but also because of the general lack of effective treatment for patients afflicted with chronic pain. When I was in medical school learning how to treat these pain problems, diagnosis and treatment was reduced to an algorithm or “recipe.” I dutifully memorized these algorithms and when I began practice, applied them as I was taught. While I would go through the algorithm, unfortunately most of the time the patient would be only slightly improved, and sometimes they would even get worse! I began a long quest for more knowledge by attending numerous conferences, seminars and workshops that had to do with pain treatment. One of the most effective treatments I encountered was a technique developed in Europe called “neural therapy.” This treatment is designed to repair dysfunction of the autonomic nervous system—that part of the nervous system responsible for the “automatic” functions of the body. When used in conjunction with other techniques, such as prolotherapy, I have found neural therapy to be very effective in resolving even the worst cases of chronic, seemingly intractable, pain. This article will discuss neural therapy, its history, background, technique and application. I will also discuss my protocol, the Harris Method of Pain Treatment, which provides a sequence for treatment of the chronic pain patient, along with case reports of typical patients treated.
The Autonomic Nervous System (ANS)
To understand neural therapy, it is important to understand what the autonomic nervous system (ANS) is. Once outside the brain, the nervous system has two basic divisions: the somatic (voluntary) nervous system and the autonomic (involuntary) nervous system. The somatic or voluntary nervous system is the part most people are familiar with because it controls voluntary movements such as walking, talking and movement of limbs. The autonomic (involuntary) nervous system, on the other hand, regulates internal body functions such as immune function, blood pressure and circulation, hormones, digestion, body temperature, heart rate, breathing, urination, sexual function, menstruation, and other automatic body functions. If the ANS is injured, these internal functions will not perform at optimum levels and ultimately lead to disease and chronic pain.
History and Theory of Neural Therapy
Neural therapy is a gentle, healing technique developed in Germany that involves the injection of local anesthetics into autonomic nerve ganglia (grouping of nerves), peripheral nerves, scars, glands, acupuncture points, trigger points, and other tissues.¹ Two German physicians practicing in the early 1900s, Ferdinand and Walter Huneke, are considered the founders of neural therapy.² Neural therapy is one of the best-known natural healing methods in Germany where there are more than 5,000 practitioners. It is now also practiced in other countries in Europe and the United States. Neural therapy is based on the theory that any trauma, infection, or surgery can damage the autonomic nervous system and produce long-standing disturbances in the electrochemical or electromagnetic functions of tissues.³ If there is a disturbance of the autonomic nervous system, the resulting dysfunction can last indefinitely unless repaired. When the autonomic nervous system is injured or not functioning correctly, various consequences result. An example is blood flow going out of synch with demand in an area that needs it, such as a soft tissue injury, thus resulting in incomplete healing. It has been reported that “a correctly applied neural therapy injection can often instantly and permanently resolve chronic long-standing illness and chronic pain.”⁴ In my experience, it usually requires more than one treatment to reach this end. However, the phenomena of a “lightning reaction” (instant reaction) has been noted by researchers and physicians over the years.⁵
Development of Neural Therapy
Neural therapy evolved and developed along with the discovery of local anesthetics. The first local anesthetic, cocaine, was discovered to have anesthetic effects by the famous Sigmund Freud. Dr. Freud shared his knowledge with his friend, ophthalmologist Koller, who was the first physician to perform eye surgery using a cocaine solution in 1884.⁶ Because of the addictive and toxic qualities of cocaine, a search for a safer local anesthetic ensued and resulted in the discovery of procaine (introduced under the trade name “Novocain”) in 1905 by Einhorn.⁷ In 1906, Spiess and Schleich discovered that infiltration of procaine into a wound greatly enhanced healing. This extreme healing lasted much longer than the duration of action of the actual anesthesia. The famous French surgeon, Leriche, was the first to successfully treat a migraine headache with a local anesthetic nerve block injection and who called Novocain (procaine) “the surgeon’s bloodless knife.”⁸ In 1925, the brothers Dr. Ferdinand and Walter Huneke—both sons and grandsons of physicians—discovered the healing aspects of procaine without any prior knowledge of the work of Spiess, Schleich or Leriche. This occurred by accident when, in 1925, Ferdinand Huneke gave his nurse, whom he had been treating for rheumatism, an I.V. infusion of procaine and her previously therapy-resistant migraine disappeared. This “lightning reaction” impressed Dr. Huneke who realized he may have found a new therapy for pain. He named this new therapy “Healing Anesthetics.” Ferdinand Huneke, along with his brother, Walter, first reported the results of their research into the healing properties of local anesthetics with the publication in 1928 of “Unknown Distant Effects of the Local Anesthesia.”⁹ The Hunekes reported that reaction to the injections could help organs at a distant site and described this phenomenon as a reflex. The publication of the book “Cybernetics” by Weiner in 1948 led to more clarification about neural therapy in that the main concept of that book is that the body functions as a whole and that every disease, every scar, and every treatment affects the whole body system.¹⁰
“It has been reported that ‘a correctly applied neural therapy injection can often instantly and permanently resolve chronic long-standing illness and chronic pain.’⁴ In my experience, it usually requires more than one treatment to reach this end.”
How Neural Therapy Works
There are several theories on how and why neural therapy works. It can be understood better by a short review of nerve cell physiology. Normal resting nerve cells have a “resting membrane potential” which is the difference between the electrical charges inside the cell and outside the cell. While at rest, a healthy nerve cell does not generate nerve impulses. In most neurons, this resting membrane potential has a value of approximately 70 mV.¹¹ If there is a stimulus to the cell, the membrane resting potential drops. When it drops to approximately 45 mV there is an “action potential” generated¹² and the nerve fires an impulse. In a nerve cell damaged by surgery or trauma, the resting membrane potential is chronically low—for example, it may be at 47 or 50mV.¹³ This means the nerve will fire off a nerve impulse with much less of a stimulus.
While different theories exist as to the mechanism of action for local anesthetics, it is well known that these substances raise the resting membrane potential, making the nerve less likely to fire a nerve impulse even with more stimuli.¹⁴ In addition, studies with procaine have shown its ability to increase the refractory period (time interval between nerve firing).¹⁵ Kidd sums this up: “A pathological reduction (usually) or increase (less often) in membrane resting potential leads to a reduced threshold of excitation within the affected tissue. The lower threshold creates chronic low-grade excitation, impaired intracellular metabolism and ion exchange, and persistent inability to maintain a normal resting potential, resulting in chronic neurophysiologic instability.”¹⁶ Since the half-life of local anesthetics is short, how does treatment with a local anesthetic affect long-term change? It is believed that by repeatedly infiltrating the local anesthetic around the cell wall, the ion pumps progressively resume normal activity and eventually the autonomic nervous system starts functioning properly again.
Neural therapy is performed with local anesthetics, usually procaine or lidocaine, and occasionally carbocaine if allergy problems are encountered. These anesthetics should never contain epinephrine. The standard solution I use for superficial infiltration (scars) is 1% procaine or 1% lidocaine with a small amount of sodium bicarbonate to buffer the PH and decrease the pain of the injection, although the sodium bicarbonate is optional.
Conditions Appropriate for Treatment With Neural Therapy
Neural therapy is potentially useful for any type of musculoskeletal pain complaint, including low back pain or other chronic joint pain not responsive to other treatments. Painful, sensitive or keloided scars are particularly responsive. Chronic pelvic pain is frequently responsive to neural therapy, as are dysmenorrhea and menstrual irregularities. What are deemed “regional pain syndromes” are frequently secondary to autonomic dysfunction and amenable to treatment with neural therapy if initiated soon enough. Trigeminal neuralgia can be effectively treated if combined with treatment of dental infections. Raynaud’s also will frequently respond to neural therapy.
Jurgen Huneke, MD, nephew of Ferdinand and Walter Huneke, and president of the International Association for Neural Therapy, summarizes a list of conditions for which neural therapy is used:
- acute and chronic pain (including headaches of different origins),
- inflammatory responses,
- poor circulation,
- multiple chronic conditions, caused by interrupted interference fields (such as rheumatism),
- diseases of the motor system (sciatica, arthritic joint conditions, shoulder or arm syndrome),
- internal diseases such as prostate, female, allergies, kidney; and
- sports injuries where it assists in healing.¹⁷
Types of Neural Therapy
There are three types of neural therapy treatment:
1) Segmental therapy. This involves intracutaneous injections of the cutaneous branches of the deep autonomic nervous system structures that are malfunctioning. These skin injections work by indirectly correcting the function of the deeper nerves. There are charts of the location of these cutaneous branches for many body organs so that the practitioner knows where to place these injections.
2) Injection of scars. Scars are often sites of dysfunctional nerve tissue. Direct injection of scars with local anesthetic is thought not only to help restore function of damaged nerve cells but has a secondary benefit of reducing the mechanical “pull” of the scar on other normal tissue. For example, a large scar on a patient’s sternum acquired from open-heart surgery may put unnatural tension on the thoracic spine, causing back pain. Injections into the scar soften it and reduce the pull.
3) Locating and treating “interference fields.” (See below.)
A very important part of neural therapy treatment is the identification and treatment of “interference fields.” Interference fields are areas of altered nerve cell resting membrane potential (discussed above) where nerve cells are not functioning normally. These areas can found almost anywhere in the body and are often far from the part of the body that is experiencing symptoms. Typical locations include scars of all types (trauma, surgical), deep autonomic ganglia (grouping of nerves) and internal organs. An interference field has also been defined as local tissue irritation with the potential to cause destabilization of the autonomic nervous system (ANS) either locally or systemically.¹⁸ Interference fields usually occur on the same side of the body as the symptoms, however the symptoms or signs may be bilateral or contra lateral. Interference fields generally arise in locations where there has been an injury, either from sharp or blunt trauma, local infection or inflammation, mechanical strain injury and frequently surgical scars.¹⁹
The phenomena of interference fields affecting areas at a distance was demonstrated when, in 1940, Ferdinand Huneke injected procaine into the shoulder of a patient with a severe and therapy-resistant frozen shoulder. No immediate relief was noted by the patient however, several days after the shoulder injection, the patient developed severe itching in a scar on her leg. That itching scar was injected and within seconds the patient obtained full, painless range of motion in the previously frozen shoulder. Review of history revealed the patient had previous surgery on that leg because of osteomyelitis. The surgery had been considered successful, but shortly after the surgery the patient had developed the frozen shoulder. Huneke recognized the therapeutic importance of this “lightning reaction”²⁰˒²¹ with the scar on the leg being the site of the actual interference field.
“It is interesting to note that if pain does not resolve or is aggravated after an injection treatment utilizing local anesthetics—such as trigger point injections or prolotherapy—this is a strong indication that an interference field is present and needs treatment.”
Conditions Caused by Interference Fields
Chronic pain, especially migraine, has an autonomic component and is often the result of an interference field. Since the autonomic nervous system regulates the automatic functions of the body, any symptom related to those functions can be caused by an interference field. Chronic musculoskeletal pain is often related to the presence of interference fields because they can affect blood flow to injured areas. This occurs through regulation of the smooth muscle walls of the blood vessels, which should open to allow more blood to an injured joint or organ but, if disturbed, may not. Decreased blood flow to an organ may eventually result in illness or disease. Examples of disturbed autonomic nervous system function include indigestion, constipation, sluggishness, weight gain, headaches, migraines, dizziness, confusion, optic neuritis, chronic ear infections, tinnitus, vertigo, hay fever, sinusitis, tonsillitis, asthma, liver disease, gallbladder disease, menstrual pain, eczema and a host of others.²² Neural therapy, because it increases blood flow, may have profoundly positive effects on such conditions.²³ It is interesting to note that if pain does not resolve or is aggravated after an injection treatment utilizing local anesthetics—such as trigger point injections or prolotherapy—this is a strong indication that an interference field is present and needs treatment.
Testing for Interference Fields
Location and treatment of interference fields is the most precise way to do neural therapy. However the determination of these fields was a challenge until the introduction of Autonomic Response Testing (ART), a type of kinesiologic testing developed by Dietrich Klinghardt and Louise Williams in the 1990’s. Development of this technique was a milestone in neural therapy treatment and has since been adopted by most North American physicians who practice neural therapy. Although interference fields are detectable by other methods (listed below), these methods can be “hit or miss” with several unsuccessful trial injections. The development of ART has allowed for much greater accuracy in injections that patients do receive.²⁴ Prior to ART, the methods listed below were the primary methods used, and can still be used, but without the increased accuracy of ART.
- Temporal Association. The chronology of when symptoms began can be a clue as to the presence of an interference field. If a chronic pain or condition started within several months of surgery, dental work or other procedure without any other inciting event, then interference fields as a result of that procedure should be considered.²⁵
- Empirical Approach. There are known relationships between certain interference fields and commonly associated illnesses and areas of pain. This is particularly important with teeth because each tooth will tend to affect distinct areas of the body when they become dysfunctional.
- Systematic Approach. Determine as many past trauma and injury sites as possible during the history taking and then systematically treat them all, carefully checking the patient for improvement after each site is treated. Improvement can be determined subjectively by the patient or objectively by the practitioner through the use of range of motion before and after treatment of each site.
- Proximity. Scars or trauma sites that are situated in close proximity to the area of symptomatology are more likely to be causative of symptoms than those situated further away. (Examples are: earring hole scar and neck and shoulder pain, appendectomy scar and hip pain). It is important to remember, though, that any interference field anywhere in the body can cause symptoms anywhere else.
Autonomic Response Testing (ART)
ART is based on applied kinesiology and, when properly done, appears to be the most accurate method to detect interference fields. ART is based on the theory that a muscle will become weak when an interference field is palpated. While the actual “how” of ART still remains controversial, an individual who is tested and treated based on the interference fields located by this method often gets well. Several studies have documented the accuracy of this method, without explaining the how.²⁶⁻²⁸
How To Do Autonomic Response Testing
A discussion of how to do autonomic response testing in its entirety is quite lengthy and therefore this is just a summary and introduction. The first step in ART is to determine if the patient is “open” (able to be tested) or “blocked,” a condition where the patient’s autonomic nervous system is so affected by some factor that it cannot be reliably tested. An “indicator muscle” is chosen. I prefer to choose the biceps muscle since it is usually fairly strong in most people. The patient is placed in the supine position and instructed to put their arm in a 90-degree angle with their elbow on the table at their side and fist loosely clenched. The examiner puts his palm over the patient’s umbilicus—the first “scar” the patient experienced in his/her life. (See Figure 1.)
The patient is instructed to maintain his/her arm at a 90-degree angle while the physician attempts to push his/her arm down straight on the table. If the patient’s arm goes weak (loses strength) then that patient is said to be “open.” If the patient’s muscle stays strong, the patient is said to be “blocked.” Since the umbilicus is the first scar a patient had, the patient’s indicator muscle is expected to go weak. If the patient is “open,” testing then continues in a stepwise and logical progression, the physician directly presses on the suspected area (scar, injury site, deep autonomic ganglia, or other pain locations) and then compresses the indicator muscle to determine if it goes weak or stays strong. After these steps are done, a plan is made as to which areas to treat first. There is a detailed protocol for which areas are tested and then how to determine which to treat first. However, that is a subject of its own and for which a future article is planned. In any case, when correctly applied, ART is a useful tool for the physician and worth the time invested in learning its proper use.
Scar Injection Technique
Probably the easiest and safest technique the pain practitioner can start with is the injection of scars. Without training in autonomic response testing, it may not be possible to easily identify interference fields. However many scars are the site of an interference field and by injecting them there is a good likelihood of improvement—especially scars associated with previous trauma, surgery or infection.
Technique for scar injection:
1) Identify the scar.
2) Prep with alcohol or benzyl chloride.
3) Outline the scar with a surgical marker or pen.
4) Prep the area with betadine, let dry.
5) Select the narrowest gauge needle that will suffice for that particular scar, and bend the needle to a 45-degree with the bevel pointed up, using the inside of the needle cap (see Figure 2). A 27 gauge, 1-1/2 inch needles work well for most average length scars.
6) Insert the needle intracutaneously (not intradermally) in the scar, parallel to the skin. The needle shaft is placed against the betadine-cleansed area of the skin and slowly advanced full length into the scar, taking care to neither go too deep and out of the scar, nor too shallow and push through the surface of the scar (see Figure 3).
7) After the needle has been advanced full-length, the plunger is gently depressed and injection made and continued while the needle is slowly withdrawn. The scar should fill up from within (see Figure 4). Note that if scar is lifted but not filled, then the needle was too deep.
8) For long scars, re-insert the needle near the end of where the last injection ended, inserting the needle through some of the previous anesthetic. Repeat as in numbers 5 to 7 above.
9) Repeat until the scar is completely filled.
10) This process is repeated at 1 to 3 week intervals. In most cases, 6 to 16 treatments are usually needed.
A phenomenon well recognized by the neural therapy practitioner is emotional release after neural therapy injections and is typically described as unpleasant emotions associated with the trauma sites being injected. This release can start during a treatment and last for a few days afterwards, or may not occur at all. Warning the patient of this occurrence is usually sufficient to prevent misinterpretation of this expected phenomena and the patient assigning these unpleasant emotions to something in the patient’s current environment. Because of this phenomenon, neural therapy is a relative contraindication for a patient who is severely psychiatrically unstable.
Sequencing of Treatment: The Three Layers of Musculoskeletal Pain and the Harris Method of Pain Treatment
I have concluded over the years that there are three layers of musculoskeletal pain, and so have developed a protocol which successfully guides me through the treatment of even the most difficult pain patients (see Figure 5).
First Layer. The first layer is that of muscle spasms. The important thing to remember about muscle spasms is that they are usually only a symptom, not a problem in and of themselves. When the body is injured or unstable, it will tighten the muscles around the unstable, weak or injured area in an attempt to stabilize it. So, other than the fact that the muscle spasms indicate areas where the body is detecting something wrong, we generally don’t waste too much time on them. They will usually resolve spontaneously once the underlying problem is treated.
Second Layer. The next layer below muscle spasms, and the first layer where you have real pathology, is the connective tissue layer. By connective tissue, I am referring to ligaments, tendons and fascia—basically, the “gristle” that holds the body together. The connective tissue is tough and difficult to damage. However, once it is damaged it heals slowly and often does not heal completely.²⁹ Incomplete healing is common in connective tissue and makes the area prone to re-injury. Injured connective tissue also frequently refers pain so that often where one feels the pain is not where the problem originates,³⁰ For example, a problem in the lumbar spine can cause sciatica pain down the leg, or a problem in the upper cervical can refer into the head causing headaches. So it is important to do a good musculoskeletal and connective tissue exam and history, as well as have an understanding of ligament and tendon referral patterns which can be found in several books and texts discussing this issue.³¹⁻³³
Third Layer. The bottom, or third layer, is that of autonomic nervous system dysfunction. Once the ANS is disrupted, from whatever cause, there are several effects that result. One is pain. Pain from the ANS can go on as long as the dysfunction persists. The longest I’ve recorded is 60 years in one patient. The second effect of ANS dysfunction is that function is altered, usually with respect to decreased blood flow to the area of the body that is controlled by that part of the ANS. This causes chronic under-nourishment of the affected body tissues and results in progressive weakness—especially in connective tissue. The third effect of ANS dysfunction is tightening of the connective tissue around the area of ANS dysfunction. This is significant because, although the connective tissue will bend and twist easily, it does not stretch much at all. Since the connective tissue cannot stretch and absorb this pull, it will transfer the force down its entire length to whatever bone it connects to. This results in restrictions or tightness in certain ranges of motion and, if present long enough or if the patient sustains some sort of high-energy trauma, it can cause the connective tissue to begin to tear loose from the bone. This will then result in a “second layer” (connective tissue) problem.
In my practice, I start treatment with the “third layer” (ANS) and work up. I first check and repair ANS dysfunction with neural therapy, then treat the “second layer” of connective tissue weakness or instability with prolotherapy, followed by physical therapy to rehabilitate the muscles. While I personally follow this treatment protocol, other treatment protocols exist and can be effective. For instance, prolotherapy can be done first in the case of a straightforward soft tissue injury and may resolve the pain complaint. However, if healing with prolotherapy injections is slow or pain remains, then checking for ANS dysfunction and treatment with neural therapy would be appropriate. Either way, once the patient is pain-free, function usually needs to be restored with physical therapy or exercise since oftentimes muscles may have atrophied or weakened from disuse.
Contraindications to Neural Therapy
Absolute. Do not inject into an area where there is a known active cancer or tuberculosis.
Relative. (1) Disease states resulting from severe nutritional deficiencies or genetic illness (because it won’t help); (2) unstable diabetes (because it can cause instability in blood sugar); (3) severe psychological disorders are a relative contraindication because the emotional releases that often occur can destabilize the psychological state; and (4) pregnancy (treatment anywhere near the uterus might possibly trigger a miscarriage).
Where to Get Training in Neural Therapy
Annual seminars and workshops (Neural Therapy I and Advanced Neural Therapy II) are given by Dietrich Klinghardt, MD of the American Academy of Neural Therapy (information is available at www.neuraltherapy.com). Training in neural therapy, along with prolotherapy, is also given at the American College of Osteopathic Sclerotherapeutic Pain Management conference in March each year (information is available at www.acospm.com).
Conclusions and Case Reports
Autonomic nervous system dysfunction is common and can lead to chronic pain. Neural therapy is a powerful treatment that can be quite effective in resolving autonomic nervous system dysfunction and pain, especially in the complex pain patient. Neural therapy requires training and practice by the pain practitioner to be most effective. However, even with application of only basic principles such as injection of scars, the patient may greatly benefit. Neural therapy is especially effective for joint pain when used in conjunction with prolotherapy and/or platelet rich plasma (PRP) prolotherapy injections.
Case 1. A 52-year-old white female who presented with chief complaints of pain and numbness in her left upper extremity, and secondary complaints of pain in her left jaw, and left lower back. She had significant history of wisdom tooth extractions approximately 4 or 5 years previous, as well as multiple root canals. One of the latter, in the lower left jaw, was still sensitive with chewing. Physical exam and autonomic response testing found the patient to have an autonomic interference field in the left lower 1st molar. ART showed a correlation between this dental interference field and her areas of shoulder and low back pain. She was given her first treatment of neural therapy consisting of a direct injection of 1% lidocaine 2cc on the buccal side of the tooth and about 4mm inferior to the gingival margin. The patient returned two weeks later and stated that she felt much better with regards to all her pain areas. She also stated that she had experienced an emotional release in the form of sadness, without any specific memories, subsequent to her treatment. The patient was seen eight more times with the same treatment given each time until the tenth office visit at which time the patient was found with ART to be completely cleared, and the patient stated that all her pain had resolved. The patient was discharged and has had no further complaints to date.
Case 2. A 35-year-old female with a history of low back pain over ten years following a motor vehicle accident. This patient also underwent radial hysterectomy for cervical cancer including lymph node dissection five years previous. She was left with loss of feeling and numbness in her right pubic area and thigh, and continued to have low back pain. A lumbar spine MRI was negative for radiculopathy.
The patient received several prolotherapy treatments that gave her 75% improvement in her low back pain, and a platelet rich plasma prolotherapy injection that further improved her low back pain to 90%. During this time patient went on a hiking trip and hit her head on the inside of a camper shell, after which she was diagnosed with facial neuralgia and had recurrent episodes of burning facial pain, which was only partially helped with neurontin.
When seen at the time of her first neural therapy evaluation, patient was still improved in her low back from the prolotherapy treatments (75%) but was getting recurrent flares of low back with certain activities and suffering almost constant episodes of intense neuralgia facial pain. ART revealed interference fields in the inferior hypogastric ganglia and hysterectomy scar anteriorly, and in a large tattoo posteriorly at the lumbosacral region. Additional interference fields were located on a left knee scar and upper molars. Injection was done to all interference fields with 1% procaine. The patient had pain relief and almost instant and complete resolution of her facial neuralgia pain after one treatment. She experienced an emotional release manifested in episodes of grief during the week following her first treatment. The second treatment three weeks later found the presence of these same interference fields and the addition of the coeliac ganglia. These ganglia and scars were injected with 1% procaine. The patient had complete relief of her facial neuralgia pain but low back pain remained at the same level.
A third treatment revealed a hidden interference field where two tattoos overlapped in her lumbosacral region. This overlapping tattoo area was injected with 1% procaine and the patient experienced almost instant relief of the remainder of her low back pain and has begun to experience feeling in the previously numb right thigh and pubic regions. Her facial neuralgia pain has not returned.