Neural Fascial Prolotherapy (NFP)
The second form of RIT is Neural Fascial Prolotherapy which is very similar to a popular treatment called Biopuncture. This form of RIT involves injecting 5% dextrose in water with or without a small amount of lidocaine near the subcutaneous nerves that provide sensation to our skin, joints, muscles, tendons and ligaments. There is a vast network of these non-myelinated sensory nerves that get in trouble after injury or degeneration sets into a particular area of a patient's anatomy.
There is much research going on in this area of musculoskeletal medicine. Dextrose is a potent TRPV-1 receptor antagonist that causes down regulation of several pro-inflammatory mediators such as Substance P, CGRP and glutamate. These TRPV-1 receptors are found in abundance in our subcutaneous sensory nerves and seem to be at least part of the reason our chronic pain conditions remain so chronic. Until the use of low dose near nerve dextrose injections we did not have an effective way of helping these superficial nerves to heal. There are studies showing that if these painfully inflamed nerves are treated w/ several injections of low dose dextrose the nerve will heal and the result is healing of the damaged tissue where the nerve ends. An example of important research proving this treatment works was a randomized controlled trial of achilles tendinosis treated with near nerve low dose subcutaneous dextrose published by Dr. M. Yelland and others in the British Journal of Sports Medicine for a second time in April of 2011 because the editor of the journal wanted to make sure the sports medicine community understands the importance of this new treatment technique. During this treatment, small injections of low dose dextrose were injected just under the skin overlying the achilles tendon. Ultrasound was used to study the diseased tendon and subsequently after the treatment was finished. The needle never touched the diseased tendon yet follow up ultrasound showed the tendinosis had healed. I believe the future of Regenerative Injection Medicine will harbor the healing power of these subcutaneous sensory nerves. If these nerves are working properly positive growth factors are transported up and down the length of the nerve signaling and controlling the healing mechanism. If these nerves are injured, entrapped, swollen or cut, this will block the flow of these growth factors and potentially impede healing. This may be an important factor in successful healing that has been ignored by modern orthopedics up until now. And paying attention to the superficial sensory nervous system may help explain why there is such a poor rate of healing of soft tissue injuries that lead to the chronic pain that plagues so many of our patients.