Neural Prolotherapy for Trigeminal Neuralgia

Abstract

Trigeminal neuralgia (TGN) is a syndrome of unilateral, lancinating, paroxysmal, stabbing orofacial neuropathic pain, confined to the distribution of one or more of the branches of the trigeminal nerve. Most of the patients respond well to pharmacotherapy; carbamazepine and oxcarbazepine being the first line treatment. Surgical options are available if medications are no longer effective or tolerated. Microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies are most promising surgical alternatives [1, 2]. Recently, neural prolotherapy has been described in relation to the management of TGN. It is also known as perineural injection therapy (PIT) and is one of the latest advancements in regenerative medicine. First described by Dr. Paul Pybus and Dr. Roger Wyburn-Mason, PIT targets neurogenic inflammation in subcutaneous nerves that potentially generates pain [3, 4]. It was further refined by Dr. John Lyftgoft using hypertonic dextrose injection, which provided substantial pain control in a series of 300 Achilles tendinopathy [5]. He described the technique as subcutaneous injections of 0.5–1 mL of hypertonic dextrose and local anesthetic at each tender point alongside the affected tendon and thereafter repeating the treatment at weekly intervals. This was a departure from the traditionally described prolotherapy in which a more concentrated proliferant is injected directly into the enthesis of an affected structure causing discomfort and increased pain at the time of injection and in the immediate following few days.