How Sugar Heals Pain. Vis Medicatrix Naturae. Laurie Steelsmith, N.D., L.Ac.

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1 How Sugar Heals Pain Discover Perineural Injection Treatment Dr. Laurie Steelsmith, N.D., L.Ac. Laurie Steelsmith, N.D., L.Ac. Ø B.S., M.S., and Doctorate in Naturopathic Medicine from Bastyr University, 1993 Ø Private practice in Honolulu since 1993 Ø Author of Natural Choices for Women s Health (Random House, 2005), and Great Sex, Naturally (Hay House, 2012) Ø No Professional Conflicts of Interest Vis Medicatrix Naturae 1

2 Your Foundation of Health DIET EXERCISE DETOXIFI- CATION MIND AND SPIRIT Primary Objectives: Ø Discover how D5W can stop pain. Ø Know indications and contraindications for PIT. Ø Learn how to set up an effective treatment plan. Ø Discover how to give multiple injections in a relatively pain-free manner. Ø Learn areas of injection for trigeminal neuralgia, achillodynia, and chronic whole body pain. Dr. John Lyftogt 2

3 How Does PIT Stop Pain? Ø The technique uses near-nerve subcutaneous injections with a buffered solution of D5W, 5% dextrose in water with neutral ph. Ø This solution has two effects: 1) It blocks chronic pain up to 4 days, and 2) It reduces inflammation over a 4 to 5 week period. This nerve inflammation is caused by small nerve fibers carrying the TRPV1 ion channel. Activation of the TRPV1 ion channel causes release of proinflammatory neuro-peptides Substance P and CGRP, responsible for chronic pain and degeneration. D5W down-regulates the TRPV1 ion channel, reducing inflammation and allowing physiological healing to take place. Dr. Lyftogt TrpV1 = Transient Receptor Potential Cation Channel Subfamily V Member 1, also known as the Capsaicin Receptor 3

4 How PIT Stops Pain, continued Ø Buffered D5W also stops pain by resolving neuropathic pain associated glycopenia in tissues. Ø It changes the potassium and chloride ions across cell membranes, which decreases inflammation. Ø It frees up entrapped nerves, or areas of chronic constrictive injury where nerves run through sheaths. How PIT Stops Pain, continued Ø Finally, this treatment allows for chronically sick nerves to heal. When a peripheral nerve is injured, surrounding nerves hyper-upregulate, causing painàpain cycles. By injecting buffered D5W into the area of an injured nerve, the upregulated nerves down-regulate and halt the inflammatory cycle. 4

5 Indications for PIT Ø Chronic neurogenic inflammation as seen in achillodynia, trigeminal neuralgia, post herpetic neuralgia, Morton's neuroma, plantar fasciitis, carpal tunnel syndrome, neurogenic itching, and chronic pain syndromes. Ø I have also used it to treat acute muscle tension and strains. Contraindications for PIT Ø Infection of any kind, e.g., cellulitis, skin rash, or joint infection Ø Autoimmune arthritis Ø Extreme phobia of needles or injections, or highly sensitive patients Ø Allergy to corn? 5

6 Materials Needed for PIT Ø D5W and sodium bicarbonate 8.4% Ø ½ inch 27- and 30-gauge needles Ø 3 cc, 5 cc, and 10 cc syringes Ø Gloves, 70% alcohol Ø Cotton balls Ø Willing patient PIT Solution Recipe for D5W Bags Ø For a 500 ml D5W bag, add 4 ml of 8.4% sodium bicarbonate. Ø For a 1,000 ml D5W bag, add 8 ml of 8.4% sodium bicarbonate. Ø Check ph; it should be >6.9. PIT Solution Recipe for Sterile Water Bags For a 500 ml sterile water bag: 1) Remove 50 ml sterile water, then replace with 50 ml of 50% dextrose. 2) Add 6 ml of 8.4% sodium bicarbonate. 3) Check ph; it should be >6.9. 6

7 PIT Solution Recipe for Sterile Water Bags For a 1,000 ml sterile water bag: 1) Remove 100 ml of the sterile water, then replace with 100 ml of 50% dextrose. 2) Add 8 ml of 8.4% sodium bicarbonate. 3) Check ph; it should be >6.9. Injections Ø For most body areas, inject.5 cc of fluid. Ø For some areas of the body, inject 3 cc, 5 cc, and 10 cc of fluid to impact deeper structures by flooding the area being treated. Ø Use 30 g needles on face, hands, feet, and other sensitive areas. To spare your hands, use 27 g needles everywhere else. Ø Become proficient at painless injections. How to Inject Relatively Painlessly Ø Let alcohol dry before injecting! Ø Distract by gently pinching skin or applying pressure with fingernail near site of injection. Ø While injecting, wiggle injecting hand slightly and inject fluid at the same time. Ø Be Quick! 7

8 Treatment Protocols Ø Typically 4 to 6 treatments needed for full recovery. Some patients get well so fast that they only need 2 visits. Others may need 12 or more visits. Ø The good news is that the first 2 treatments are diagnostic. If a patient doesn t get any improvement in 2 visits, they don t have neurogenic inflammation and another therapy is indicated. Post-Treatment: What to Expect? Ø Area injected has less pain and feels lighter, looser, and has increased ROM. Ø Improvement can be immediate or take 12, 24, or 48 hours. Ø Some patients may experience an aggravation followed by improvement a few hours later. Ø Most experience some pain relief before leaving your office. Videos of Treatments Ø First video is on treating trigeminal neuralgia. Treat the foramina with.5 cc buffered D5W with a 30 g ½ inch needle. Use a 3 cc syringe to prevent hand strain. Ø Second video is on treating achillodynia. Inject with 27 g ½ inch needle. Treat deep tibial point with 3 cc of buffered D5W. Treat other points along sural and saphenous nerves. 8

9 Final Video on Treating Whole Body Pain Ø Treatment of dorsal rami from C2àS2. Ø Inject.5 cc buffered D5W with 27 g needle. Ø In TCM these are located where the T1àL5 Huatuojiaji points are (.5 cun lateral to the lower border of the spinous process). Resources Ø John Lyftogt, M.D.: Contains research articles, courses, and background on PIT. Ø Laurie Steelsmith, N.D., L.Ac. Personal contact information for questions/comments: info@drsteelsmith.com (808)