It has been discovered that low sugar levels beside nerves lying in the tissues is a significant cause of neuropathic pain, which sends signals to the spinal cord and brain when sugar levels are low in tissues. This is different from nociceptive pain, which results from pressure or pinching. Neuropathic pain is processed through its own calcium ion channel, and this causes inflammation of nerves, which raises acidity in the area and lowers the sugar level in the tissue.
Based on the observations and teachings of John Lyftogt, a physician who used 5% sugar water with bicarbonate to help with neuropathic pain. Why the mix? We know that TRPV1 pain receptors activate at pH lower than 6.5. Since D5W from the United States arrives in an acidic form with a pH ranging from 3 to 6.7, adding a small amount of sodium bicarbonate can lower the acidity in the tissue. This buffered solution with sterile sugar water is the most effective way to stabilize pain fibers and maximize relief when injecting around an inflamed nerve.
Lidocaine, which blocks sodium channels, stops the “upward” stroke of nerve fiber activation, which helps with anesthesia, blocking nociceptive pain. This leads to numbness, which decreases musculoskeletal function. Glucose, however, does not give anesthesia or help nociceptive pain, instead functioning by producing analgesia — blocking neuropathic pain (or neuralgia). Good analgesia decreases pain signals and enhances musculoskeletal function. Administered correctly over time by an experienced provider, this can increase the pain threshold.
For those diabetics concerned about “sugar” injection therapy, there is no increase in blood glucose levels after perineural dextrose prolotherapy, which is completely opposite of the reaction when injected with a steroid. Additionally, anti-inflammatories (NSAIDs) do not interfere with neural prolotherapy, although patients generally no longer need them after treatment.
Research
Chen, S., Shen, Y., Ho, T., Chen, L., & Wu Y. (2018). Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: A case report. Medicine.
Lin, M., Liao, C., Hsiao, M., Hsueh, H., … & Wu, C. (2020). Volume matters in ultrasound-guided perineural dextrose injection for carpal tunnel syndrome: A randomized, double-blinded, three-arm trial. Frontiers in Pharmacology.
Liu, L., Dana, R., & Yin, J. (2021). Sensory neurons directly promote angiogenesis in response to inflammation via substance P signaling. FASEB journal.
Mansiz-Kaplan, B., Nacir, B., Pervane-Vural, S., & Genc, H. (2020). Pain relief in a patient with snapping scapula after 5% dextrose injection. Turkish Journal of Physical Medicine and Rehabilitation.
Mansiz-Kaplan, B., Nacir, B., Pervane-Vural, S., Tosun-Meric, O., … & Genc, H. (2022). Effect of perineural dextrose injection on ulnar neuropathy at the elbow: A randomized, controlled, double-blind study. Archives of Physical Medicine and Rehabilitation.
Oh-Park, M., Desjardins, E., Chator, A., Wang, L., & Reeves, D. (2019). Therapeutic injection of dextrose: Prolotherapy, perineural injection therapy and hydrodissection. PM&R KnowledgeNow.
Peiro, C., Romacho, R., Azcutia, V., Villalobos, L., … & Sanchez-Ferrer, C. (2016). Inflammation, glucose, and vascular cell damage: the role of the pentose phosphate pathway. Cardiovascular Diabetology.
Rhatomy, S., Margaretha, E., & Rahmadian, R. (2020). Dextrose prolotherapy for muscle, tendon and ligament injury or pathology: A systematic review. Annual Research & Review in Biology.
Tsai, S., Hsu, Y., Lee, M., Huang, H., … & Tun, Y. (2018). Effects of dextrose prolotherapy on contusion-induced muscle injuries in mice. International Journal of Medical Sciences.
Wu, Y., Wu, C., Lin, J., Su, D., … & Lam, S. (2021). Efficacy of 5% dextrose water injection for peripheral entrapment neuropathy: A narrative review. International Journal of Molecular Sciences.
Additional Information
A review of dextrose prolotherapy and clinically-based evidence for usage | Sports Medicine Review
Can sugar shots effectively treat joint and muscle pain? | Richmond Times-Dispatch
Can sugar water ease your pain? | Flagstaff Business News
Dextrose prolotherapy for unresolved neck pain | Practical Pain Management
Prolotherapy | Cleveland Clinic
Prolotherapy for the injection treatment of ligamentous laxity | University of Pittsburgh Medical Center