What Is Neuroprolotherapy?
Neuroprolotherapy, also called NPT, is a minimally invasive, injection-based treatment for chronic neurogenic pain. It specifically targets superficial nerves just under the skin using a low-concentration dextrose and mannitol solution.
This technique was developed by New Zealand physician Dr. John Lyftogt. In the mid-2000s, Dr. Barr had the opportunity to study directly with Dr. Lyftogt. Learning his methods provided an important foundation for understanding how superficial nerves and scars can contribute to chronic pain.
This method of perineural injection uses very superficial injections of a mixture of two sugars combined with lidocaine and normal saline, placed directly into scars and around painful joints.
The goal of therapy is to release small superficial nerve fibers, called C fibers, that travel just under the surface of the skin, helping reduce neurogenic inflammation and pain.
It is important to understand that cutaneous nerves can become entrapped by scar tissue. When surgery occurs around a joint, scar tissue can restrict movement of the skin around that joint and also limit the motion of the small cutaneous nerves just beneath the skin.
Many people are surprised to learn that joint range of motion can be affected by bound-down skin and nerves from postoperative scarring. This is why treating surgical scars more than 6 weeks after surgery can be very helpful during recovery.
By treating subcutaneous nerve entrapment that often develops after surgery or trauma, we may see meaningful improvement in range of motion along with reduced pain and swelling.
This treatment often requires 3 to 6 weekly sessions. At Barr Center, we use neuroprolotherapy frequently and can also combine traditional Lyftogt methods with ozone. This added booster effect has been a game changer for many of our patients, and there is no added cost.
How Does Neuroprolotherapy Address Pain and Inflammation?
- Mechanism: It is believed that when small sensory nerves become irritated, they release inflammatory neuropeptides that trigger neurogenic inflammation by activating pain-sensitive TRPV1 receptors in nerve endings. The injected sugar-based solution likely acts on these receptors to decrease inflammation and restore nerve function by acting as a metabolic signal and membrane stabilizer. Put simply, nerves like sugar. Dextrose and mannitol help calm the inflammatory process.
- Another proposed mechanism of action involves Hilton’s Law, named after British surgeon Dr. John Hilton. Dr. Hilton observed that the nerve supplying a joint also supplies the skin over that joint and the muscles that move it. Using this model, Dr. Lyftogt hypothesized that irritation to a nerve supplying sensation to the skin over a joint may also contribute to pain, dysfunction, and limited range of motion in the muscles and tissues around that joint. It has long been known that dextrose in traditional prolotherapy promotes healing in connective tissues such as ligaments and tendons. Because nerves also contain connective tissue, Dr. Lyftogt proposed that dextrose may support healing in nerves as well. This concept forms the basis of what we know today as neuroprolotherapy.
- Target Areas: Neuroprolotherapy may be helpful for chronic nerve pain in the back, neck, shoulder, hip, knee, elbow, wrist, foot, and ankle, especially when pain is being driven by nerve irritation or postoperative scarring rather than only structural joint damage.
What Is Involved With the Procedure?
A 5% dextrose solution, mixed with lidocaine, normal saline, and sometimes mannitol, is injected just below the skin and along the length and width of a surgical scar or other painful superficial nerve pathway.
These injections are generally not very painful because they are placed very superficially and include local anesthesia.
At first, the injection site may look a little puffy, and bruising can occur over the following several days. Injections are typically repeated weekly for 3 to 6 sessions as needed.
Is Neuroprolotherapy Safe?
Yes. Neuroprolotherapy injections are considered very safe.
Localized swelling and bruising are common but temporary. As with any soft tissue injection, there is a small risk of local skin infection. If you notice redness, warmth, or increasing pain after an injection session, you should contact us right away.
