BackgroundCan the application of local anesthetics (Neural Therapy, NT) alone durably improve pain symptoms in referred patients with chronic and refractory pain?If the application of local anesthetics does lead to an improvement that far exceeds the duration of action of local anesthetics, we will postulate that a vicious circle of pain in the reflex arcs has been disrupted (hypothesis).MethodsCase series design. We exclusively used procaine or lidocaine. The inclusion criteria were severe pain and chronic duration of more than three months, pain unresponsive to conventional medical measures, written referral from physicians or doctors of chiropractic explicitly to NT. Patients with improvement of pain who started on additional therapy during the study period for a reason other than pain were excluded in order to avoid a potential bias. Treatment success was measured after one year follow-up using the outcome measures of pain and analgesics intake.Results280 chronic pain patients were included; the most common reason for referral was back pain. The average number of consultations per patient was 9.2 in the first year (median 8.0). After one year, in 60 patients pain was unchanged, 52 patients reported a slight improvement, 126 were considerably better, and 41 pain-free. At the same time, 74.1 % of the patients who took analgesics before starting NT needed less or no more analgesics at all. No adverse effects or complications were observed.ConclusionsThe good long-term results of the targeted therapeutic local anesthesia (NT) in the most problematic group of chronic pain patients (unresponsive to all evidence based conventional treatment options) indicate that a vicious circle has been broken. The specific contribution of the intervention to these results cannot be determined. The low costs of local anesthetics, the small number of consultations needed, the reduced intake of analgesics, and the lack of adverse effects also suggest the practicality and cost-effectiveness of this kind of treatment. Controlled trials to evaluate the true effect of NT are needed.

Study design Retrospective cohort study. Objectives To investigate the effect of training intensity and-volume on improvements in respiratory muscle strength in individuals with spinal cord injury (SCI). Setting SCI rehabilitation center in Switzerland. Methods Inpatients with SCI, lesion level C4-T12, who had at least 10 individualized inspiratory muscle training sessions with respiratory function measurements before and after the training period. Multiple regression analysis with natural logarithmic (ln) transformation of the outcome values was used to examine the effect of training intensity and-volume, lesion level and completeness, and baseline respiratory muscle strength on improvements in respiratory muscle strength. Results Overall, 67 individuals were analyzed. Variation in PI max was explained by PI max at baseline and training intensity. This adjusted effect size suggested a 7% (95% CI 2.8 to 11.6%) increase in PI max per 10 units of increase in training intensity. Controlling for the variation in baseline PE max , the effect of training intensity on PE max was conditional on AIS (p < 0.021). While individuals with motor complete lesions showed a 6.8% (95% CI 2.1 to 11.7%) increase in PE max per 10 units of increase in training intensity, the corresponding adjusted effect size in those with motor incomplete lesions was 0.1% (95% CI −4.3 to 4.5%). The full models explained 57 and 60% of the variance of lnPI max and lnPE max , respectively. Conclusion The intensity of inspiratory muscle training was more relevant than training volume for the improvement of respiratory muscle strength in individuals with SCI. Thus, training intensity should be chosen as high as possible.

Hintergrund: Die Ärztlichen Zuweisungen therapieresistenter chronischer Schmerzpatienten zur Neuraltherapie sind ansteigend. Therapeutisch werden gezielt neurophysiologische Reiz- und Hemm-Mechanismen angesprochen. Studienziel: Ziel der Studie ist es, die Wirkung der Neuraltherapie nach Huneke bei therapieresistenten chronischen Schmerzpatienten zu dokumentieren. Studiendesign: Offene Studie in einer neuraltherapeutischen Praxis. Methoden: In die Studie aufgenommen wurden alle Patienten mit therapieresistenten chronischen Schmerzen (n=72), welche in einem Zeitraum von drei Jahren zur Neuraltherapie zugewiesen wurden. Bei allen Patienten lagen schwere, chronische SchmerzzustÄnde vor (am hÄufigsten RÜckenleiden), welche auf konventionelle (Medikamente, physikalische Therapien, Operationen usw.) und auf komplementÄre Therapien (z.B. Akupunktur) resistent waren. Der Behandlungserfolg der Neuraltherapie wurde nach einer Langzeitbeobachtung mit den ZielgrÖssen Schmerz und Medikamentenverbrauch erfasst. Ergebnisse: Durchschnittlich waren 8.2 (± 7.7) neuraltherapeutische Konsultationen notwendig. Die deutlichste Verbesserung ergab sich nach durchschnittlich 3.7 (± 4.0) Konsultationen. Ein FÜnftel der Patienten blieb therapieresistent, ein Drittel erlebte eine deutliche Verbesserung und ein Viertel blieb auch nach mehreren Monaten beschwerdefrei. Bei knapp 60% der Patienten konnte der Schmerzmittelverbrauch gesenkt werden (mehrmonatige Beobachtungszeit). Schlussfolgerung: Bei chronischen Schmerzpatienten mit Resistenz auf konventionelle und komplementÄre Behandlungen liefert die Neuraltherapie bei einer Mehrheit der Patienten gute Langzeitergebnisse.

Respiratory resistance training improved respiratory function of individuals with acute spinal cord injury. Even if the combined respiratory muscle training was performed with more repetitions per training and nearly twice as long, relative improvements of respiratory function parameters were comparable with isolated inspiratory muscle training.

Two female patients were referred to us with a complex regional pain syndrome (CRPS) of the upper limb. One patient developed a CRPS type 1 after a radius fracture, the other presented a CRPS type 2 after a wrist trauma with a nerve injury of N. ulnaris. Both patients had progressive pain in spite of medical treatment (NSAID, Gabapentine, Calcitonine), physiotherapy, occupational therapy and osteopathy. In addition to pain they also showed the typical autonomic symptoms like oedema, hyperhidrosis, disturbances of skin colour and temperature and a severely limited motility of wrist and fingers. The clinical symptoms of both types of CRPS are identical and not restricted to the peripheral nerve distribution. The sympathetic nerve system is not only involved in the pain mechanism with reflectory processes in the segment and with the sympathetic afferent coupling, it also takes part in the neuroplasticity and in the neurogenic inflammation. The logical therapeutic intervention is therefore to normalize the hyperactivity of the sympathetic nerve systems with local anaesthetics. This regulation is done with injections to the stellate ganglion if upper limbs are affected (affections of lower limbs are treated with injections to the lumbar sympathetic trunk). Repeated injections to the stellate ganglion caused immediate improvement of pain and other symptoms in both patients.