Sugar (Dextrose 5%) For Spinal Pain in Wilmington, NC
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Dextrose (sugar) ranging in concentration from 12-25% strength has been used for over 50 years in the practice of “prolotherapy”. The premise behind using dextrose in prolotherapy is that by injecting small amounts of concentrated dextrose into areas of “enthesopathy” (damage in areas of muscles, ligaments, and tendons), a temporary state of inflammation can be created that triggers the body to jump start the healing process in an area that was having difficulty doing so on its own.
More recently, dextrose has been studied in its “weaker” form (Dextrose 5% in Water, or “D5W”) as a potential therapeutic agent in the treatment of different types of nerve pain, including spinal pain. In its weaker form, D5W does not cause an inflammatory response, and in fact can have an analgesic (pain relieving) effect, in both the short and long-term.
Working with three of the “sugar experts”, Dean Reeves, John Lyftogt, and David Rabago, Dr. Liza Maniquis-Smigel demonstrated in 2017 that, in 35 patients with non-surgical low back pain, the administration of 10 ml of 5% Dextrose in Water into the epidural space provided 50% pain relief for patients who had previously been suffering from pain for over 6 months. Although the relief lessened as time went on after the single injection, there was still a 30% reduction in pain at 2 weeks after the injection.
In a follow-up study, an additional 33 patients were followed for a year after receiving 4 biweekly injections of 10 mL of D5W, and then additional injections as needed during the year. Most patients received an average of 3.6 injections during the first 3 months and additional 2.4 injections from months 3–12. Results of this study showed that pain was reduced by 56% and disability measures (ODI) improved by 18.5% at 12 months. Some of the patients were followed as far as 41 months after the injection series and were still noting 30% reduction in pain and 13% improvement in disability at 41 months. At one year, 70% of patients have relief of at least 50%. At 41 months after injections, 45% of patients still had relief of at least 50%.
You may be asking yourself:
- “Why in the world would I want to inject sugar (dextrose) into my back?”
- “How does dextrose work to reduce pain?”
- “Is injection of dextrose into the spine safe?”
- The reasons to consider using dextrose instead of steroids include the fact that repeated steroid injections into the spine may predispose someone to the negative long-term side effects of steroids including decreased immune function, elevation and blood sugar or blood pressure, and osteoporosis. Not to mention weight gain and water retention for some people. This is not to say that steroids are “bad”; but to merely state the fact that for some patients, steroids do not provide the necessary duration of relief in order to use them safely and effectively over time. For people who either do not want to use steroids, or cannot continue to receive steroids for one reason or another injection of caudal D5W may provide a safe and effective alternative to steroid injections.
- How does dextrose work to relieve pain? At this point in time it is believed that dextrose functions as a TRPV1 receptor antagonist (blocker). Most people are very familiar with the most famous TRPV1 receptor agonist (activator)… Capsaicin! Capsaicin is a chemical found in jalapeno peppers. When capsaicin binds to the TRPV1 receptors in the mouth it causes our tongue to burn. When applied experimentally to nerves it has a similar pain producing effect. Dextrose works to block this effect by binding (and blocking) the same receptor that capsaicin is trying to latch onto. So, in summary — at least in the spine — dextrose works on the same receptor as capsaicin but in an opposite manner than capsaicin. Capsaicin causes a burning sensation. Dextrose blocks the burning sensation. (Unfortunately eating sugar does not cool the burn of jalapenos when you eat them —-trust me, I tried it!)
- D5W (5% Dextrose in Water) is the same concentration of dextrose used in intravenous solutions that are given to millions of people all over the world. Additionally, historically and even currently, dextrose is used in clinical anesthesia to change the properties of local anesthetics injected into the spine so that the local anesthetic acts on only very specific nerves in the spinal cord, and not the entire spinal cord all at once. Dextrose does this by making the local anesthetic solution “heavier”. Typically, the concentration is used to achieve these goals is much higher than the 5% dextrose concentration being used for pain relieving purposes. Additionally, for the purpose of spinal anesthesia, dextrose is being injected directly into the spinal fluid inside the spinal sac. For pain relieving purposes, D5W is injected into the epidural space, which is outside of the sinal sac. This offers an added degree of protection and safety.
- One of the questions commonly asked regarding the use of dextrose in pain management is “Will it make my blood sugar go up?”. Looking at the numbers, the amount of dextrose in 10 cc of D5W is 500 mg. That’s one half of 1 gram of dextrose, which is obviously a lot less than we find in common foods! Steroid injections typically have a much more profound (and negative) effect on blood sugar for patients who need to be concerned with diabetic control.
The use of dextrose for pain control is considered “experimental” by most insurance companies and therefore is a service that is not covered by most insurance plans. However as described above, and also in the setting of traditional “prolotherapy” dextrose is felt to be a very effective and safe alternative to standard “steroid injections”. As with any medical procedure, guarantees of efficacy cannot be offered with D5W injections. If you have further questions regarding whether this therapy would be appropriate for your condition, please discuss it with your provider at Center for Pain Management.
Poster 385 Caudal Epidural Dextrose Injections (D5W) for Chronic Back Pain with Accompanying Buttock or Leg Pain: A Consecutive Patient Study with Long-Term Follow-up. Smigel, Liza R.Reeves, K. DeanLyftogt, John et al. PM&R , Volume 8 , Issue 9 , S286 – S287
Maniquis-Smigel L, Dean Reeves K, Jeffrey Rosen H, et al. Short Term Analgesic Effects of 5% Dextrose Epidural Injections for Chronic Low Back Pain: A Randomized Controlled Trial. Anesthesiology and Pain Medicine. 2017;7(1):e42550. doi:10.5812/aapm.42550.