Global Journal of Medical Research, F: Diseases, Volume 22 Issue 6

on what exactly is happening when the glucose arrives directly in the extracellular matrix (ECM). In other words, the mechanisms of action of glucose as found in lab tests ( in vitro ) or hypotheses from diabetic research provide only limited value. VIII. W orking H ypothesis of G lucopuncture Glucose is a crucial energy source for cellular health. The goal of Glucopuncture is to deliver additional glucose in the extracellular space to support directly cellular ATP production. Hypertonic solutions are not advised because they lead to osmotic destruction of the cells. When glucose is injected into the body, it arrives in the extracellular matrix (ECM). Then, the glucose is transported across the cell membrane [xxxvii]. a) The Effect of Glucose on Dermal Sensory Nociceptors Nociceptors are sensory neurons that detect harmful stimuli, and can become sensitized following injury or repetitive stimulation. When sensitized, nociceptors often exhibit spontaneous activity in the absence of apparent stimulation [xxxviii]. Sensory receptors are found in dermis, muscles, fascia, tendons and ligaments [xxxix]. These receptors xliii include mechanoreceptors, nociceptors, and thermoreceptors [xl, xli]. Especially dermal nociceptors [xlii, , xliv] are important to explain the pain modulating effects of intradermal glucose injections. And this is very likely the most important mechanism when treating regional neuralgia [xlv]. The transient receptor potential ankyrin1 (TRPA1), a member of the TRP channels, acts as 'polymodal cellular sensor' on primary sensory neurons where it mediates the peripheral and central processing of pain [xlvi]. b) ATP as a Pain Modulator ATP may play a direct role in pain modulation, especially when dealing with peripheral nerves. It has been illustrated that ATP injection increases expression of several markers for regenerative activity in sensory neurons, including phospho-STAT3 and GAP43 [xlvii]. It has been found that ATP infusion improves spontaneous pain and tactile allodynia [xlviii, xlix] in patients with (postherpetic) neuralgia. It also became clear that it works for neuropathic orofacial pain, but not for other types of orofacial pain, indicating that the neuropathic element seems to be an important factor in the effects of ATP [l]. These studies might indicate that glucose may have its pain modulating effects on neuropathic pain via ATP [li]. More research in this field may confirm the anecdotal information available so far. IX. H istory of G lucopuncture Subcutaneous injections with glucose 5% were first described in the treatment of Achilles tendinopathy [lii]. Later on, glucose 5% injections were used to treat other forms of musculoskeletal pain [liii, liv, lv]. Some physicians also used glucose 5% injections for tennis elbow [lvi], tension headache, postherpetic neuralgia, and Dupuytren’s stage 1. As the total amount of glucose is very small (similar to eating a few strawberries once a week), glucopuncture can be applied for patients who are diabetic or those who are on a strict calorie diet. X. D ifference B etween G lucopuncture and P rolotherapy Glucose and dextrose injections have been used for several decades in prolotherapy [ lviii lxiii lvii, , lix, lx, lxi, lxii, , lxiv]. Prolotherapy injects hypertonic dextrose (10% net concentration or more) into, for example, entheses of ligaments, bands and tendons. Injections into periost and into joint cavities are also given. Hyperosmolar solutions lead to localized cell shrinking and subsequent cell destruction. This phenomenon creates release of arachidonic acid (from the cell membrane) which creates a local inflammatory reaction. The latter may lead to local tissue proliferation – hence the description prolotherapy - and even formation of scar tissue [lxv]. Local anesthetics are always added to make the injections less painful. Glucopuncture also injects glucose (or dextrose) but only in an isotonic concentration (5%). As a result, there is no local osmotic shock, no cell death, no subsequent inflammatory reaction. That is why the ATP hypothesis was required to explain the pain modulating effects of glucopuncture, as well as the positive effect of glucose 5% injections on tissue repair (as in Dupuytren’s stage 1). The injection techniques are also different. Glucopuncture typically uses more shallow injections than prolotherapy. Most of the injections are given in the dermis, and also in trigger points of muscles and ligaments. In contrast to prolotherapy, local anesthetics are never added to the solution (Table 1). XI. I ntradermal G lucose 5% I njections for L ocalized N europathic P ain During questioning, the patient is asked to point out the zone of pain referral. Sometimes the physician can localize pain points within the pain region which are extra sore. Such points may receive an extra dose of injectate. The treatment itself is remarkably simple and straightforward. The injection procedure itself typically takes less than a minute to perform. After identifying the tender zone, one gives multiple intradermal injections (intracutaneous wheals) with glucose 5% in the pain region, as indicated by the patient. Intracutaneous injections usually feel like sharp stings for a few seconds. Intracutaneous injections (IC) are more painful than subcutaneous injections (SC) but IC injections seem to be more effective regarding modulation of Intradermal Glucose 5% Injections for Mild Localized Neuropathic Pain- A New Approach to Reduce Pain Medication 3 Year 2022 Global Journal of Medical Research Volume XXII Issue VI Version I ( D ) F © 2022 Global Journals