Asst. Professor Bronx VA / Mount Sinai Sch of Med Bronx, New York, United States
Case Diagnosis: Chemotherapy-Induced Peripheral Neuropathy
Case Description: A 69 year-old-male with a history of mantle cell lymphoma stage IIIB was treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine, and rituximab. After treatment, he experienced several years of discomfort and tingling of the bilateral lower extremities, progressive difficulty with ambulation, and multiple falls. EMG showed sensorimotor axonal demyelinating tibial and peroneal neuropathy of the bilateral lower extremities. He was treated with gabapentin with inadequate pain relief. Gabapentin was discontinued and the patient was treated with 5 treatments of isotonic 5% dextrose in water prolotherapy injections along with the distribution of the bilateral tibial and personal nerves in the lower extremities. He endorsed immediate pain relief after the initial session with sustained pain relief and improvement in gait after the completion of the final session of injections.
Discussions: Recent literature has shown the benefit of dextrose prolotherapy for the treatment of peripheral neuropathy. It is thought that perineural injection treatment with isotonic dextrose solution has a sensorineural effect. In addition, hydrodissection with dextrose adjacent to peripheral nerves is thought to release peripheral nerves from encasing fascia providing a decompressive effect. In this case, we have found a case of chemotherapy-induced peripheral neuropathy to have immediate and sustained pain relief response to dextrose prolotherapy injections, as well as improvement in ambulation.
Conclusions: Dextrose prolotherapy is an emerging treatment for peripheral neuropathy. We demonstrate a case with improvement in pain and function in a case of chemotherapy-induced peripheral neuropathy. Prolotherapy is a potential treatment for pain and improvement in function for chemotehrapy-induced peripheral neuropathy and is a potential pain treatment in the field of cancer rehabilitation.