Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRTI) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Neroreflexotherapy (NRTI)

It consists of the stimulation of skin nerve fibers related to the nerves involved in pain, inflammation and muscle contracture. Surgical material -surgical staples- is implanted on the skin surface, and kept in place for approximately three months.

Objective

To reduce pain, inflammation and muscle contracture.

Theoretical base

Pain, neurogenie inflammation and muscle contracture are produced by activation of specific nerve cells.

Neuroreflexotherapy (NRTI) consists of stimulating other nerve fiber endings on the skin - named Ab-. Their stimulation activates medullar cells - called "layer IV neurons"- that release a substance - called "enkephaline"-. This substance affixes to pain nerves, inactivating them. By this mechanism nerves stop releasing substances that trigger neurogenic inflammation, and activation of the cells provoking muscle contracture ceases. It is essential that the stimulated neurons of layer IV are specifically the ones that connect with the activated pain nerves in each specific patient.

Diverse neurologic mechanisms could explain why, if NRT intervention has been successful, when withdrawing the implanted surgical material pain may not reappear.

Evidence of efficacy

Available scientific studies coincide in proving the efficacy of NRT intervention in the treatment of back pain resistant to pharmacological treatment, including chronic cases.

Risks and contraindications

Adverse effects derive from the surgical material implanted into the skin, although it is performed very superficially (it penetrates about 2 mm). This may be bothersome, especially in sensitive patients. Additionally, immediately after implantation, patients may feel skin tightness, which may take hours to fade.

Infection of implanted material occurs very rarely -studies performed showed occurrence in less than 2% of cases- but the skin may become irritated and temporarily require the use of an ointment.

Finally, after extraction of the surgical material, a little scar remains at the site of implantation. Usually, scars will vanish within days or weeks, but may take longer in sensitive skins.

Indications

NRT intervention is not mentioned by the existing recommendations based on scientific evidence, probably because they have only considered scientific publications before 1996 with preference for those published in English. Research studies performed on NRT before 1996 were published in Spanish, and publications in English appeared afterward.

NRT intervention is indicated in patients whose:

1. Back pain lasts for more than 14 days despite pharmacological treatment.
2. Pain is sufficiently intense to justify the skin discomfort derived from implanting surgical material, and
3. Medical evaluation indicates that there are no objective criteria for urgent surgery.