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This letter is written soon after returning from the American Association of Orthopaedic Medicine's annual meeting in Washington, DC. The meeting was largely devoted to prolotherapy, a method of strengthening ligaments and joint capsules by injecting irritant solutions, such as dextrose, into weakened connective tissue. As it happens, one of the first patients I saw in my office this week was a 49-year-old woman with iliolumbar syndrome, a back pain centering in the iliolumbar ligament and radiating into the hip region. She had had this for many years and manipulation of the pelvic ring and lumbar spine had provided only temporary relief. The pelvic ring seemed unstable and I accordingly began prolotherapy about three months ago -- injecting the iliolumbar, posterior sacroiliac and interosseous ligaments bilaterally with a 12-1/2% dextrose solution. My practice is to repeat the injections every two weeks. After two sessions, the woman was experiencing considerable pain relief; and after the third session, I felt she was "home free" and would probably need no further prolotherapy. Accordingly, the next appointment was scheduled for six weeks later with the expectation that it would be a simple follow-up visit. However, I was disappointed to hear that soon after her last visit, the pain had returned as strongly as ever. In fact, it seemed to be worse at night; her sleep was being badly disturbed. In my 28 years' experience, patients' response to prolotherapy has usually been a steady, gradual improvement. A sudden relapse without triggering trauma raised a red flag and made me think something else was going on -- perhaps an interference field. Could an interference field be causing the pain? The most common non-mechanical location of an interference field in the low back is the third lumbar sympathetic ganglion, but autonomic response testing revealed nothing. Abdominal and pelvic viscera were unlikely candidates, as the patient had good gastrointestinal and genitourinary function and was otherwise healthy. She had no surgical scars and no history of recent dental work. However, the patient complained that a dental bridge in her ipsilateral upper molars was chronically uncomfortable and that the irritation had recently worsened. Autonomic response testing indicated an interference field at the site of a previously extracted upper wisdom tooth. Whether the remaining second molar, anchoring the problematic bridge, was irritating the wisdom tooth space was uncertain. However, injection of the wisdom tooth space with procaine 1/2% followed by an intravenous bolus gave immediate relief. This patient's long-term prognosis is still uncertain. She may have had an interference field in the wisdom tooth space since extraction in her 20s, in which case repeat procaine injections into the tooth space may be all that is required to cure her iliolumbar syndrome. Another possibility is that the space is irritated by a badly fitting bridge. If so, dental work on the bridge may be necessary. A third option might be chronic infection or even a cavitation in the wisdom tooth space. Injection of homeopathics or dental surgery would be required in that case. The point of this case history is not just that dental interference fields can cause trouble almost anywhere in the body. A more subtle lesson is that interference fields can be an underlying or "background" factor complicating a legitimate diagnosis made on mechanical or other grounds. This patient definitely had an iliolumbar ligament syndrome and also had underlying low-back instability. However, treating the abnormal mechanics was not enough in her case. Resetting the neurological (or energetic) controls is often needed when response to the usual treatments is unusual. Sincerely, Robert F. Kidd, MD, CM |