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Treatise of Mesotherapy Pharmacology
Table of Contents
1. MESOTHERAPY: HISTORY AND GENERAL ASPECTS
1.1 Definitions - History – General aspects – Domestic and International Bodies
1.2 Skin Anatomy and Physiology
1.3 Action mechanism of Mesotherapy
1.4 Chronophysiopathology of the mesotherapic act - Mode of action
1.5 Different techniques to be used – TPL Classification
1.6 According to deepness, localization and amount of product to be used
1.7 Materials used in the mesotherapic act
1.8 Case history in Mesotherapy
1.9 The Mesotherapic act proper
2. PHARMACOLOGY IN MESOTHERAPY
2.1 Pharmacological phases and interactions
2.2 Pharmacocynetics of drugs introduced by mesotherapy route
2.3 General characteristics of mesotherapy drugs
2.4 Pharmacodynamics of drugs introduced by mesotherapy route
2.5 Properties of drugs to be used in mesotherapy
2.6 Utilization criteria for drugs via mesotherapy route
2.7 Properties of drugs that must not be used via mesotherapy route or that may be used with extreme caution
3. CLASSIFICATION OF DRUGS USED IN MESOTHERAPY
3. General classification of dugs used in Mesotherapy
3.1 Sympathicolytic drugs
3.2 Arterial, venous and lymphatic vasoactive drugs
3.3 Muscle relaxant drugs
3.4 Antiinflamatory drugs
3.5 Antirheumatic action and treatment drugs
3.6 Antiinfectious drugs
3.7 Immunological drugs
3.8 Neurological drugs
3.9 Gastroenteric drugs
3.10 Classification of drugs acting on the skin, the subcutaneous cell tissue and the peripheral nervous system
3.11 Drugs of selective action on the skin and the subcutaneous cell tissue
3.12 Drugs acting on the peripheral nervous system
3.13 Antiseptic and disinfectant drugs
3.14 Selection criteria for antiseptics and/or disinfectant in the mesotherapy practice
4. TOLERANCE – SIDE EFFECTS AND LEGAL ASPECTS
4.2 Side effects
4.3 Reactions of drugs introduced via mesotherapy routes
4.4 Complications of mesotherapy drugs. Treatments.
4.5 Legal aspects of medical practice: Medical responsibility – Contract nature of medical acting – Concept of fault – Importance of the case history
4.6 Regulations, decrees and laws governing the regulatory legislation of the medical activity: regulations for the practice of medicine - Regulatory decree of Argentine Law Nº 17,227
4.7 Case law on professional responsibility
+ What is mesotherapy?
Dr. Michel PISTOR, creator of mesotherapy, defines it in the following terms:
“Mesotherapy is a new and simple therapeutic conception which takes the drug administration site as closely as possible to the disease location with intradermal or subcutaneous injectable doses of a minimal, locoregional nature”.
The mesotherapy principle is the local administration of medication, in the locus dolenti, based on the concept that “the action of drugs is greater and stronger in the place were their action is required” than if a way of administration impregnating the whole organism is used with general routes such as the digestive, intramuscular or intravenous routes, among others.
In 1893 Head and Mackenzie discovered the cutaneous-visceral sensory reflex and introduced the concept that local analgesia in the cutaneous area corresponding to the underlying diseased organ determines a beneficial effect in the treatment of visceral pain.
These works were endorsed in 1924 by Lemaire who also proposed the treatment of visceral pains using metameric cutaneous injections of Procaine, discovered by Einhorn in 1905.
Afterwards, Leriche in 1925 and Sicard and Lichwitz in 1929, demonstrated the importance of dermis in the treatment of visceral pain, supporting and acknowledging Leriche's thesis. Years before Leriche had started using intradermal injections of histamine and procaine for painful osteo-tendinous disorders.
In 1933 F. Huneke observed that the paravenous injection of procaine at the loco dolenti produced an almost immediate relief of migraine crises.
This is due to the richness of perivascular neuro-vegetative plexus, and this led to the term NEURALTHERAPY. In 1940 this author defined interferencial fields from cicatricial zones, responsible for distant pathologies.
An injection of Procaine or Lidocaine in these distortion fields or interference fields inhibits the organic pathologies they generate distantly.
In 1937, like Leriche, Aron performed studies with histamine injections and published his results, finding 3 levels of action:
1) an injection of any substance at the locus dolenti, even with distilled water, provokes analgesic effects.
2) The intradermal route increases the fastness and efficacy of neurotropic substances’ action.
3) An intradermal injection of histamine is useful as analgesic and to ameliorate muscle contractures in rheumatic diseases.
In 1947 Hazard and Aslam work with procaine injections in geriatrics.
As from 1950 the deepness of local cutaneous injections is increased, and they are performed on precise anatomical structures, at stellar and sympathetic lumbar level (Leriche), radicular level (De Seze) and articular level (Hollander). The intradermal route is used to get and ensure a complementary temporary local anaesthesia.
In 1952 Dr. Michel Pistor, in the rural town of Bray-Lu, performs the first intravenous 1% procaine injection to relieve the symptomatology of an asthmatic patient and solve his respiratory distress. He achieved the hearing recovery of the patient, a shoemaker who had been deaf for more than 40 years.
As from that moment, and thanks to the knowledge derived from Leriche’s work, Dr.Pistor begins injecting procaine as closely as possible to the lesion to be treated, that is, at the tragal level. At the same time he also increases the number of drugs to be used, such as vasodilators, among others.
That was the beginning of injections at a loco-regional level, an indispensable condition in mesotherapy practice; periauricular injections for hearing impaired patients, vertigo, tinnitus; and periorbicular injections for presbiopia, myopia, headaches, sleeplessness, etc.
The French Mesotherapy Society was created on the 21st of April, 1964, with Dr. Lebel as president and Dr Pistor as deputy-president.
THEORIES ON THE MECHANISM OF ACTION
In its beginnings, mesotherapy was not developed on verifiable scientific bases, but on empirical bases regarding its mechanism/s of action.
Experience and vast investigations provided us with the knowledge of specific pharmacocynetics for the intradermal route.
Thus, Dr. Bicheron states:
“The intradermal route potentiates what is administered”
Pistor, in his book “Mesotherapy, a therapeutic challenge” sets the bases that define mesotherapy:
1- Loco-regional administration
2- Via intradermal or subcutaneous route
3- Of allopathic drugs administered in minimal doses
4- At longer time intervals than those required by other administration routes
5- With a reduction of economic cost and iatrogenic effects.
Dr. Pistor summarizes it in: “little, few times and in the right place”.
Most authors define mesotherapy as:
1. Topic or local administration of drugs
2. in low or minimal doses
3. administered via intradermal route
4. in numerous sites proximal to the affected area
5. in a reduced number of sessions.
Bicheron defines mesotherapy as “a way to potentiate the action of medications”.
For Pistor, “mesotherapy is a new and simple therapeutic concept that takes the therapeutic action of drugs closer to the disease location, thus increasing efficacy”.
MESOTHERAPY ACTION MECHANISMS
1. Dr. Pistor’s or Pistonean Theory or Concept
2. Bicheron’s Microcirculatory Theory or concept
3. Dalloz – Bourguignon’s Mesoderm Theory and Three Units Theory or concept
4. Ballesteros’s Energetic Mesotherapy theory or concept
5. Dr. Mrejen’s Systematized Spot Mesotherapy Theory or concept
6. Multedo’s Third Circulation Theory or concept
7. Kaplan’s Unified Theory: scientifically developed with nuclear medicine
8. Dalloz - Bourguignon – Hutear’s Four Units Theory
Treatise of Mesotherapy Pharmacology
Authors; Picon – Silva, year 2000.