Treatment Protocol for Bee Venom Therapy Indications: 1. All types of arthritis, 2. Musculoskeletal pain of all other origin (trauma, chronic pain syndromes). 3. Vertigo, or inner ear hearing problems. 4. Eye problems (loss of vision, cataract). Contraindications: Known allergy to bee venom. (In my experience, most patients who stated they were highly allergic to bee stings in the past, proved to not be allergic to bee venom. They have been allergic to wasp stings or stings of other insects. There is no known cross allergy between wasp venom and bee venom.) Procedure: The painful area of the patient (for example, area about the shoulder joint, area of the upper back) is cleaned with rubbing alcohol. The area is now very carefully examined for tender spots. I, myself, prefer to use my thumb to push onto the tissue and let it rest there for a few seconds. Often the tender spot is found only after the pressure is maintained for two or three seconds on the area, I like to follow the distribution of the acupuncture points; however, this is not absolutely needed for successful treatment with bee venom. In case of pain originating from the spine, I first palpate the midline (pressure on the spinous processes and on the interspinous area). Tender spots are marked with a felt pen. Then I examine the area of the bladder meridian (two lines parallel to the midline, each about one inch and two inches away from the midline). Again, the tender spots are marked. I get my bee venom from Charles Mraz in Vermont (see address below). Each of the tender spots should be injected with an amount of bee venom that is equal to the amount of a "natural bee sting." In the case of the venom that I use, this is 0.05 cc per tender spot. I dilute the bee venom with 1% lidocaine in a 50/50 mixture. I am using a tuberculin syringe with a 30 g. needle. I am using a 27 g. 1/2 inch needle to draw up the bee venom, I am drawing up the lidocaine first and then the bee venom, I am drawing up the lidocaine first and then the bee venom in the same syringe. This avoids contamination of the lidocaine with bee venom. If I plan to inject ten tender spots, I therefore draw up 0.5 cc of lidocaine and 0.5 cc of bee venom (equals ten times 0.05 cc). The injection should be strictly intracutaneous (the needle tip about 1 mm underneath the skin surface). We have found that deep injection of bee venom, or subcutaneous injection of bee venom, does not have a beneficial effect. The first injection of any given patient has to be done very carefully. Epinephrine and Benadryl have to be available. During the very first session of a treatment protocol, one tender spot is injected at first. I wait twenty minutes to see if any allergic symptoms develop. If no symptoms develop, I give another three injections during the first session. I inject then the other tender spots that I have found with my usual trigger point mix (Marcaine, Procaine, or various other substances). The injections should be given twice a week; in patient's that develop thick red wheals, once a week. No matter how severe the given case is, it is rarely necessary to treat longer than six weeks. Usually at that time, pain relief for several months is obtained. This is the number of tender points that I inject: First session, four; second session, six; third session, eight. I do not hesitate to give as many as twenty injections (which would be session number nine). However, I have never given more than twenty injections at one given time. Reactions: The injection itself is usually painless, Several seconds after the injection, the patient develops an ache in the area which can be quite painful. After ten minutes, however, the pain usually stops and the patient feels, for several days, various degrees of mild ache and usually quite a strong itch in the area. I tell the patient that it is OK to occasionally use a soft brush to brush the skin over the itchy area to relieve some of the itching temporarily. However, no topical solutions (i.e., Benadryl, Calamine, meat tenderizers) should be used to ease the itch since the itch is an important part of the treatment success, However, once in a while, a patient just cannot stand the itching any more. In that case, it is OK to rub a little meat tenderizer into the skin, which relieves the itch almost instantly. However, this also stops the effectiveness of the bee venom. Quite frequently, I have observed that people, after the second or third series of injections, go through several hours of a flu-like feeling, which could easily be misinterpreted as a mild viral illness. In my opinion, this is the outer expression of an immune response of the patient which is very valuable and usually signals that this patient, soon thereafter, will be significantly improved. Patients with a true arthritis (rheumatoid, etc.) usually have very little pain and very little redness after the first few injections. It is usually after several injections that, suddenly, they perceive more pain after the injection and the injection sites become red and swollen. It is after this reaction that their pain usually dramatically improves. In patients with severe rheumatoid, therefore, it is beneficial to do the therapy until a strong reaction to the injections is observed. It helps the patient to understand this and don't stop the therapy at this point. The patient will be getting better after he starts to develop this reaction. There often is not much improvement before that. If patients develop significant pain after the injections, and severe redness and itching after the first or second injection, there frequently is a structural problem. (I have observed this frequently in patients with discogenic back pain.) If the patient has an underlying arthritis or a chronic pain syndrome, there is usually very little reaction after the first or second injection. I have never, myself, had a patient have an immediate allergic reaction to the bee venom. Charles Mraz, who has been using this therapy for fifty years (he uses live bees) had very rare incidence of a true allergic reaction. In all the cases he has seen, the patient responded completely and instantly to 0.3 cc of Epinephrine subcutaneously and 75 mg Benadryl p.o. He has treated thousands of patients. However, it is important to have Epinephrine and Benedryl immediately available. Personal Experience: I, myself, have a chronic neck problem due to a slipped disc at C5-6, with some impingement on the thecal sac. If I get bee venom injections twice a week on four occasions, I am usually pain-free for about two months, then the pain recurs. If I get an injection right away, one injection will again take care of the pain. If I wait for several weeks, I need another four injections to again have the same results. I have observed excellent improvement in people with chronic pain syndrome without underlying structural damage. Usually six to eight treatments give permanent improvement. People with rheumatoid arthritis frequently need a six week course (two times a week) to obtain several months of pain relief. When I learned this treatment from Mr. Charles Mraz, he treated several people with MS. They reported excellent improvement of their overall conditions and of their pain. It appears that people who are under bee venom therapy appear generally healthier, look rosier, and are less depressed after they have had a couple of treatments. For the treatment of inner ear conditions, an injection is given over the tip of the mastoid on the affected ear, usually on two or three occasions. The improvement frequently is instantaneous. People with cataract or loss of vision for other reasons get an injection in the area of the acupuncture point GB-1 at the side of the affected eye. Bee venom is, in itself, an FDA approved drug (see PDR). I prefer to use the bee venom from Mr. Charles Mraz. His bee venom was used as a standard to evaluate the effectiveness of the commercially available bee venoms in the United States. His bees live in a very controlled environment in Vermont where there is virtually no industrial pollution and very little insecticides are used in the area. I assume that the low, or virtually absent, incidence of allergic reactions is due to the purity of his venom. His production plant has been inspected by the FDA on several occasions and has been approved. There is very little literature available on the bee venom therapy. The main book on this subject was written by a German physician and published in 1935. ("Bee Venom Therapy" by Dr. Bodog, F. Beck, with a new edition in 1981. The book can easily be obtained by writing to Mr. Mraz.) Another book that is also available is: "Bees Don't Get Arthritis" by Fred Malone. This is published by Academy Books, 1979, Rutland, Vermont 05701. There have been a number of publications on bee venom therapy in West Germany and in the Eastern Block countries. A study by an American physician (Dr. Kim, M.D.) was published in the Journal of the International Association for the Study of Pain (supplement IV, 1987). He presented his work at the First World Congress on Pain of the International Association for the Study of Pain in Hamburg in August, 1987. The best source for more information material is Mr. Charles Mraz, Box 127, Middlebury, Vermont 05753. There have been very few studies about the chemical content of bee venom. The best study that I have found is a tape that got into my hands from a biologist who worked for the U.S. Government in San Diego and died several years ago. He did the most detailed electrophoretic analysis of bee venom. I have a tape of his findings and am willing to get a print-out and send it out on request. Summary of Bee Venom Therapy: Step 1 You need: a) A tuberculin syringe with 30 gauge needle to inject and 27 gauge needle to draw up the solution (half inch needles). b) Lidocaine 1% c) A felt pen to mark the trigger points. d) Rubbing alcohol and cotton balls. e) Anaphylaxis kit with Epinephrine injectable and Benadryl liquid. In case of anaphylaxis: Inject 0.3 cc of Epinephrine subcutaneously and give 75 mg of liquid Benadryl p.o. Step 2 To draw up solution in tuberculin syringe, mix half bee venom and half l% xylocaine; 0.1 cc of this solution is then injected into each tender spot. Step 3 First treatment: Injection of one tender spot, wait 20 minutes, then injection of three more tender spots. Step 4 Every treatment, inject two more points until all tender points are injected during each treatment. Injections should be given once to twice a week until pain is subsided. Maximum: 20 injections per session. Step 5 Tell the patient about the anticipated itch and swelling of the injected area. Since there is so little literature available on this form of therapy, the physicians that use bee venom should stay in close communication with each other. I would appreciate your phone call or letter anytime, in order to discuss this subject and share our observations. You should attempt to publish articles on this subject in our established medical journals. Dietrich Klinghardt, M.D., Ph.D.