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Hilo specialist uses innovative alternative for pain treatment

Hilo physical medicine and rehabilitation specialist Dr. Liza Maniquis-Smigel treats pain with a series of relatively simple but site-specific injections at the Hawaii Center for Regenerative Medicine.

Remember high school biology?

Maniquis-Smigel said she uses sugar injections that trigger production of energy-carrying ATP (adenosine triphosphate). That allows the body to use ATP molecules to do their job of transporting energy to affected cells so the cells can repair and rebuild the body naturally, thus relieving pain.

Dextrose has an analgesic effect, Maniquis-Smigel said.

“It’s a very natural ingredient in our body. It’s sugar. It’s very safe and it’s effective,” she said.

The treatment, known as prolotherapy, is at the vanguard of treating sports injuries. But only a few physicians nationwide specialize in prolotherapy to treat various forms of non-sports pain in the back, neck, wrist, foot, head, hip and shoulder.

“As a pioneer in Regenerative Medicine therapies, Dr. Smigel is well experienced in prolotherapy, having been practicing this for 14 years,” her biography on the Center for Regenerative Medicine’s website says. “She was among the first physicians in the United States to experience firsthand the miraculous effects of neural prolotherapy. She is considered to be the most experienced neural prolotherapist in the United States. She coordinates annual conferences on the Big Island and Chicago on neural prolotherapy, where approximately 100 international doctors attend yearly.”

Prolotherapy(, of the type Maniquis-Smigel provides, is still considered investigational by the Food and Drug Administration, she said. But she hopes to change that by publishing the results of research studies undertaken with colleagues. She expects publication of three studies within the coming year, laying the groundwork for other researchers to build upon. Once that happens, she hopes, insurance will begin covering the therapy.

“It’s really an exciting time in chronic-pain management right now,” she said. “Almost every day, there’s something new.”

As Maniquis-Smigel’s knowledge of prolotherapy has evolved, so has the number of invitations to far-flung locations where she presents her techniques to physicians around the globe.

“I get invited to a lot of different places because people are interested,” she said during an interview at her Ululani Street office near Hilo’s YWCA.

She jets to international locations such as Argentina, Italy, Guatemala and Australia, working to help other physicians learn best practices that she herself has had a hand in advancing.

“I’m from small-town Hilo — but when you’re from out of town, you’re considered an expert,” she said, letting a smile emphasize her deflection of notoriety.

Email Jeff Hansel at


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