What are Perineural Injections?

Perineural therapy is a safe and effective way for treatment of persistent pain. The injections aim to help reduce the neural inflammation such as neuralgia, low back pain, shingles, fibromyalgia, headaches/migraines, nerve impingement and neuropathy. This therapy supports the body to heal itself.

Perineural therapy is subcutaneous injections below the skins surface. Using Dextrose or mannitol in a saline solution combine with sodium bicarbonate. This focuses on areas of skin above nerve pathways to address pain at the root cause.

How does this therapy work?

Perineural injections supply the painful skin nerves with a dilute sugar solution and this almost immediately shuts off production of the painful substances and helps the nerve swelling to go down. We don’t know the exact mechanism at the cellular level, but it has been postulated that the dextrose works at the cellular level on the TRVP1 receptors to decrease Substance P and other chemicals that produce pain. Dextrose is also thought to work on ion channels in the affected nerve, once again aiding healing at the cell level.

Goals of Perineural Injections

Every treatment aims to extinguish the pain. After the first treatment pain relief may last for a period of four hours to four days. Repeated treatments (4-6 sessions) usually done weekly, result in gradual reduction of the overall pain, with the aim of complete resolution – a zero pain score – and allow return of full function.  Success rates vary between 80-100% depending on the condition. For most conditions recurrence is unlikely unless re-injury occurs.

What are the risks?

Since this is drug-free treatment, and dextrose is a part of normal human function, side effects are rare and include occasional small bruises at the site of injection.  Allergy is not an issue.


What are Trigger Point Injections?

Trigger point injections involve the intramuscular injection of a procaine, nutrient, and saline solution into an identified muscle trigger point in an area of myofascial pain.  The injection will cause the trigger point to first contract and then return to its normal default resting state. As pain can also be the result of poor nutrition to the muscle, the injection also provides an instant source of usable nutrients to the muscle.

A muscle trigger point (MTP) is a palpable tight band or “knot” in the muscle.  These points are notably tender on palpation, and can be a major cause of chronic-type pain and dysfunction.  An MTP represents an area where the muscle spindle fibers are in a state of constant contraction and therefore dysfunction.  The normal resting chemical balance of the muscle fiber is disrupted, and the nerves are often irritated to fire constant pain signals.  The sub-functioning muscle also suffers disruption to its normal supply, which can lead the malnourished muscle to fire even more pain signals in response.

What are the treatment goals of Trigger Point Injections?

Treatment goals are to reduce or eliminate chronic pain and restore proper functioning and range of motion.  Recommended treatment course is one session every 3 weeks until improvement, which averages 4-8 treatments. Patients can expect a quick pinching sensation upon needle insertion, and then either a muscle twitch response or an aching sensation as the substance is injected. Substances typically used are dextrose, lidocaine and saline. There can be some bruising to injection sites, and areas treated can remain sore or tender for up to 3 days after treatment.  As the needle used is larger than that used for a perineural or scar treatment, the risk of injury is greater but still considered minimal. To date there have been no known allergic reactions to the substance used for injection.


What are Scar Tissue Injections?

Injection treatment for scars involves the superficial injection of 1% procaine into and around the scarred area of skin.  Results of this therapy can include: a visible softening and shrinking of the scar, a detachment of the scar from structures it is adhered to underneath, a normalizing of the nervous activity within the scar area, and sometimes pain reduction to areas on the body the scar may be interfering with.

Besides being undesirable by some patients due to their visual appearance, scars also represent areas of disrupted functioning.  As scar tissue is quite different than normal skin (being more dense and less elastic), the normal activity in this area is impaired.  Injured neurons can improperly heal and fuse, which can cause reduced nerve signal transduction, resultant decrease in normal nervous system function, and even a pooling of waste materials that would normally be carried away and broken down.  Scar tissue can also cause injured nerves to continuously fire pain signals both to the local area and to areas that nerve should supply. The collagen in a scar can anchor it to muscles and tendons underneath, limiting and interfering with their normal range of motion.

What are the treatment goals of Scar Tissue Injections?

Treatment goals are to reduce the appearance of the scar, reduce or eliminate pain, and remove any interference it is providing to proper movement or function.  Treatment course is usually once per week until improvement, which can be within 2-6 treatments. Patients can expect a mild stinging sensation as the substance is injected.  Often the injection sites remain puffy or raised for a period of time, and there may be slight bruising at some sites. To date there have been no cases of allergic reaction to procaine, but there can be a histamine response (redness and itching) for up to a day after treatment as the tissue effectively detoxifies and releases its “waste cache” for the system to break down.

Our injection therapies are provided by Dr. Alex Del Duca, ND