How to Overcome Chronic Pain Using Perineural Injection Therapy

Did you know that the vast majority of chronic pain is associated with the nervous system? This means that most of the conventional pain management treatments are ineffective as they are focused on targeting musculoskeletal components.

Many people suffer from chronic nerve pain (and sometimes persistent burning) after a major surgery, such as the knee or back. Chronic nerve pain can also be brought by trauma, participating in sports, arthritis, overuse of certain body parts that leads to an injury, and a person’s occupation.

 

Here’s what happens in your body as you start to experience pain

When a nerve is stimulated by pain, a door opens up in the wall of the charge separation and the membrane to let sodium, potassium, calcium and several other molecules in and out of this cell. Once this stimulation is complete, the door closes, and an electrical current is created. This electrical current from the impacted nerve then carries a pain message to the spinal cord and then to the brain to let you know that something isn’t right – this is when you start to feel the pain.

The injured nerve will continue to send an electrical current pain message to the brain even though the nerve is no longer being stimulated by the pain. Ultimately, this creates what is known as a “short circuit,” which can also prevent muscles, tendons, and ligaments from properly healing.

When a nerve has branched out and moves back and forth over the surface of a bone, then this can cause inflammation. Typically this is what produces pain in the knees among runners and cyclists.

A nerve that is tangled in scar tissue that develops in tendons, such as the Achilles tendon, can become chronically inflamed. These are thought to play a significant role in developing pain that stems from overuse of certain body parts that leads to injuries.

There is also the end of a nerve that terminates in the skin and tissue immediately beneath it, which can also become inflamed. The saphenous nerve, which is the largest cutaneous branch of the femoral nerve, can also become inflamed after surgery in the knee when part of the hamstring is used to create a graft for repair on the ACL.

 

Treatments for neuropathic pain
Many patients try conventional treatments and continue to experience chronic nerve pain. These treatments typically consist of cortisone shots and pain medication, laser therapy, and chiropractic care.

Unfortunately, conventional treatments fail to get to the root cause as to what is causing the pain and they do not present an approach designed to help you overcome the pain – they are designed to just manage the pain. This is where newer and safer alternative methods, such as Perineural Injection Therapy – a type of Prolotherapy – can come into play.

Perineural Injection Therapy can be used to treat neuropathic pain that is associated with damaged nerves. Common conditions in which Perineural Injection Therapy can treat include:

  • Knee and shoulder pain
  • Foot and ankle pain
  • Achilles Tendonitis
  • Musculoskeletal and neuropathic pain
  • Acute and chronic conditions
  • Plantar Fasciitis
  • Trigger Points
  • Patellar Tendinopathy
  • IT Band Syndrome
  • Back Pain, including cervical, lumbar and thoracic
  • Fibromyalgia
  • Headaches and migraines
  • Elbow, wrist and hand pain
  • Neck pain

 

How Perineural Injection Therapy Works

Perineural Injection Therapy involves multiple small injections with a small amount of dextrose (5% – basically sugar water) along the path of the tender superficial nerves. The dextrose blocks the nerve endings that are responsible for the nerve pain and inflammation. Ultimately, this leads to healing beneath the nerve and deeper structures, which can include associated muscles, tendons, ligaments and cartilage of joints that are involved.

 

How Long Does it Take for Perineural Injection Therapy to Work?

The number of perineural injections is determined by the number of different nerves that are inflamed, how much of the nerve is inflamed, and how long the nerve has been inflamed.

Most patients require four to six Perineural Injection Therapy treatments, which can be spaced anywhere from seven-ten days to two-four weeks out, depending on the patient’s condition. No local anesthetics or pain medications are required.

There are no medication restrictions for patients receiving perineural injection therapy, and anti-inflammatory medications can still be taken. However, patients who are taking opiate pain medicine may not do as well with the treatment as the opiates do compete with the receptor on the cell, which keeps the dextrose from getting into the impacted nerve cell(s).

Regarding side effects, since this is a drug-free treatment and dextrose is a part of the normal human function, side effects are rare. However, patients may experience small bruises at the site of injection.

 

Where to go for Perineural Injection Therapy

Here at Osteopathic Center for Healing (OCH), we specialize in helping patients recover from pain quicker using innovative procedures, including perineural injection therapy.

In conjunction, we also offer more natural ways to help assist with or augment the management of chronic pain. Movement therapies, such as Pilates, Yoga, TaiChi, Physical Therapy, and Feldenkrais help with joint and musculoskeletal pain syndromes.

We also work with you in helping to adjust your nutritional diet as this can significantly affect pain control levels. The use of Omega 3-fatty acids, ginger, turmeric, magnesium, malic acid, and MSM are typically recommended when putting patients on an anti-inflammatory diet.

We also look at nutrient deficiencies and will prescribe a game plan to assist you in getting these back up to optimal levels. A vitamin D deficiency, low magnesium, heavy metal exposure or other increased or deficient levels can contribute to chronic pain.

Lastly, the mind-body connection is also considered as a way to improve the ability to control pain. Hypnosis, guided imagery, biofeedback, meditation, and relaxation are all considered and attempted as a way to help manage pain. And physical treatment in the form of Osteopathic Manipulation, Acupuncture, Reiki, physical therapy, and massage are all valuable strategies to assist with pain control.

Ultimately, we assess each situation individually and develop a personalized strategy to assist our patients on their path to pain management.

 

Meet Dr. Neil Spiegel

For over 20 years in osteopathic medicine, Dr. Spiegel has applied traditional and alternative methods to diagnose and treat his patients. He has a special interest in caring for patients with acute and chronic musculoskeletal and neurologic pain syndromes. Dr. Spiegel has received numerous professional and volunteerism honors including Top Doctor Survey Awards and the State of Maryland Volunteer Service Award. He also serves on the Board of Directors of a free clinic serving the uninsured in Montgomery County, Maryland.

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