Perineural Injection Therapy for Chronic Pain

Also called ‘neural prolotherapy’, this is a service offered by Dr. Mollie Brennan, ND as a tool to help manage chronic pain. Perineural injection therapy is a series of shallow injections of 1% procaine over 3-4 appointments. Pain relief should be felt almost immediately, and there is evidence that it can support a variety of chronic pain conditions. 

CONDITIONS SUPPORTED

  • Healed bone fractures

  • Joint sprains

  • Tender or painful scars

  • Whiplash

  • Neck pain

  • Headaches

  • Low back pain 

  • Herniated discs

  • Rotator cuff

  • Chronic nerve pain

  • Post surgical pain syndromes

Any condition where there is chronic pain, or tender points around the area of injury. Dr. Brennan will assess this in an appointment.

More About the Injections

  • These are shallow injections of 1% procaine just under the surface of the skin. Procaine is a numbing agent often used in dental procedures. The concentration used is much lower than what is found at a dentist’s office. It does not freeze the area but may create mild numbness in the skin. Traditionally perineural injections are done with dextrose solution, or sugar water, with similar success. 

  • Perineural therapy helps to calm ‘cranky’ or chronically inflamed nerves. Nerves can be inflamed from past injuries, scar tissue, and adhesions. This inflammation sends signals up the smaller nerves to larger nerve bundles, creating the chronic pain cycle.

  • It is important to know that these injections do not go into the joint or muscle tissue. Because they are shallow in the skin, they are quite safe. 

  • This therapy can be done alongside chiropractic or physiotherapy protocols. Often patients try it if progress has plateau’d with other therapies, or if pain commonly returns after chiropractic or massage appointments. 

LASTING EFFECTS

Pain relief should be felt immediately and last anywhere from 2 hours to 2 days after the initial appointment. With repeated visits the goal is to have pain relief last for weeks or months prior to needing another appointment. Many people report up to 80% pain relief. There is evidence that it can lower pain scores in knee replacements, low back pain, neck, and shoulder pain. 

Neural Prolotherapy Perineural injection therapy

  • People who have any of the following conditions are not candidates for therapy:

    Allergy to procaine/lidocaine or benzyl alcohol (preservative)

    Pregnancy/breastfeeding

    Uncontrolled low blood sugar

    Needle phobia

    Uncontrolled bleeding disorders. 

    Areas that are not injected are lips, eyelids, genitals, breast tissue, or ears. Scars and fractures must be entirely healed prior to starting injections. 

    Side effects are rare and similar to acupuncture. Bleeding or bruising of the injection site is the most common. Perineural injections are very safe, however dizziness, feeling flushed, slightly ‘loopy’ feeling, and low blood pressure can happen. These feelings tend to wear off in 15 minutes. 

  • 1) Güzel İ, Gül D, Akpancar S, Lyftogt J. Effectiveness of Perineural Injections Combined with Standard Postoperative Total Knee Arthroplasty Protocols in the Management of Chronic Postsurgical Pain After Total Knee Arthroplasty. Med Sci Monit. 2021 Feb 6;27:e928759. doi: 10.12659/MSM.928759.

    2) Atalay NS, Sahin F, Atalay A, Akkaya N. Comparison of efficacy of neural therapy and physical therapy in chronic low back pain. Afr J Tradit Complement Altern Med. 2013 Apr 12;10(3):431-5. doi: 10.4314/ajtcam.v10i3.8.

    3) Xie P, Qin B, Yang F, Yu T, Yu J, Wang J, Zheng H. Lidocaine Injection in the Intramuscular Innervation Zone Can Effectively Treat Chronic Neck Pain Caused by MTrPs in the Trapezius Muscle. Pain Physician. 2015 Sep-Oct;18(5):E815-26. PMID: 26431135.

    4) Egli S, Pfister M, Ludin SM, Puente de la Vega K, Busato A, Fischer L. Long-term results of therapeutic local anesthesia (neural therapy) in 280 referred refractory chronic pain patients. BMC Complement Altern Med. 2015 Jun 27;15:200. doi: 10.1186/s12906-015-0735-z.

    5) García-Triana SA, Toro-Sashida MF, Larios-González XV, Fuentes-Orozco C, Mares-País R, Barbosa-Camacho FJ, Guzmán-Ramírez BG, Pintor-Belmontes KJ, Rodríguez-Navarro D, Brancaccio-Pérez IV, Esparza-Estrada I, Bernal-Hernández A, González-Ojeda A. The Benefit of Perineural Injection Treatment with Dextrose for Treatment of Chondromalacia Patella in Participants Receiving Home Physical Therapy: A Pilot Randomized Clinical Trial. J Altern Complement Med. 2021 Jan;27(1):38-44. doi: 10.1089/acm.2020.0287.