Perineural Injection Therapy

What is perineural injection therapy?

Perineural injection therapy, also known as neural prolotherapy or PIT, is a safe and effective treatment for some types of chronic pain. This therapy is mainly used to target pain that is caused by inflamed or injured nerves. These nerves relay distressed cell signals to the brain resulting in persistent pain that can be unresponsive to pain medication. In addition to cell signals, the injured nerves release a series of substances that can inhibit the healing of affected muscles, tendons, and ligaments, leading to chronic inflammation, sensitivity, and pain. 

How does neural prolotherapy work?

It was found that dextrose, a naturally occurring carbohydrate, can be used to stop the release of these substances and the transmittance of pain signals. There are numerous theories describing the mechanism of action of prolotherapy  however it is not yet well understood. One of the most promising theories is that concentrated dextrose acts by dehydrating the cells near to where it is injected causing localized tissue trauma. This in turn triggers the local inflammatory process resulting in the release of growth factors by the injured cells. These growth factors function to promote the body's natural healing ability in the affected region and can reduce some of the contributing factors to chronic nerve pain by causing healing and tissue regeneration. Another promising theory states that dextrose has the ability to bind to the TRPV1 nerve cell receptor, which transmits pain signals and releases pain-inducing substances through the TRPV1 channel. Once bound to the TRPV1 receptor, dextrose inhibits the transmittance of pain signals and the release of these pain-inducing substances, restoring the nerve cell to its normal function. It is not yet certain the exact mechanism by which dextrose can alleviate pain caused by entrapped nerves and more research will be needed to confirm any of the stated theories. However, there are plenty of well-documented cases in which dextrose injection at a specified concentration has resulted in the relief of chronic pain symptoms secondary to nerve entrapment. 

How is perineural injection therapy performed?

Perineural injection therapy can be used to treat conditions including but not limited to frozen shoulder, migraines, sciatica, carpal tunnel syndrome, plantar fasciitis, tennis elbow, trigeminal neuralgia, and TMJ. The quick procedure involves a series of prepared dextrose injections administered through short needles just below the surface of the skin. The number of injections needed depends on how long the patient has been experiencing pain and the severity of it, however, most patients respond to 3 to 4 treatments. The treatment is very similar to the TB test as it involves getting a small prick along the course of the affected nerve. The injection does not require any local anesthetic as it is generally well-tolerated. 

What can patients expect after receiving neural prolotherapy?

Many patients experience pain relief and increased mobility that lasts for a few hours to a few days, after which the pain will return. After the second treatment, there should be a slightly increased improvement of symptoms and the pain should decrease in severity. Following subsequent treatments, usually spaced about a week apart, the pain should ideally fade away until normal function returns. Obviously, every patient is unique and will likely have a variable response to the injections. However, we find that this can be a useful treatment option for specific patients. 

A substantial number of patients have relief from their pain and return to their normal activities of daily living and work. Although there are no medication restrictions for individuals receiving the treatment, those taking opioids tend to not respond as well because opioids are thought to compete with dextrose for attachment to the nerve receptor. Side effects, infection, or allergies are extremely rare as dextrose is naturally found in the human body, however, the patient may experience temporary bruising or swelling at the injection site. 

In Conclusion

Unfortunately, most insurance companies in the U.S. and U.K. do not cover these treatments as they are relatively new. However, these prolotherapy treatments along with other more powerful regenerative medicine treatments, such as PRP and Stem Cell injections, expand the range of options available to your physician in order to better tackle the problem of your chronic pain condition. The doctors here at Ospina Medical are extensively trained in regenerative medicine procedures as well as prolotherapy and interventional pain medicine. Please schedule an appointment today if you are interested in receiving prolotherapy or any other regenerative medicine procedures. 

Check out the rest of our blog to learn more about regenerative medicine as well as other topics in medicine! 

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Author: Nawal Panjwani

Editor: Ospina Medical Team