Perineural Injection Therapy

This type of injection therapy takes advantage of the fact that the nervous system is vertically integrated, which means that if a nerve in the skin is stimulated, it sends signals by nerve pathways that connect with other nerves deeper in the tissue and finally to the large nerves that come from the spine. Each nerve that comes from a particular level of the spine has a coverage area that has been fairly accurately mapped out on the skin called a dermatome. The pain nerves which come from the subcutaneous tissue, the muscles, tendons, ligaments, and covering of the bones (called periosteum), roughly corresponds to the area of the dermatome.

This concept is most easily illustrated by the example of you bumping your lower leg against something quite forcefully. Where do you rub the skin when this happens? You rub the skin over the area you bumped – right? You don’t rub the other leg. The input you give the nerves in the skin lessens the pain in the muscle where you bumped it, because the rubbing sends signals to the spinal cord via the same nerve trunk which supplies sensation to the overlying skin and muscle. Why it helps is a different conversation.

The second process to discuss is that larger nerves have on their surface much smaller nerves which are called “nervi nervorum” or “nerves of the nerves.” These small nerves are very sensitive, and if pressure is put on them, they start to secrete chemicals which are inflammatory and can cause swelling and neuropathic pain in the larger nerve they are sitting on. In situations where the larger nerve is injured due to pressure being put on it, like being caught between two layers of fascia (strong supportive tissue), or is being squeezed as it passes out of a bone canal, it can cause pain farther down the nerve, which feels like muscle pain or achy pain in an area distal to the site of the nerve injury itself.

Dr. John Lyftogt from New Zealand discovered that a low concentration of dextrose solution infused into the subcutaneous tissue over the pathway of the nerve which supplies the area of the injury can relieve the pain of the injury. The injection does not need to be to the depth of the injury. Sometimes the pain is resolved with one treatment, but most often it takes four to eight treatments. The injections are done with a very small needle and are virtually painless.

The pain relief results obtained by the use of this technique can be quite long lasting or even permanent. Of course, in order for the results to be long lasting, it is important that the stimulus which caused the pain in the first place is treated or is resolved. If it was an acute injury, there would be no reason for the pain to return. If it is due to a chronic or recurrent activity such as poor posture, the results may be short lived, unless the underlying issue is addressed.