Perineural, Epineural & Neural Prolotherapy

Sometimes referred to as Neural Prolotherapy but we use the more commonly used Perineural Injection Therapy to differentiate it from Prolotherapy which uses higher concentrations of dextrose and focuses on proliferation of tissue rather than neurogenic inflammation.

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How do trapped nerves cause pain?
See that part to the right of the image of a healthy nerve? It looks nice & healthy, the sheath around it is able to move smoothly around the nerve as you move your body. Then there's that great big lump right in the middle, the nerve is inflamed and stuck because the sheath around it isn't moving the rest of the nerve to the left is stretched and very sensitive to motion. If you stick your finger in a clamp and try to walk away you might understand how having things going in two directions might not be too comfortable.

Neurogenic inflammation often doesn't respond to anti-inflammatory medications or steroid injections, but oddly enough pain can be relieved immediately with sugar. Most painful conditions respond well to perineural treatments but they are specifically effective at treating pain due to nerve entrapments, complex regional pain syndromes, chronic constrictive injuries, neuralgia, neuropathy or neurogenic pain.

What gets injected?
We use a mixture of buffered 5% Dextrose with vitamin B12 and a 1% Procaine solution. Dextrose was discovered to have analgaesic properties in the 1950's but research was largely set aside as new medications were synthesised and those pesky wars came to an end which reduced the demand for affordable pain treatments.
Procaine is our local analgaesic of choice because it breaks down in the local tissues, as opposed to the liver, and generally carries less risk of adverse effects. It helps reduce some of the discomfort during the treatment as well as any soreness afterwards.
There are a few different forms of B12, one is better for issues with muscles while another is better for the nerves; we choose which is appropriate for the treatment.
All of the solutions we use are sterile and preservative free.

How does it work?
Dextrose doesn't work on the nerve endings (which sense pain) but rather on the TRPV1 receptors involved in neurogenic inflammation, and it works almost instantly. TRPV1 receptors are involved with inflammatory processes and are associated in neuropathic pain, joint inflammation, inflammatory bowel disease and other conditions. It is becoming more understood that neuropathic pain is a signal from peptidergic fibres indicating critically low sugar levels. These dilute sugar injections seem to completely block Substance P and other chemicals associated with pain and also physically free the nerves so they move and slide through the fascia as they're supposed to.

How well does it work?
Dextrose injected around entrapped nerves has an instant analgaesic effect which often lasts from 4 hours to 4 days (up to 2 weeks). Much like acupuncture treatment we like to get a few treatments close together to get the inflammation down before tapering off as the pain disappears. Sometimes an issue can be resolved within just a few treatments but can often take 6-8 treatments. You'll know after just a couple of treatments if this therapy is right for you because you will notice results very quickly.
Our goal with any treatment is always to get the pain down to zero.

Will it hurt?
Needles used for perineural treatment are very thin, not as thin as acupuncture needles but still much thinner than intramuscular needles. Injections are done into the fascia and tissues between the skin and muscles. The sugars in the solution work immediately to relieve the inflammation and the procaine also helps to numb the area so this treatment focuses on the opposite of hurt. There might be a small piece from the needle, as with any acupuncture treatment.
We will do everything possible to make your treatment comfortable.

What are the risks?
Shallow point injections carry the same risks that accompanies any gentle acupuncture or needling treatment.
From mild to serious, potential risks include:

  • Light-headedness or nausea
  • Bruising
  • Soreness or even aggravation of existing symptoms
  • Increasing redness and pain at injection sites (sign of infection, very rare)

How much does it cost?
The cost of all of our acupoint injections vary depending on the amount of treatment needed - larger areas need more time and supplies. But treatment costs start at around $100 which is still around the average cost of a standard, one on one acupuncture treatment at any clinic.
Our services are covered under most extended health insurance plans.

Other treatment options you might want to consider
  • Acupuncture: It's been effective treatment for thousands of years and is usually so gentle that most people barely feel anything more than a tiny pinch. We still charge only between $20-40 per treatment for this.
  • Trigger point: If nerve entrapments are being caused by constrictions within the muscles, at a deeper level than the fascia then deeper trigger point and acupoint injections will probably be more effective.
  • Others: Maybe your condition might respond better to a different form of treatment like massage, physiotherapy or structural integration. Our priority is your effective treatment (not having a full schedule) and we happily refer out when it's warranted.

Segmental Therapy & Scar Treatment

These are separate therapies but are closely related to neural therapy and don't need their own pages.

Segmental Therapy
This is a therapy which is related to both German neural therapy as well as traditional acupuncture and is used to treat both pain and organ dysfunction. Usually tiny procaine injections are introduced just under the skin over the affected tissues to normalise autonomic innervation with the goal of reducing pain & inflammation and improving tissue function & local circulation.

Scar Treatment
The same treatment we use to clear adhesions in the fascia around nerve can be used to free tissues which are stuck to scar tissue. If you're having pain, discomfort or poor circulation around an area of significant scarring then it's worth considering some treatment for it. Pain can exist around the scar as well as further along the nerve; either way these superficial treatments around and under the scar are very effective.

Pre & Post Care

Before you come for treatment:

  • It is strongly recommended to eat some food within a couple hours before getting acupuncture or point injection therapy, as getting any needle therapy on an empty stomach has a greater risk of adverse effects from treatment.
  • It is also recommended that you wear dark clothing; between our sanitising solution and any leaks that occur during treatment there's a significant risk for staining.
  • Loose fitting clothes such as sports tops and loose shorts are preferred.
  • If you have long hair, please bring something with you to keep it in place.
After your treatment:

  • Unlike deeper treatments like trigger point injections or prolotherapy, there's no prohibition on strenuous exercise after treatment.
  • If you're having chronic and recurring pain due to inactivity or poor posture then finding varied activities you enjoy will be very helpful to prevent recurrence.
  • A good diet that avoids processed and inflammatory foods will help a lot in more ways than just reducing pain.
  • Supplements such as fish oils, turmeric and essential minerals help a lot to reduce inflammation and pain.
  • Getting adequate sleep and rest is key, a relaxed (para-sympathetic) nervous system reduces inflammation.