Neuropathic pain can best be described as severe and debilitating pain that can render a person “unable to walk, work, sleep or enjoy life.” It is often chronic (longer than 3 months) when a patient seeks treatment, but it can have a sudden onset. Neuropathic pain can result from trauma, arthritis, sports injuries, overuse, occupational and surgical injuries, and inflammation from unknown sources. Regardless of the cause, the resulting pain is caused by the nerve’s pain mediators; the most prominent are Substance P and CGRP. The injection of sterile dextrose in the area of the nerves that are inflamed and swollen disrupts these mediators of pain. The treatment breaks the cycle, which allows the nerve to “settle down.” This treatment is often referred to as Neuroprolotherapy or Perineural Injection Technique. I call it simply Regenerative Nerve Therapy.
A successful treatment involves several key steps: doctor-patient interaction at all steps is most important and indispensable; a thorough history of the onset of pain to reveal obvious and otherwise unknown contributing factors; a detailed physical assessment of the affected nerves and related areas of the body; a methodical and gentle approach at each treatment.
One of the benefits of this therapy is that the first treatment is also diagnostic. So, the patient does not need to undergo a long series of treatments to see if there is any benefit at the end. If there is no benefit from the therapy, the clinician understands that this is not a useful treatment, and the doctor and patient can then pursue other approaches.
Most patients will require 4-8 treatments spaced anywhere from 1-2 weeks apart, depending on the condition. In some instances, such as in sports injuries, a more aggressive approach can be used. No pain meds or local anesthetics are required. The number of injections given depends on various factors, such as the number of different nerves inflamed and the intensity and duration of the inflammation.
After the first treatment, the pain relief can last from a few hours to a few days or longer. The pain can then return, though it is usually not as intense, widespread, or frequent as it was before the initial treatment. Eventually, the pain goes away, and normal function returns. This is the goal of treatment. A significant number of patients respond well.
Medications are not restricted when patients are receiving Regenerative Nerve Therapy. Anti-inflammatory medicines taken for other conditions do not need to be stopped. Patients taking opiate pain medications tend not to do as well because the opiate competes with the receptor on the cell and can keep dextrose from getting to the cell.
As far as activity restrictions, patients are encouraged to remain active but only to the point where the given activity does not increase the pain during or after the activity.
Since dextrose is a part of normal human function and drugs are not used, adverse reactions are rare. The most common is occasional small bruises at the site of injection, which disappear in a few days to a few weeks. Allergy is not an issue. Although infection is a potential side effect anytime the skin is injected, I have not seen one in the many years I have used this treatment in my patients being treated for neuropathic pain.