Nerve Blocks for the Treatment of Chronic Neuropathic Pathology
“Neuropathic Pain results from dysfunction within the nervous systems without regard for its site of origin or etiology”. Fields HL Pain. New York, NTY; McGraw Hill: 1987: 133-169
Pathophysiology of Nerve Injury
When pain originates from a nerve origin, it is called “neuropathic pain”. Neuropathic pain can originate from the central nervous system (brain, brainstem and spinal cord) or from the peripheral nervous system. When a peripheral nerve becomes damaged, if often leads a painful process in which neurotransmitters cause increased pain, muscle spasm and swelling to the area. Often you can physically feel a painful “knot” or “rope” under the skin.
Peripheral nerve (all nerves found outside of the spinal cord) pain can be the result of injury, nerve damage, arthritis to a joint where the nerve innervates, or any biologic cause of nerve irritation. When nerves are irritated from any of those sources, the nerve becomes over-active and agitated and does not know how to “turn itself off”. Often this results in pain to the area that seems to out of character for the extent of the injury itself. In essence, the nerves do not know how to toggle down their pain response to the injury itself after the initial injury has improved. Abnormal function of these nerves can cause pain and increased degeneration to the joints and ligaments that they supply.
How Rejuv Manages Nerve Pain
Here at Rejuv Medical, we perform many different types of peripheral nerve injections that help to reset those nerves, and by doing so, can control pain in a much different manner. In other words, in much the same way that you need to reset your computer or your phone, we can do a “reset” of your nerves. In this procedure, we identify the nerves that are irritated, follow along the route of the nerve, and bath that nerve in our nerve injection solution. The solution, made up of mannitol and very small amounts of glycerin, lidocaine and betamethasone, is placed at these locations, often concentrated around neuromas and constricted nerve areas. These injections are most often done superficially but can also be performed with an ultrasound for deeper sites of nerve compression. When the nerve is bathed in that solution, it will turn off a specific ion-channel/nerve receptor by the name of TRPV-1, thus breaking the normal pain cycle. Our goal is to avoid the damaging effects of higher doses of cortisone.
Frequently asked questions about Nerve Injections
What Body Parts Does Rejuv Implement the Use of Nerve Injection?
There are superficial nerves that can be found throughout every inch of your body, however, in certain places, superficial nerves move through areas referred to as CCI (Chronic Constriction Injuries). These are key areas where nerve injection may work best. Your provider is knowledgeable in identifying those CCI’s and the routes in which the nerve moves around that CCI. In a nerve injection procedure, we will physically mark the area with a temporary marking pen, cleanse the area with a Hibiclens/Alcohol prep, and proceed with the injection.
What type of pain relief response should you expect with a Nerve Injection Treatment?
Typically, we will perform these injections 3-4 times, 1-2 weeks apart, and you should expect to get only a few hours to a few days of improvement after the first injection. After the second injection, you may experience a few days to weeks of improvement, and after the third injection you may get months of improvement. These injections will help to essentially “reset the nerve”. The cumulative effect of these multiple injections on the nerve will essentially reset the nerve for longer periods of time. Ideally, the sets of injections are in close approximation to each other, however, there are people who get excellent improvement with only one or two injections. This is not a procedure that fixes the original injury or arthritis. It does, however, give many people long term relief of their neuropathic pain. Research is showing that a healthy nerve will create healthier tissue around it.
What is in the injection that you will be getting?
The solution is primarily made up of 5% Mannitol. A glucose solution that is not metabolized by the body the way glucose normally metabolized, rather it is effective in blocking the TRPV-1 ion-channel/nerve receptor, thus breaking the pain cycle. The solution is also made up of small amounts of Glycerin for nerve blockage, Lidocaine for a slight anesthetic effect, and Kenalog (a steroid) used at an extremely low concentration to mimic the body’s natural anti-inflammatory hormones produced in the body. This solution has very little to no side effects, short of those individuals that are allergic to any of the above compounds. Additionally, it can be used by diabetics without any concerns of the glucose being metabolized or the steroid increasing blood sugars the way a traditional cortisone injection would.
What can and can’t I do after a nerve injection treatment?
The area injected will have multiple injection sites. These sites technically are openings into your body, and leave you exposed to potential infection. We would recommend that after an injection, you stay away from soaking in a bath, hot tub, pool or lake for 24 hours after your injection (Showering is not a problem). Additionally, using any oils, lotions or other topical solutions over the injections should be held for the first 24 hours.
Exercise and physical therapy done within the 24 hours of the treatment is encouraged. You may feel better with the reduced pain, so this would be a good time to further manage your pain with exercise and stretching. Strenuous cardio or weight-lifting would be discouraged in the first 24 hours.
Cupping treatments used by physical therapy in and around the site injection should be withheld for 48 hours (2 days) on either side of the nerve injection treatment.
Chiropractic treatment can be performed as long as it is not a deep manipulation. The Activator is encouraged and can be used without restriction.
Myofascial Release, Deep Tissue Massage and any deep palpation of the areas being treated with Nerve Injections should not be done any time around the nerve injection treatments. That will negate any potential benefit and will likely cause further damage to the superficial nerves that we are treating.
Additional Adjunctive Treatments here at Rejuv
Practicing good eating habits by utilizing a low inflammatory diet is strongly encouraged during your nerve injections. Here at Rejuv, we offer many services that can be used in conjunction to your treatment to optimize not only the nerve injection, but your overall health as well. In addition to the pain relief from treating the pathologic nerves, PRP and Stem Cell procedures can then be used to regenerate damaged and degenerated peripheral joints and spine. We would be happy to get you a referral to address your hormone imbalance, your supplementation and peptide choices, furthering your orthopedic care or any other medical fitness needs you might need to give you the best benefits possible for your Rejuvinated life!