Background & Aims
Neural prolotherapy is the subcutaneous perineural injection of isotonic D5W (dextrose 5% in sterile water) solution especially at the fascial penetration points of the sensory nerve through which sensory nerve reaches the subcutaneous plane. It was found to produce an immediate analgesic effect following its injection. It is a type of prolotherapy. Prolotherapy is the injection of a small quantity of a proliferant solution in specific points at the painful musculoskeletal structure to induce healing process. The most common proliferant solution is dextrose solution. Dextrose is a water soluble, and it is normally present in the blood. It can be injected safely in multiple areas and in any quantities . Meralgia paresthetica (MP) is a neuropathy of the lateral femoral cutaneous nerve (LFCN) (i.e., lateral cutaneous nerve of the thigh).
The aim of this study is to assess the efficacy of perineural injection therapy with buffered 5% dextrose on multiple sites of neuropathic pain.
Methods
The current study is a case report of a 54 year old female that complains of recurring headaches, chronic bilateral intercostal neuralgia, as well as meralgia paresthetica. She received bilateral perineural injections with isotonic D5W solution at their bony attachments including the lamina, facet joints, transverse processes of cervical vertebrae C2 to C7, the mastoid process, superior and inferior nuchal ridges on the occiput, posterolateral clavicle and superior angle of the scapula; suboccipital and erector spinae muscles, including longissimus capitis, iliocostalis cervicis, longissimus cervicis, scalene posterior, splenius capitis, splenius cervicis, semispinalis cervicis, and semispinalis capitis; sternocleidomastoid, trapezius, levator scapula, and serratus anterior muscles. Aditionally, she received subcutaneous perineural injections of D5W solution at multiple sites along the affected intercostal nerves, as well as along tender points of the anatomical course of the LFCN.
Results
The study participant experienced headaches at least monthly prior to treatment with prolotherapy. After prolotherapy treatments, she reported the frequency of her headaches as less than once per month. The patient was asked to rate the intensity level of her headaches prior to receiving prolotherapy and after her last prolotherapy treatment, using a scale of 1 to 10. Following treatment, significant decrease in intensity level was noted.
There was a significant improvement in the VAS of patient assessment of overall MP symptoms, patient assessment of MP pain, patient assessment of MP paresthesia and patient assessment of MP effect on function and QoL when the findings at the postinjection visit were compared to the preinjection assessment. The pain associated with the recurring headaches and bilateral intercostal neuralgia improved significantly according to the VAS scale after the first procedure, with a notable increase in the mobility of the cervical, as well as thoracic spine. The patient tolerated the injection procedure-induced pain, and she experienced immediate postinjection relief of the MP pain. At the postinjection assessment visit the patient was satisfied with the procedure.
Conclusions
In regards to the headache pain, clinically significant improvements across all indicators were reported on completion of prolotherapy treatments including decreased intensity level, frequency, duration and number of associated symptoms.
With regard to meralgia paresthetica and intercostal neuralgia, neural prolotherapy can be effective in relieving pain, paresthesia and improving function and quality of life in selected patients.
In conclusion, perineural injection therapy with isotonic D5W solution has the potential of being an easy, safe, tolerable and effective alternative to other more costly regenerative injection therapies. In a selected number of cases, treatment may entail a combination of various regenerative injection therapies over a certain amount of time in order to achieve better results. Further multi-center randomized placebo controlled studies should be conducted on a larger number of patients for corroboration of the effectiveness of neural prolotherapy in the trea
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Presenting Author
Iuliana Teohar
Poster Authors
Iuliana Teohar
Resident Physician
The Clinical Rehabilitation Hospital from Cluj-Napoca
Lead Author
Stephen G. Cavallino M.D
Lead Author
Andrei Tibrea M.D.
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Other