Physiatry Menu Physiatry Perineural Injections Platelet Rich Plasma Prolotherapy Perineural Injections The Basics For many people, pain and limited mobility are ever-present in their daily lives. Typically, this is the result of injured or worn-down ligaments and tendons causing the joint to be wobbly. However, pain and dysfunction can also derive from the nervous system. Our natural reflexes are transmitted through the nervous system, helping to keep us safe. However, these reflexes can also lead to muscle spasms and tightness, which in turn can cause pain. Irritated nerves cause neurogenic inflammation and neurogenic pain. Perineural injections are a type of regenerative medicine treatment that injects a substance near the nerve to influence that nerve. The focus is to nourish and reset that nerve with the end goal of relieving or eliminating pain and increasing mobility. Dr. Michael Bertram, a board-certified Physician of Physical Medicine and Rehabilitation (also called Physiatry) at St. Elizabeth Physicians, is specially trained and certified in regenerative medicine treatment approaches, including prolotherapy, Platelet Rich Plasma (PRP) and perineural injections. Who does it benefit? Patients struggling with neuropathic pain can benefit from perineural injections. Neuropathic pain can be a dull, burning type of pain over a wide area of the body. It can also cause deep aching. Treating the body with perineural injections can help decrease nerve impingement and inflammation, allowing the muscles and musculoskeletal system to move with less pain, spasms and tightness. Patients benefiting from perineural injections include those struggling with: Carpal tunnel Regularly spasming muscles Nerve pain Pinched nerve Nerve compression Herniated disc Ulnar neuropathy Whiplash Make an Appointment For more information and to schedule an appointment with Dr. Michael Bertram, a specialist in Interventional and Regenerative Musculoskeletal and Spine Physiatry at St. Elizabeth Physicians, please call (859) 957-0052 or click here. FIND A LOCATION How does it work? Perineural injections can be either superficial injections – just under the skin – or deep perineural injections that target a specific nerve, like the radial, ulnar or median nerve. These injections provide a machinal local effect on stretching and moving the tissue within the fascial plane, helping to make additional space for the nerve and potentially breaking up adhesions that are causing pain. There are three solutions that can be used in perineural injections: Lidocaine – temporarily shuts down a nerve response. Steroids – reduces inflammation and swelling around the nerve. Low percentage sugar (dextrose) solution – hyperpolarizes the nerve, which makes it take more stimulus to fire the nerve and send pain signals. The sugar solution also affects nerve receptor TRPV-1 which over time can reset the nerve to be less inflammatory or reactive. Additionally, it directly supplies a nutritional energy source that the nerve could be lacking. Perineural injections are a great non-surgical option for patients who are struggling with chronic pain or limited mobility. Dr. Bertram utilizes a multispecialty-based evaluation during your initial appointment, looking at the entire body instead of just focusing on the painful problem area. By collaborating with physical therapists, chiropractors and other physicians when necessary, Dr. Bertram creates a comprehensive, personalized treatment plan for each patient, helping to improve function, reduce or eliminate pain and improve the patient’s overall health. How is It Different? Perineural injections are different from other regenerative injections – such as PRP and prolotherapy – in a few ways: The area around the nerve is the target; as opposed to a tendon or ligament. The goal of perineural injections is to nourish and reset the nerve, freeing up entrapments. The goal of PRP and prolotherapy is to cause an inflammatory response to kick-start the healing process. The solution in perineural injections is not inflammatory, while the other regenerative treatment options do stimulate an inflammatory response in the body. Deep perineural injections may need two to three treatments to help a specific location. The superficial perineural injections are a series of once-a-week injections for six to eight weeks total. As the nerves are reset, the patient feels less pain with each treatment, sometimes taking their pain level from an 8/10 down to a 0/10.