Neural Therapy & Perineural Injection Therapy

Evidence-Based Integrative Pain Treatment

Neural Therapy and Perineural Injection Therapy (PIT) are integrative medical techniques used to address chronic pain, neuropathic pain, and dysfunction related to nerve irritation, scarring, and autonomic nervous system imbalance. These therapies involve the targeted use of low-dose local anesthetics (such as procaine or lidocaine) or 5% dextrose injections applied to nerves, scars, and specific anatomical regions.

These approaches are not simply “pain blocking” techniques. Scientific evidence suggests they may help normalize abnormal nerve signaling, reduce neurogenic inflammation, and support nervous system regulation, potentially leading to sustained symptom improvement rather than temporary relief alone.
(Yılmaz et al., 2021; Wu et al., 2017; Vinyes et al., 2023)

Conditions Commonly Addressed

Neural Therapy and Perineural Injection Therapy may be considered as part of a comprehensive medical approach for patients experiencing:

Chronic low back, neck, and limb pain
Neuropathic pain (burning, tingling, electric-type pain)
Fibromyalgia and widespread pain syndromes
Post-herpetic neuralgia and shingles-related nerve pain
Entrapment neuropathies (carpal tunnel syndrome, sciatica, occipital neuralgia)
Painful scars and post-surgical nerve irritation
Vulvar and pelvic neuropathic pain
Facial and trigeminal nerve pain

Each treatment plan is individualized and based on clinical evaluation.

Chronic Spine and Musculoskeletal Pain

A randomized controlled trial published in Spine evaluated patients with chronic low back pain resistant to standard medical and physical therapy. Patients treated with neural therapy—including intradermal, pelvic plexus, intravenous, and scar injections (including umbilical and post-surgical scars)—experienced significantly greater reductions in pain and disability at 3 and 6 months compared to trigger-point injections alone.
(Yılmaz et al., 2021)

Neural therapy has also demonstrated comparable effectiveness to extracorporeal shock wave therapy in chronic lateral epicondylitis, with significant improvements in pain and hand function.
(Dönmez et al., 2023)

Fibromyalgia and Central Sensitization

Fibromyalgia is characterized by widespread pain, fatigue, and central nervous system sensitization. Clinical trials indicate that neural therapy, when added to conventional treatments such as exercise, can result in greater improvements in pain intensity, quality of life, and mood symptoms compared to standard care alone.
(Altınbilek et al., 2019; Balevi Batur & Atan, 2020)

These findings suggest that neural therapy may help modulate nervous system dysregulation often present in centralized pain syndromes.

Neuropathic Pain and Post-Herpetic Neuralgia

Neuropathic pain conditions—including post-herpetic neuralgia (PHN)—can be particularly difficult to treat. A randomized clinical trial showed that patients with chronic herpes zoster–related pain experienced substantial and sustained pain reduction when neural therapy was included as part of an integrative treatment protocol.
(Hui et al., 2012)

Additional case reports and series have demonstrated significant pain relief using intradermal and perineural injections of 5% dextrose in elderly and refractory PHN patients, with benefits maintained at follow-up.
(Kersschot & Karavani, 2022; Park et al., 2024)

Entrapment Neuropathies and Nerve Compression

High-quality randomized, double-blind clinical trials have demonstrated that ultrasound-guided perineural injection therapy with 5% dextrose provides greater and longer-lasting improvement than corticosteroid injections in mild-to-moderate carpal tunnel syndrome. Improvements were seen not only in pain and function, but also in nerve conduction and ultrasound imaging parameters.
(Wu et al., 2017; Wu et al., 2018)

Narrative reviews and clinical studies further support the use of perineural dextrose injections in other entrapment neuropathies, including ulnar neuropathy, radial tunnel syndrome, occipital neuralgia, and sciatic nerve irritation.
(Wu & Lin, 2021; Lam et al., 2024; Nwawka et al., 2017)

Painful Scars, Neuromas, and Interference Fields

Scar tissue can disrupt local nerve signaling and contribute to chronic pain patterns. Neural therapy applied directly to painful or restrictive scars has been associated with pain reduction, improved tissue mobility, and functional improvement.
(Haller et al., 2018)

Perineural and dextrose-based injection approaches have also demonstrated benefit in neuroma-related pain, such as Morton’s neuroma, where patients reported marked reductions in pain and activity limitation following targeted injections.
(Hauser et al., 2012)

Importantly, the chronic low back pain RCT by Yılmaz et al. explicitly included injections into umbilical and post-surgical scars, supporting the clinical relevance of addressing abdominal and surgical “interference fields.”
(Yılmaz et al., 2021)

Pelvic, Vulvar, and Orofacial Neuropathic Pain

Emerging clinical evidence suggests that neural therapy may provide meaningful symptom relief in vulvodynia and localized vulvar pain syndromes. Case series report significant pain reduction after a small number of targeted neural therapy sessions, with benefits lasting several months.
(Novoa et al., 2021; Weinschenk, 2022)

Perineural injection therapy has also shown effectiveness in trigeminal neuralgia and facial neuropathic pain, supporting its use in dental and orofacial nerve-related conditions.
(Kim et al., 2024)

Proposed Mechanisms of Action

Scientific literature suggests several mechanisms by which neural therapy and perineural injection therapy may exert their effects:

Modulation of neurogenic inflammation
Regulation of autonomic nervous system activity
Reduction of ectopic nerve firing
TRPV1 receptor modulation and metabolic support of superficial nerves (with 5% dextrose)

These mechanisms extend beyond temporary anesthesia and may help explain the sustained clinical benefits observed in multiple studies.
(Vinyes et al., 2023; Wu & Lin, 2021)

Clinical Perspective

Based on current peer-reviewed evidence, Neural Therapy and Perineural Injection Therapy may be considered safe, minimally invasive options within an integrative medical framework for managing chronic pain and neuropathic conditions. Outcomes vary by individual, diagnosis, and underlying pathology, and these therapies are most effective when applied by experienced medical professionals as part of a personalized treatment plan.

Scientific References

Yılmaz, E. The Determination of the Efficacy of Neural Therapy in Conservative Treatment-resistant Patients with Chronic Low Back Pain. Spine, 46(14), E752–E759, 2021. DOI: 10.1097/BRS.0000000000003909
Altınbilek, T., et al. Evaluation of the Effects of Neural Therapy in Patients Diagnosed with Fibromyalgia. Turkish Journal of Physical Medicine and Rehabilitation, 2019. DOI: 10.5606/tftrd.2019.1931
Balevi Batur, E., & Atan, T. Neural Therapy for Fibromyalgia. International Journal of Clinical Practice, 2020. DOI: 10.1111/ijcp.13719
Dönmez, Ü., et al. Comparison of Neural Therapy Injection and ESWT. Journal of Surgery and Medicine, 2023.
Hui, F., et al. Integrated CAM Therapy for Chronic Herpes Zoster-related Pain. Alternative Medicine Review, 2012.
Kersschot, J., & Karavani, I. Isotonic Glucose Injections for PHN. Cureus, 2022. DOI: 10.7759/cureus.29740
Park, M. K., et al. Ultrasound-Guided 5% Dextrose Injection for PHN. Journal of Electromyography and Neuromuscular Disorders, 2024.
Kim, H., et al. Perineural Injection Therapy for Neuropathic Pain. Journal of Dental Anesthesia and Pain Medicine, 2024. DOI: 10.17245/jdapm.2024.24.1.47
Wu, Y.-T., et al. Perineural Dextrose for Carpal Tunnel Syndrome. Mayo Clinic Proceedings, 2017. DOI: 10.1016/j.mayocp.2017.05.025
Wu, Y.-T., et al. Dextrose vs Steroid for CTS. Annals of Neurology, 2018.
Wu, Y.-T., & Lin, C.-H. 5% Dextrose for Entrapment Neuropathies. Journal of Pain Research, 2021.
Hauser, R. Dextrose Injection for Morton’s Neuroma. Journal of Prolotherapy, 2012.
Haller, H., et al. Patient Experiences with Neural Therapy. Complementary Therapies in Medicine, 2018. DOI: 10.1016/j.ctim.2018.03.006
Novoa, M. R., et al. Neural Therapy for Vulvar Pain. Complementary Medicine Research, 2021. DOI: 10.1159/000514945
Weinschenk, S. Local Anesthetic Therapy for Vulvodynia. Sexual Medicine Open Access, 2022. DOI: 10.1093/smoa/100482
Vinyes, D., et al. Therapeutic Use of Low-Dose Local Anesthetics. Journal of Clinical Medicine, 2023. DOI: 10.3390/jcm12237221