INTRANEURAL INJECTIONS by Gus J. Prosch, Jr., M.D. Lecture #2-- 1987

I WOULD NOW LIKE TO DISCUSS THE THEORY AND PRACTICE OF THE ART OF INTRANEURAL

INJECTIONS SO THAT YOU WILL HAVE A BETTER UNDERSTANDING AS TO HOW AND WHY THESE TECH-

NIQUES ARE SO EFFECTIVE IN RELIEVING JOINT PAIN IN ANY TYPE OF THE ARTHRIDITIES THAT YOU

MAY TREAT IN YOUR PRACTICE. THESE TECHNIQUES CAN BE SUCCESSFULLY USED FOR PAINS OF OTHER

TYPES IN THE BODY SUCH AS LOW BACK PAIN, SCIATICA, HEADACHES, AND OTHER PAIN SYNDROMES.

MOST PHYSICIANS ARE TAUGHT IN MEDICAL SCHOOL AND WITH GOOD REASON, THAT THE IDEA OF

INTERFERING WITH THE PERIPHERAL NERVES CAN BE VERY DANGEROUS AND WE SHOULD LEAVE THE

NERVES ALONE BECAUSE TO INTERFERE WITH THESE DELICATE STRUCTURES COULD CAUSE MUCH PAIN,

DISTRESS AND EVEN PARALYSIS. THIS CONCEPT IS OF COURSE TRUE WITH SUCH PROCEDURES AS

SURGERY, INJECTING SCLEROSING AGENTS OR BY USING COAGULATING DIATHERMY, BUT BY USING THE

TECHNIQUES I WILL SHOW YOU TODAY, I WANT TO ASSURE YOU THAT THE TECHNIQUES ARE ABSOLUTELY

SAFE AND HARMLESS. I

’

VE GIVEN LITERALLY THOUSANDS OF INJECTIONS AND I

’

VE NEVER SEEN OR FOR

THAT MATTER, EVEN HEARD ABOUT ANY DETRIMENTAL EFFECTS ON THE INJECTED NERVES BY THESE

TECHNIQUES. ANY PHYSICIAN WITH AVERAGE COMPETENCY, WITH A REASONABLE PROFICIENCY WITH A

SYRINGE AND NEEDLE AND A FAIR KNOWLEDGE OF ANATOMY, ESPECIALLY THE SUPERFICIAL NERVES,

CAN EASILY PERFORM ALL OF THE PROCEDURES IN HIS OFFICE. THESE TECHNIQUES ARE WELL WORTH

LEARNING AND USING IN YOUR PRACTICE AND THE RESULTS WILL BE MOST GRATIFYING TO YOUR

PATIENTS AS WELL AS TO YOURSELF.

IN THE LATTER PART OF THE LAST CENTURY AND THE BEGINNING OF THIS CENTURY, MEDICAL

SCIENCE AT THAT TIME, ACCEPTED THE FACT THAT THERE WERE (MICROSCOPIC SIZE NERVES THROUGH-

OUT THE BODY) KNOWN AS TROPHIC NERVES, THAT CONNECTED ALL CELLS TO THE NERVOUS SYSTEM.

THESE NERVES WERE ACCEPTED BY SCIENTISTS AS SERVING A PROTECTIVE ROLE FOR THE VARIOUS

BODY TISSUES BUT THEY WERE NEVER SCIENTIFICALLY PROVEN AND REMAIN SO TODAY. THIS INABIL-

ITY TO PROVE THEIR EXISTENCE ANATOMICALLY WITH HISTOLOGICAL STUDIES FINALLY LED TO THEIR

VERY EXISTENCE BEING CHALLENGED AND SINCE THAT TIME THEY HAVE BEEN LARGELY IGNORED.

RECENT INTEREST HAS BEEN STIMULATED WITH THE EMERGENCE OF A RELATIVELY NEW FIELD OF

MEDICINE CALLED PSYCHO-NEURO-IMMUNOLOGY WHERE MUCH EVIDENCE IS ACCUMULATING THAT THE

BRAIN, PERIPHERAL NERVES AND THE IMMUNE SYSTEM IS ALL INTERRELATED. ORTHODOX MEDICINE I

SUSPECT, NATURALLY WILL CONTINUE TO OPPOSE SUCH THINKING AS SHOWN BY MOST ADVANCEMENTS IN

THE HISTORY OF MEDICINE.

ANYHOW, IN THE EARLY 1940’s, DR. WYBURN-MASON AND HIS STUDENT, DR. PAUL PYBUS, BECAME

TOTALLY CONVINCED THAT THESE TINY MICROSCOPIC NERVES GOING TO THE BODY CELLS WERE

INVOLVED IN CELL NUTRITION AND CONTROLLED THE BASIC FUNCTIONING OF ALL CELLS. IN FACT,

DR. WYBURN-MASON PUBLISHED A 1,000 PAGE BOOK ENTITLED

“

TROPHIC NERVES

”

IN 1950 IN WHICH

HE RESEARCHED THE LITERATURE CONCERNING THE ROLE OF THESE TROPHIC NERVES IN NORMAL AND

PATHOLOGIC PHYSIOLOGY. THE GENIUS OF HIS WORK WAS NEVER RECOGNIZED AND THIS BOOK IS

FASCINATING TO READ. MOST SCIENTISTS OF TODAY HAVE HAD TO RECOGNIZE THE EXISTENCE OF

THESE NERVES BECAUSE IT IS SO OBVIOUS THAT CERTAIN CHEMICALS SUCH AS HISTAMINE AND

VARIOUS PROSTAGLANDINS ARE RELEASED IN AREAS OF INFLAMMATION BY A NERVOUS INFLUENCE.

IN STUDYING THE PROCESSES INVOLVED IN INFLAMMATION, DR. WYBURN-MASON HAD TO CONSIDER

NUMEROUS FACTORS THAT WERE INVOLVED AND WHEN ALL FACTORS WERE CONSIDERED TOGETHER, THIS

GAVE HIM A VERY CLEAR PICTURE AS TO WHAT TAKES PLACE IN THE ENTIRE PROCESS OF INFLAMMA-

TION.

HE KNEW THERE WERE 2 TYPES OF PAIN EXPERIENCED BY THE HUMAN BODY. THERE IS SUPERFICIAL

OR EPICRITIC PAIN SUCH AS PRODUCED BY A PINPRICK OR BURN AND THIS IS CONDUCTED BY THE

ALPHA TYPE NERVE FIBERS OR TYPE III BY THE AMERICAN CLASSIFICATION. THESE FIBERS ARE

FAIRLY THICK, ABOUT 5 MICRONS IN DIAMETER AND CONDUCT PAIN AT A RATE OF 12 TO 30 METERS

PER SECOND AND THEY ARE MYELINATED FIBERS WHICH ALLOW A SLOW ANESTHETIZATION RATE OF 4-

6 MINUTES.

THEY PRIMARILY ORIGINATE IN THE SKIN RECEPTORS AND ARE FAIRLY SPARSE IN NUMBER AND

THEIR CELL BODIES ARE LOCATED IN THE POSTERIOR OR DORSAL HORN OF THE SPINAL CORD AND BY

INTERMEDIATE NERVE CELLS WHICH CARRY THE NERVE IMPULSE TO TWO PLACES - THE BRAIN AND

REFLEXLY BY WAY OF THE ANTERIOR OR VENTRAL HORN CELLS TO THE MUSCLES IN THE REGION OF THE

STIMULUS. THESE FIBERS PLAY NO PART AT ALL IN ARTHRITIC PAIN. THESE FIBERS BECOME

FATIGUED VERY EASILY.

THE SECOND TYPE OF PAIN IS DEEP PAIN OR PROTOPATHIC PAIN AND IS THE TYPE OF PAIN SEEN

IN INFLAMED TISSUES AS THE ARTHRITIC JOINT PAINS. THIS DEEP OR SLOW PAIN IS POORLY

LOCALIZED AND IS CARRIED BY THE C-TYPE OR TYPE IV FIBERS AND THESE FIBERS ARE VERY THIN

WITH A DIAMETER OF 0.5 TO 0.8 MICRON AND A VERY SLOW CONDUCTION RATE OF 1/2 TO 2 METERS

AND THEY ARE UNMYELINATED WHICH PRODUCES A RAPID ANESTHESIATION RATE OF 2 SECONDS. THESE

FIBERS ARISE FROM RECEPTORS IN THE DEEP AND SUPERFICIAL TISSUES AS THE SKIN AND INTERNAL

ORGANS AND WHEN STIMULATED, THEIR AXONS CAN TRANSMIT NERVOUS IMPULSES IN BOTH PRODROMIC