Neural therapy

What is Neural Therapy?

Neural therapy refers to the therapeutic use of local anesthetics outside of a classic nerve block. Small injections into the skin (wheals), into areas of the spine near segments or into pain-associated structures are intended to influence pain processing via reflex connections in the autonomic nervous system. In orthopedic practice, this method is primarily tested for myofascial complaints and functional pain syndromes when warning signs have been ruled out.

Historically, a distinction is made between segment therapy (refers to a spinal cord segment) and interference field therapy (e.g. scars). While the segment-related approach is neurophysiologically plausible, the interference field concept is scientifically controversial. We use neural therapy in a targeted and evidence-conscious manner as a supplementary option - never as a replacement for well-founded diagnostics or active therapy.

How does neural therapy work?

Local anesthetics stabilize nerve membranes and can temporarily dampen the transmission of stimuli. In addition, there is evidence that they modulate autonomic reflexes outside of a complete conduction block and influence the pain threshold via peripheral and spinal mechanisms. This can reduce excessive tension in muscles and fascia and briefly interrupt pain spirals.

• Modulation of segmental pain reflexes: dampening overactive feedback between skin, muscles and the autonomic nervous system.
• Peripheral effects: Attenuation of nociceptive inputs and local inflammatory mediators.
• Centrally acting gate control mechanisms: Short-term stimulus control in the dorsal horn of the spinal cord.
• Diagnostic utility: Temporary pain relief may provide clues to structures involved.

The effect is individual. Often, if improvement occurs, it occurs quickly after the injection and lasts from minutes to days. For sustainable improvement, the combination with active measures (e.g. physiotherapy, training) is crucial.

Possible areas of application in orthopedics

In our practice, neural therapy is only used after a thorough examination and if there is a clear indication. It is particularly suitable for relieving functional and myofascial pain or as a diagnostic aid. For structural causes involving nerve compression, more targeted procedures are often superior.

• Myofascial pain and trigger points in the spinal muscles, shoulder, neck or lumbar area.
• Non-specific neck and back pain with protective muscular tension.
• Accompanying symptoms of facet joint irritation or SIJ dysfunction (as a supplementary component).
• Painful scars in the musculoskeletal system (e.g. after orthopedic surgery).
• Overload syndromes of tendon attachments and soft tissues in individual cases.
• Tension headache or cervicogenic headache components with muscular involvement.

Neural therapy is not suitable for treating clear nerve root compression, relevant joint inflammation or acute injuries. In such cases, we examine specific alternatives or initiate further diagnostics.

Limitations and evidence

The study situation on neural therapy is inconsistent. There are positive reports and smaller studies, some with short-term effects, but at the same time there are methodological limitations and heterogeneous protocols. It is currently not possible to make a reliable statement about its superiority over other conservative measures.

• Short-term pain relief is possible, but durability varies.
• As a diagnostic test block, the method can help to narrow down the segments involved.
• A multimodal approach with exercise therapy and self-management remains central.
• We only recommend neural therapy if it is plausible, safe and fits into your overall concept.

Process in our practice in Hamburg

A session usually lasts 15-30 minutes. For a reliable assessment, we often plan 1-3 appointments 1-2 weeks apart. The treatment takes place in our practice at Dorotheenstraße 48, 22301 Hamburg.

Neural therapy techniques

• Wheal technique (intradermal/subcutaneous): Very superficial depot administration in painful skin and connective tissue zones of a segment.
• Paravertebral segment therapy: Injections near the exit points of segmental nerves in the spine area.
• Peri-/supraperiosteal or myofascial infiltration: Low-volume administration to muscle attachments or fascia.
• Scar infiltration: Treatment of painful, hardened or hypersensitive scars in the musculoskeletal system.

We focus on orthopedically sensible, safely feasible techniques. We evaluate non-orthopedic interference field concepts cautiously and only apply them after a clear plausibility check.

Safety, risks and contraindications

Local anesthetics are proven substances. When used correctly, side effects are rare but possible. We work sterilely, check for allergies and have emergency equipment on hand.

• More common: temporary numbness, feeling of warmth, bruising, tenderness at the injection site.
• Rare: infection, vascular or nerve irritation, circulatory reactions.
• Very rare: Systemic toxicity of local anesthetics with dizziness, ringing in the ears, metallic taste, tingling; If it occurs, seek immediate medical attention.
• Allergic reactions, particularly to ester anesthetics such as procaine, are possible.

• Contraindications: Acute infections at the injection site, known allergy to the local anesthetic used, untreated coagulation disorder.
• Relative contraindications: anticoagulation (individual risk assessment), relevant cardiac arrhythmias, pregnancy and breastfeeding (only after strict indication), severe liver disease.
• Safety rules: Do not actively participate in traffic for several hours after the injection; Protection in the event of temporary sensory disturbances.

Preparation and aftercare

• Bring a list of medications with you, particularly anticoagulants and allergies.
• Light meal before treatment, adequate hydration.
• Plan to have an accompanying person and avoid driving on the day of treatment.
• Observe for 10-30 minutes after injection; Keep the puncture site clean and dry.
• Short rest on the same day, then activation according to the individual exercise program.

Coherent overall concept instead of individual syringes

We see the best results when neural therapy is embedded in a structured, active concept. The aim is to create the conditions for exercise, training and everyday strategies through short-term relief.

• Physiotherapy with a focus on mobility, strength and coordination.
• Individual home exercises and load control.
• Manual techniques based on findings, combined with active stabilization.
• Pain education, stress and sleep management.
• If necessary, temporary medication support according to guidelines.

Costs and reimbursement

Billing is usually carried out according to GOÄ. Private health insurance companies reimburse neural therapy depending on the contract. For those with statutory health insurance, the service is usually an individual health service (IGeL). We will inform you transparently in advance about the expected costs.

Related injection procedures in our practice

Depending on the cause, targeted infiltrations may be more useful than segmental neural therapy, for example if facet joints, the SIJ or nerve roots are specifically affected. We will advise you on the appropriate options and, if indicated, carry out the procedures safely using imaging or palpation.

• Facet infiltration in facet joint syndrome.
• SIJ infiltration for sacroiliac joint problems.
• Periradicular therapy (PRT) or nerve root injections for radicular pain.
• Joint infiltrations in activated arthrosis or irritable effusions.
• Trigger point and tendinopathy injections for specific soft tissue problems.
• Bursa injections for bursitis.