Global Journal of Medical Research, F: Diseases, Volume 22 Issue 6

Intradermal Glucose 5% Injections for Mild Localized Neuropathic Pain- A New Approach to Reduce Pain Medication Jan Kersschot quality of life, physicians are challenged to look for treatment modalities which are easy to apply, safe and effective. Over the last decade, isotonic glucose (or dextrose) injections have received more attention among clinicians worldwide. In this article, the focus is on the application of intradermal injections of glucose 5%. Glucopuncture is especially interesting for doctors and patients who live in remote areas where pain medications are not available, or too expensive. I. N europathic pain erves are usually viewed as simple conduits of electrical signals to make muscles move and enable sensation of pain, temperature and pressure. However, axons within nerves, also known as nervi nervorum, are also capable of reacting to their immediate environment, such as to mechanical pressure or to direct injury from trauma. Nociceptors are sensory neurons that detect harmful stimuli, and can become sensitized after infection (e.g., herpes), direct injury, surgery [i,ii] or repetitive overstimulation. When nociceptors are sensitized, they often exhibit spontaneous activity in the absence of stimulation, called “ongoing activity” [iii]. Because of their very specialized anatomy and physiology, nerves are capable of creating or mediating certain types of (chronic) pain [iv]. It has been made clear that nociceptor neurons also release neuropeptides and neurotransmitters from nerve terminals which can regulate adaptive immune cell responses [v]. Macrophages can activate nociceptors and nociceptors can secrete neuropeptides and chemokines which act on macrophages; in chronic pain these bilateral macrophage-nociceptor interactions are mediated by microRNAs and microRNA-containing exosomes [vi]. Neuropathic pain (NP) is described as a (superficial) pain arising as a direct consequence of a lesion or disease affecting the somatosensory system at the peripheral or central level [vii]. It affects about 10% of the world population [viii, ix]. Despite the progress in Author: e-mail : jan@kersschot.com pain management methods made over the last decades, neuropathic pain significantly impacts patients’ quality of life. Both pharmacological and non- pharmacological methods often fail to reduce the pain or may induce serious side effects. Neuropathic pain resulting from diabetes or chemotherapy are not considered as a subject of this article. Diverse causes of neuropathic pain are associated with excessive inflammation in both the peripheral and central nervous system which may contribute to the initiation and even maintenance of persistent pain [x]. Chemical mediators, such as cytokines, released during an inflammatory response have the undesired side effect of sensitizing or stimulating nociceptors. These changes can promote long-term persistent neuropathic pain. Transient receptor potential vanilloid channel 1 (TRPV1), a nonselective cation channel, has been shown to play an important role in neuropathic pain (xi). It has been found that IL-6 and IL-1beta also play a role in pain induced by perineural inflammation [xii]. All this may explain why sometimes a minor trauma can lead to extreme sensitivity to touch (allodynia) and severe chronic neuropathic pain. II. L ocalized N europathic P ain In more than half of cases of NP, the pain is localized and affects a certain area of the body [xiii]. This article focusses on this peripheral or localized type of neuropathic pain. Localized neuropathic pain (LNP) is characterized by circumscribed areas of pain with abnormal skin sensitivity or spontaneous burning pain with no obvious cause. It is hypothesized that even a minor peripheral nerve injury can induce functional and structural changes in neuronal cells. These functional and structural changes release numerous signaling molecules in response to the nerve damage. As these mediators modulate corresponding receptors on cell membranes, such interactions can create vicious circles of complaints such as burning pain and allodynia. These maladaptive mechanisms contribute to further sensitization of peripheral nerve endings [xiv]. It is hypothesized that noxious stimuli stimulate peripheral nerves to release calcitonin gene-related peptide N 1 Year 2022 Global Journal of Medical Research Volume XXII Issue VI Version I ( D ) F © 2022 Global Journals Abstract- As localized neuropathic pain can seriously decrease Keywords: localized neuropathic pain, glucopuncture, allodynia, intracutaneous injection.