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

(CGRP) and prostaglandin E2 (PGE2) [xv]. Interleukin- 1beta also seems to play a role in neuropathic pain [xvi, xvii]. III. D ifferential D iagnosis LNP needs to be differentiated from complex regional pain syndrome (CRPS) which is a difficult-to- treat chronic pain condition [xviii]. CRPS often involves hyperalgesia and allodynia of the extremities and on top of that there is autonomic nervous system involvement. CRPS is not an indication for Glucopuncture. Neither can neuropathic pain resulting from nerve compression, autoimmune disease, diabetes [xix] or chemotherapy be treated with Glucopuncture. IV. R egional t reatments for L ocalized N europathic P ain The standard treatment of LNP is antidepressants and anticonvulsants [xx]. Regional treatments such as patches and injections are gaining popularity in the local management of peripheral neuropathic pain. A major advantage of transdermal treatments is that they may reduce the risk of adverse events that are often associated with systemic medication. Topical modalities may be used in combination with oral drugs resulting in less drug-drug interactions. Topical treatments such as 5 % lidocaine patches and 8 % capsaicin patches have been used in several LNP models [ xxiii]. In this article, the focus will solely be on local intradermal injections with glucose 5%. Typically, 1 mL of solution is injected per cm (half inch) of the symptomatic area. Positive feedback of patients treated with this new technique has encouraged certain clinicians to present it as a new approach to treat mild forms of LNP. The new term Glucopuncture is introduced to raise awareness about these injections among both doctors and patients. However, no randomized clinical trials have illustrated its xxi, xxii, safety or efficacy yet. This technique is especially interesting for physicians who work in remote areas where modern diagnostic and therapeutic modalities are not available, or too expensive for their patients. V. G lucopuncture for M ild L ocalized N europathic P ain As pointed out earlier, first-line pharmacological treatments for LNP include pain medication, antidepressants and anticonvulsants such as gabapentin and pregabalin [ xxvii] but this technique is not a topic of this article. Clinical randomized studies are required to see which dose, frequency and injection technique works best for mild LNP. xxiv]. However, some patients complain about side effects of such medication. Others obviously overuse pain medication. One of the goals of Glucopuncture is to reduce the use of systemic medication by giving a series of glucose 5% injections intradermally. Best results are achieved when the injections are started in the beginning of the disease before the somatosensory system is affected at central level. Instead of giving intradermal injections, one can also give the glucose perineurally [xxv, xxvi, VI. D efinition of G lucopuncture Glucopuncture (GP) is an easy-to-learn procedure which can be done in a small private practice without ultrasound guidance. GP is defined as an injection-based therapy for the management of a variety of musculoskeletal conditions [xxviii]. In general, glucose 5% in water (G5W) injections are given in dermis, muscles, fascia, tendons and ligaments. No local anesthetics nor corticosteroids are added. When treating localized neuropathic pain, multiple intracutaneous injections with G5W in the zone of pain referral are advised. The treatment is repeated once a week to once every two weeks. After a series of sessions, the pain modulation can last up to several months. If no major improvement is noticed after five sessions, the treatment is stopped. VII. G lucose M etabolism in B rain C ortex The human brain depends upon glucose as its main source of energy, and glucose metabolism is critical for brain physiology [ xxxii]. Therefore, regulation of glucose metabolism is critical for cortex physiology [xxxiii]. The largest proportion of energy in the brain is consumed for neuronal computation and information processing xxxiv xxxvi]. The question is whether glucose is equally important for the peripheral nervous system as it is for the brain. This question has not been answered yet, but further exploration of this issue might explain the clinical effects which are noticed when injecting isotonic glucose perineurally (e.g., carpal tunnel) or intradermally. It is clear that when glucose is applied to a patient systemically, for example, as an IV infusion, there are no pain modulating effects at all. This xxix, xxx]. The brain accounts for about 2% of the body weight, yet it consumes about 20% of glucose-derived energy [xxxi]. Glucose metabolism provides the fuel for physiological brain function through the generation of ATP, the foundation for neuronal and non-neuronal cellular maintenance [ [ ], e.g., the generation of action potentials and postsynaptic potentials generated after synaptic events, and the maintenance of ion gradients and neuronal resting potential [xxxv]. Additionally, glucose metabolism provides the energy and precursors for the biosynthesis of neurotransmitters [ means that in the search for the exact mode of action of Glucopuncture, the scientific community needs to focus Intradermal Glucose 5% Injections for Mild Localized Neuropathic Pain- A New Approach to Reduce Pain Medication 2 Year 2022 Global Journal of Medical Research Volume XXII Issue VI Version I ( D ) F © 2022 Global Journals