200 Section - Perineural Injection Therapy as a Novel Adjunct Intervention in the Multimodal Approach to Burn Scar Neuropathy: A Case Report

This reports a case of a 19-year-old  female, with burn scar neuropathy from chronic flame burn of bilateral lower extremities, that presented with pain over the right distal posterior leg. P<span style="color: black;">hysical and occupational therapy focused on physical agents and functional mobility, orthotic management to accommodate equinus foot, and  psychotherapy for counseling on chronic pain management, were provided to address posterior leg pain. Due to inadequate response, perineural injection therapy was initiated. A buffered isotonic dextrose solution, 5% dextrose in water (D5W) was injected around the sural nerve distribution for 8 consecutive weeks. Significant pain relief from numerical rating scale of 9/10 to 0/10, functional mobility, and return to school were achieved after repeated treatments along with the multimodal pharmacologic and non-pharmacologic interventions.


Discussions: Chronic pain among burn patients leads to significant disability, reduced quality of life and requires an effective multimodal approach. Complementary and adjuvant therapeutic modalities that can modulate pain experience are vital for restoration of function. Perineural injection therapy (PIT), also known as neural prolotherapy, is a novel intervention for peripheral neuropathies that works by decreasing adhesions, promoting circulation and nerve mobilization, and inhibiting pain and inflammation mediators.

Conclusions:

This is the first reported case of integrating perineural injection therapy with a multimodal approach to burn scar neuropathy. This paper reinforces the need for a holistic approach in managing the chronic complications of burn injury.  Perineural injection therapy with glucose water has shown to aid in providing pain relief along with pharmacologic and rehabilitative management, at a lower cost and minimal side effects.