Perineural and scar treatment
Pain with touch, clothing or movement can come from a sensitive superficial nerve or painful scar. These treatments use dextrose solution at selected sites, with the aim of improving comfort in daily life.
Purpose and potential benefits
Two approaches to pain and sensitivity
Both approaches use small amounts of 5 percent dextrose in water (D5W), a solution containing a form of sugar. The treatment target differs:
- Superficial perineural treatment places the solution just beneath the skin near selected sensory nerves.
- Scar-focused treatment places the solution around painful scar tissue or a nearby nerve.
Dr. Coon selects the approach based on your symptoms and examination.
Potential benefits and limitations
The goal is to reduce pain and sensitivity so clothing, touch or movement is more comfortable. Treatment focuses on the sites that relate to your symptoms and goals.
Clinical evidence is limited, and the amount and duration of benefit remain uncertain. Either procedure may not help. Dr. Coon will discuss the expected benefits and limits for your diagnosis.
Planning and procedure
Superficial treatment in detail
What superficial perineural treatment involves
Small amounts of D5W are placed just beneath the skin at selected tender points near sensory nerves. The aim is to reduce pain or sensitivity associated with these nerves.
Dextrose may influence pain signalling, but the mechanism and the extent of benefit in patients are still being studied.
Scar-focused treatment in detail
What scar-focused treatment involves
A painful scar may involve sensitive tissue or a nearby small nerve. Dr. Coon examines the symptom pattern and tissue involved before recommending treatment.
Scar-focused treatment places D5W around selected painful scar tissue or a nearby nerve, with ultrasound when useful. The goal is improved comfort with touch and movement. It is not a treatment to erase a scar.
Why examination and localization come first
A visible scar or tender point does not explain every symptom. Dr. Coon considers your history, examination and relevant imaging to distinguish superficial nerve or scar-related pain from deeper nerve, joint or tendon concerns.
The diagnosis determines the treatment target and the outcome you will track.
What a treatment visit may involve
A procedure generally includes:
- Review of the treatment plan and consent
- Examination and identification of the treatment sites
- Placement of small amounts of solution near the selected nerves or scar tissue
- A brief observation period and aftercare instructions
Ultrasound may be used for scar-focused treatment when useful. Dr. Coon will explain the sites, volume, any numbing medicine and proposed number of procedures beforehand.
Risks and other options
When another option fits better
Therapeutic options may include rehabilitation, activity changes, medication or watchful waiting with reassessment. A persistent nerve or scar-related problem may need a surgical opinion.
If the symptoms arise from a deeper nerve, joint, tendon, spinal or widespread nerve condition, Dr. Coon will explain why further testing or another clinician may be the next step.
Risks and health considerations
Temporary soreness or bruising can follow either approach. Other possible risks include bleeding, infection, allergic reaction, a faint or light-headed reaction, and injury to a nearby nerve or blood vessel.
Dr. Coon reviews medications, allergies, skin infection, bleeding concerns and other health factors before recommending treatment. Do not change medicines on your own.
Recovery and next steps
Recovery and aftercare
Tenderness or small bruises may occur at the treatment sites. Dr. Coon will explain how to manage tenderness while the area settles.
Your aftercare instructions will include activity guidance, when to contact the clinic and a plan to reassess your progress.
Cost and payment options
Your evaluation lasts an hour and costs $400. Dr. Coon explains the separate procedure fee and any included follow-up before scheduling. Payment is due before or at the time of your visit or procedure. NOVA Regen is a self-pay practice and does not bill insurance.
If there is little or no improvement
Dr. Coon will help you define goals you can assess, such as tolerating clothing, light touch or movement more comfortably, and set a time to review your response.
If those goals are not being met, he will review the diagnosis, treatment target and other therapeutic options with you before recommending another procedure.
Questions people ask
Is this the same as nerve hydrodissection?
There is overlap. Fluid placed near a superficial nerve may also separate it from surrounding tissue, creating a hydrodissection effect. Superficial perineural treatment focuses on small nerves just beneath the skin; ultrasound-guided nerve hydrodissection lets Dr. Coon see a selected nerve and guide the fluid around it.
Is dextrose approved for this use?
D5W is approved for intravenous use. Its use for these procedures is off-label, meaning the FDA has not approved it for this purpose.
Will this regenerate a nerve or remove a scar?
These procedures aim to improve pain and sensitivity. They are not established methods of regenerating a nerve or removing scar tissue. Dr. Coon will explain the outcome being sought for your diagnosis.
How will we assess progress?
Dr. Coon will discuss specific goals with you and review your response against them. That review guides the next decision.
How later treatment is scheduled
An evaluation helps you understand whether this treatment has a useful role in your care.
Questions about fit? Request a 10-minute fit call.