Local therapy

In order to treat local inflammation, LA can be administered at the site of tenderness or inflammation. Typical indications are: skin inflammation, wasp bites, prolonged wound healing, muscle injury, tissue damage due to chemicals, and keloidal scars.

Segment therapy

The focus here is the neurologically defined segment of the spinal and cranial nerves. A segment consists of all structures innervated by one spinal nerve: cutis, subcutis, joints (also spinal joints), joint capsules, muscles, fascia, bones, and viscera. Every part of the segment reacts simultaneously on external stimuli of any other part, probably due to the convergence of all segmental impulses on the spinal level (Sessle et al. 1986). A therapeutic stimulus applied in one segment can influence another part of the segment. The easiest way to apply a stimulus is by intracutaneous injection in the appropriate dermatome, thereby producing a small papule or wheal.

In addition, the therapist may infiltrate scars, trigger points, fascia, the periosteum, or joint capsules (in particular vertebral joint capsules), and related blood vessels in the respective segment.

Example 1 Patient with shoulder pain (segment C4 and C5): two intracutaneous routes of papules (wheals): the first route goes from the C7 spinous process to the acromion and to the base of the deltoid muscle (segments C4 → C5 → Th2) and the second goes from the anterior axillary fold on the acromion to the posterior axillary fold (segments Th2 → C5 → C4). In this way, adjacent segments with ancillary function to the shoulder joint (ACG, SCG, clavicle, first and second rib) may also be included (Fig. 7.12.1).

Example 2 Patient with gastrointestinal symptoms in the upper abdomen: Injections of intracutaneous papules/wheals and subcutaneous injections in the area of the costal arch (so-called Vogler points, Fig. 7.12.2) and the fascia of the abdominal muscles. The xyphoid process (a rudiment of the seventh rib) is of special significance in this region and belongs to the T7 segment. The duodenum and the pancreas belong to the same segment. Because of the segmental organization of skin, muscle, fascia, and periosteum there is a connection between these structures and the stomach, the pancreas and the small intestine, through which these organs can in turn be influenced. Intracutaneous and deeper prefascial injection can also be applied in the anterior midline at acupuncture point CV12 (see Fig. 7.12.2). This point is connected with the celiac ganglion, which controls the sympathetic abdominal organs (Heine 2006; Wancura 2010).

Acupuncture points are considered to be passage points in the fascia (Heine 2006) through which nerves, blood and lymphatic vessels come to the surface. It is suggested that these structures can be influenced by injecting procaine at one of these points as well. Therefore neural therapists also choose acupuncture points for treatment (Heine 2006).

Extended segment therapy, ganglia therapy

If the segmental injections are not sufficient to improve the patient’s symptoms, the clinician may block the afferent stimulus at the level of the spinal nerves, the plexus, the vessels, the sympathetic or parasympathetic ganglia (so-called extended segment therapy). By eliminating the afferent and efferent impulses, as well as simultaneously activating the descending endogenous inhibitory systems, the auto-organization of the peripheral nervous system can recover (see also Oke and Tracey 2009).

In the patient with shoulder pain (Example 1), this could be achieved by an injection into the stellate ganglion or the axillary plexus. In the patient with gastric problems (Example 2), extended segment therapy would consist of injection into the sympathetic celiac ganglion. In addition, an injection into the associated vertebral facet joints in the vicinity of the sympathetic trunk can be applied (indirect injection to the sympathetic trunk) (Kupke 2010), which affects 80% of the sympathetic afferent and efferent nerve fibers of the corresponding segment.

The cranial parasympathetic ganglia (ciliary, pterygopalatine, and otic) can be easily and safely accessed by injection. Their fibers accompany the trigeminal branches and their associated ganglia. Trigeminal irritation due to pathological processes in the sinuses, the teeth, local inflammation (e.g., granulomas), jaw disorders (e.g., TMJ syndrome), the tonsils and the ears can be treated by these injections.

The sacral parasympathetic nuclei are located in the lateral horn of the sacral cord (S2 to S4) and accompany the pudendal nerve. Thus gynecological diseases or sacral irritations can be positively influenced by neural therapy of the sacral parasympathetic ganglia, e.g., the inferior hypogastric plexus (Frankenhäuser plexus, Wander 2003).