Physiological Regulating Medicine

Clinical Applications in Pain Management May 21, 2009 Orlando, Florida Anette K. S. Mnabhi, DO, AOBFP, AOBNMM, RN, MSN

This material is based on the presenters studies in PHYSIOLOGICAL REGULATING MEDICINE.

The information presented here is not to be considered a prescription and we do not accept medical or legal responsibility for misuse of the information presented. This information is for educational purposes for licensed health care professionals within their scope of practice.

And must I then, indeed, Pain, live with you All through my life? sharing my fire, my bed, Sharing - oh, worst of all things! - the same head? And, when I feed myself, feeding you, too? Edna St. Vincent Millay (1892 - 1950) Source: The New Anthology of American Poetry

Physiological Regulating Medicine

The PRM Therapeutic Triangle

The Yellow Axis P.N.E.I. Rebalancing

P.N.E.I. Network

Psychological Neurological Endocrine Immune

The Red Axis Symptom Management

SPECIFIC REMEDY FOR ORGAN OR DISEASE Symptom management

The Blue Axis Drainage

DRAINAGE REMEDY Promotion of a healthy Matrix

Physiological Regulating Medicine Treatment Targets:

The MATRIX (Blue) Cellular Function (Organs and tissues) (Red) Organs of Excretion and Detoxification Pathways (Red) The communications system P.N.E.I. (Yellow)

THE ORIGINS OF PHSYIOLOGICAL REGULATING MEDICINE

1796
From homeopathic empiricism to homotoxicologic scientific nature

BIRTH OF HOMEOPATHY
ReRe-interpretation of homeopathic principles from an immunologic and biochemical point of view

1952
Overcoming the organistic and mechanistic (homotoxin(homotoxin-homotoxicosis) vision of Homotoxicology

H.H. RECKEWEG ENUNCIATES THE PRINCIPLES OF HOMOTOXICOLOGY

New advances in the field of Psycho-NeuroEndocrine-Immunology stimulate innovation in Homeopathy resulting in:

1994

ORIGINATION OF PHYSIOLOGICAL REGULATING MEDICINE IN ITALY (GUNA Method)

Dipartimento Scientifico Guna S.p.a.

PHYSIOLOGICAL REGULATING MEDICINE (PRM)

The science of PRM integrates state of the art scientific advances in: Homeopathy Homotoxicology Psycho-Neuro-Endocrine-Immunology (P.N.E.I.) Nutritional and Phyto-medicine

PRM
Formulating biotherapeutic medicines, Achieving the best individualized prescription for patients Promoting recovery from illness and restoration of health and wellness. wellness.

PYSCHOPYSCHO-NEURONEURO-ENDOCRINEENDOCRINE-MMUNOLOGY NATURAL MEDICINE SYSTEMS THEORY HOMEOPATHY MOLECULAR BIOLOGY EMBRYOLOGY HOMOTOXICOLOGY QUANTUM PHYSICS BIOTENSEGRITY

PSYCHE

THE P.N.E.I. NETWORK

NEUROPEPTIDES

P N

HORMONES HORMONES

E I
SOMA

INTERLEUKINS

PSYCHE

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DISEASE
HYPER-CONCENTRATION

10-6
s/ m m i ill e lit

pi

co

am gr

HEALTH
DISEASE

PHYSIOLOGICAL CONCENTRATION

10-15

m m ra g no na

m s/

r te ili ill

HYPO-CONCENTRATION

Dipartimento Scientifico Guna S.p.a.

PHYSIOLOGICAL REGULATING MEDICINE

The right dose (physiologic) Of the right biotherapeutic medicine (hormones, interleukins, neuropeptides, neuropeptides, nutrients, suis, suis, nosodes) nosodes) To the right places (PNEI axis, Cells, Matrix) For the right problem (accurate diagnosis) Leading to recovery and restoration of physiological balance and functioning

Physiological Regulating Medicine the 3 main Pillars

HOMEOPATHY AND

P.N.E.I.

Cytokines, HOMOTOXICOLOGY Interleukins & Hormones

NUTRITIONAL SUPPLEMENTATION

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P.R.M. bag of tools

From Homotoxicology From Homeopathy Plants Animals Minerals Catalysts

From P.N.E.I.
Nosodes Hormones Suis organ preparations Interleukins From Nutrition Therapy Trace elements Vitamins Nutrients
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Neuropeptides Growth factors

HOMOTOXICOLOGY
NOSODES (pathogenic micro-organisms or tissue in homeopathic dilution) Utilized according to: INVERTING EFFECT AND SIMILARITY 1. Low homeopathic dilution: acute disease/body 2. High homeopathic dilution: chronic disease/mind

SUIS ORGAN PREPARATIONS (organ extracts of porcine tissue-most similar

physiologicaly to human tissue)

Utilized according to: INVERTING EFFECT AND SIMILARITY 1. Low homeopathic dilution: stimulates target organ 2. High homeopathic dilution: slows down/inhibits target organ CATALYSTS (substrates that alter the rate of physiologic reactions) Utilized according to: LAWS OF BIOCHEMISTRY 1. Low homeopathic dilution: acute disease 2. High homeopathic dilution: chronic disease
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HOMEOPATHY
PLANTS ANIMALS MINERALS Utilized according to: INVERTING EFFECT AND SIMILARITY
In low homeopathic dilution for acute disease/body In high homeopathic dilution for chronic disease/mind

Psycho-Neuro-EndocrineImmunology
NEUROPEPTIDES HORMONES INTERLEUKINS GROWTH FACTORS Utilized according to: PHYSIOLOGY AND MOLECULAR BIOLOGY SKA physiological concentrations (ng-pcg/ml) 4C-X6

NUTRITION THERAPY
VITAMINS MINERALS TRACE ELEMENTS Utilized according to: OLIGOTHERAPY ( Use of trace minerals for physiologic support. Includes catalysts which speed up metabolism at the cellular level and essential nutrition to counter act free radical damage at the cellular level) small and sufficient amounts

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GUNA METHOD - THE THERAPEUTIC STRATEGY 1

P.N.E.I. REBALANCE

4
CELL NUTRITIONAL SUPPORT

CELL METABOLIC SUPPORT

2
DRAINAGE

3
CONTROL OF SYMPTOMS

CELL DRAINAGE

MATRIX DRAINAGE

LYMPHATIC DRAINAGE

ORGANS OF ELIMINATION DRAINAGE

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PRM in Acute and Chronic Pain

In order to effectively choose the proper biotherapeutic medicines it is important to understand the physiology behind the disease process you desire to treat Chronic versus Acute Inflammation Nerve, Muscle, Joint/Bone

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Chart of area/zone connections

GUNA-NECK

GUNA-SHOULDER

GUNA-THORACIC GUNA-HIP GUNA-LUMBAR

GUNA-ISCHIAL GUNA-HANDFOOT

GUNA-NEURAL

GUNA-POLYARTHRITIS GUNA-MUSCLE

Nerve pain

Joint pain

Muscle pain

PAIN MANAGEMENT INJECTABLE FORMULATIONS ARE SPECIFIC & SELECTIVE FOR OSTEO-ARTHRO-MYOFASCIAL PATHOLOGIES OF EACH ANATOMIC REGION
The Pain Management injectable ampoules (10) contain 60 low dose homeopathic unitary remedies:
- 4 contain:

1) 2) 3) 4)

ARNICA (Arnica montana) ACONITUM (Aconitum napellus) RHUS TOX. (Rhus toxicodendron) CIMICIFUGA (Cimicifuga racemosa)

9 out of 10 contain Beta-Endorphin (except for GUNA-MUSCLE)

- 8 out of 10 contain Anti IL1; Anti IL1 (except for GUNA-MUSCLE and GUNA-NEURAL)

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INTERLEUKIN 1
Interleukin 1 (IL-1) is a cytokine secreted by different types
of cells of the Immune System (macrophages, monocytes, dendritic cells, fibroblasts and endothelial cells) IL-1 = first discovered IL-1 has various effects on the organism both at general and local level One of these effects is to support inflammatory processes; it stimulates prostaglandin production from different type of cells (muscular, epithelial, etc.); the production of other cytokines (among which IL-2), and the activation and recruitment of other cells of the Immune System: -IL-1 -IL-1 These two classes have similar activities but different structures
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INTERLEUKIN 1
IL-1 IS A PIVOTAL PRO-INFLAMMATORY CYTOKINE CENTRALLY INVOLVED IN SYSTEMIC AND LOCAL IMMUNE RESPONSES LEADING TO TYPICAL EFFECTS OF INFLAMMATION DYSREGULATED, PROLONGED SYNTHESIS AND RELEASE OF IL-1 IN CHRONIC INFLAMMATORY SITUATIONS CONTRIBUTES TO A NUMBER OF DISEASES e.g. RHEUMATOID ARTHRITIS

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IL-1

ACTIVATES MONOCYTES/ MACROPHAGES

INDUCES FIBROBLAST PROLIFERATION

ACTIVATES CHONDROCYTES

ACTIVATES OSTEOBLASTS

INFLAMMATION

SYNOVIAL PANNUS FORMATION

CARTILAGE BREAKDOWN

BONE RESORPTION

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Why use Anti Interleukins (1) Alpha and Beta in the pain management formulas?

IL-1 (; ) activate cyclooxygenase type 2 (COX2) , prostaglandin E2 and nitric oxide, activating the inflammatory process (proinflammatory Interleukins)

As a consequence, Anti Interleukins 1 (; ) act as NSAIDs, cortisone and in part, as salicylates, without the negative side effects caused by these allopathic medicines. Consequently, homeopathically diluted Anti IL-1 and are successfully used in osteo-arthro-myalgic pain management therapy (according to Physiological Regulating Medicine Guna Method)
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What is the scientific reason for using Anti Interleukins and not Interleukins having anti-inflammatory properties? Anti-inflammatory Interleukins (mainly IL-10) are secreted by Th2 cells after the activation of Th1 cells (Phase B of Hoffs Commutative Reaction) and, as a consequence, they act after Interleukins 1 and are secreted

The inhibition of Interleukins 1 and (anti) is therefore more effective than the stimulation of IL-10 IL-10 has more anti-inflammatory action in chronic forms than in acute forms
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INFLAMMATION

PHASE A = DEVELOPMENT

PHASE B = RESOLUTION

YES

NO

RECOVERY

CHRONICIZATION
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ENDORPHIN
Endorphins are organic chemical substances produced by the CNS, having anti-pain and physiological characteristics similar to those of morphine and opium however they have a wider range Endorphins, like a number of morphinic alkaloids, can cause states of euphoria and somnolence according to the quantity released
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Physiological Regulating Medicine in Pain Management Homeopathic physiologic doses: guarantee lack of negative side-effects avoid troubles concerning tolerance avoid pharmacological catabolite overload in extracellular matrix and organs
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PRM and Pain Management

Pain Management Utilizing Physiological Regulating Medicine Diagnosis Treatment
Oral Therapies Injection Therapies

PRM-Pain Management
Oral Support
GUNA Trauma GUNA Flam GUNA Matrix GUNA Lympho GUNA Spasm

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GUNA-TRAUMA drops
OR GA NO CO THE RE RA PI C
Organotrophism and carrier function for homologous human tissues Chamomilla 1X* Hypericum 3X* Arnica 3X** Hamamelis 2X** Bellis 2X*** Calendula 1X**** Symphytum 3X**** Ruta 3X Kalmia 8X Rhus tox. 6X Bryonia 6X Modulation of all inflammatory process development phases (neurogen*, vasal**, exudative***, restitutio ad

PH AT OP ME HO E O- COR YT

Connective 12/30/200X Bone 12/30/200X Cartilago 12/30/200X

C HI

PNEI CORE
Stop to IL1, starter of inflammatory process* The stimulation of the cytokines having Th2-Th3 polarity modulates inflammation** Analgesic action***

integrum****)
Tropism remedies, specific for bones, muscles, tendons, ligaments, synovia Anti IL 1 4C* TGF-beta 1** IL 10** Beta-Endorphin 6X***
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Activity aimed at all the functional components of orthotraumatologic pain

GUNA-TRAUMA drops
Organotrophism and carrier function for homologous human tissues

Connective 12/30/200X Bone 12/30/200X Cartilago 12/30/200X

Target Organ Core

Phytohomeopathic Core

P.N.E.I. CORE

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GUNA-TRAUMA drops
Chamomilla 1X* Hypericum 3X* Arnica 3X** Hamamelis 2X** Bellis 2X*** Calendula 1X**** Symphytum 3X**** Ruta 3X Kalmia 8X Rhus tox. 6X Bryonia 6X Modulation of all inflammatory process development phases (neurogenic*, vasal**, exudative***, restitutio ad

PH

OR GA NO CO THE RE RA PI C

AT OP ME HO E O- COR YT C HI

integrum****)
Tropism remedies, specific for bones, muscles, tendons, ligaments, synovium Activity aimed at all the functional components of orthotraumatologic pain

PNEI CORE

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GUNA-TRAUMA drops
PI C
PH

OR GA NO CO THE RE RA

AT OP ME HO E O- COR YT C HI

P.N.E.I. CORE
Stop to IL1, initiator of inflammatory process* The stimulation of the cytokines having Th2-Th3 polarity modulates inflammation** Analgesic action***

Anti IL 1 4C* TGF-beta 1** IL 10** Beta-Endorphin 6X***

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 SYMPTOMS CONTROL ACONITUM 6/12/30/200X APIS 6/12/30/200X BELLADONNA 6/12/30/200X FERRUM PHOSP. 6/12/30/200X HEPAR SULF. 6/12/30/200X PYROGENIUM 30/200X BRYONIA 6/12/30/200X PHYTOLACCA 6/12/30/200X

GUNA-FLAM drops
DRAINAGE CONNECTIVE TISSUE 12/30/200X

Classic Homeopathic and and Homotoxicological Remedies Oligonutrients Minerals, Vitamins,, Trace elements

CELL NUTRITIONAL SUPPORT Protein synthesis Antioxidative protection

CELL METABOLIC SUPPORT COPPER GLUCONATE 4X NATRUM PYRUVICUM 3X ACIDUM CITRICUM 3X

Cytokines, , Hormones, , Homeopathic Neurotransmitters

P.N.E.I. ANTI -IL 1 4C MELATONINE 6X PINEAL GLAND 6X

REBALANCE IL 10 4C HYPOPHYSIS 200X

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TGF - 1 4C -ENDORPHIN 6X

GUNA-MATRIX drops
DRAINAGE
SYMPTOMS CONTROL
Modulating local or systemic phlogosis inflammation PYROGENIUM 12X FUCUS 3X THUJA 8X NATRUM SULFURICUM 8X CONJUNCTIVA TISSUE 6X LYMPHATIC VESSELS 6X HYALURONIDASE 6X

Classic Homeopathic and Homotoxicological Remedies

CELL NUTRITIONAL SUPPORT

- TYROSINE 2X - PHENYALANINE 2X - HISTIDINE 2X

Oligonutrients

Minerals, Vitamins, Trace elements

CELL METABOLIC SUPPORT

- ASCORBIC ACID 2X - KREBS CYCLE CATALYSTS 6X

Cytokines,, Hormones, , Homeopathic Neurotransmitters

P.N.E.I.
- IL 6 4C - PROLACTINE 6X - DHEA 6X

REBALANCE
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GUNA-LYMPHO drops
Reduction of local inflammation on lymphoepithelial tissues Reduction of lymphatic spasm on inflammatory basis with consequent restoration of the lymphatic circulation

Myosotis Equisetum Hydrocotile Taraxacum Sarsaparilla Lymphatic vessel Capillary tisssue L-Thyroxin Vena
REACTIVATION OF THE LYMPHATIC CIRCULATION

D-L Malic Ac./Fumaricum Ac./Pyruvicum Ac. Trychinoil/Natrium oxalac.

Lymphagogue action and stabilization of vasal walls tone with consequent reduction of exudate and lymphoedema

Calendula Phytolacca Apis Magnesia phosph.

ANTI-INFLAMMATORY ACTIVITY ON LYMPHOEPITELIAL TISSUES

HYPERTROPHY AND HYPERPLASY OF LYMPHATIC ORGANS

Hydrastis Juglans Graphites

STRENGHTENING OF THE IMMUNE DEFENCE

Humoral immunity stimulation and inhibitory modulation of the excessive cell mediated compensatory response

Hindrance to the proliferative proneness of lymphoepitelial tissues Magnesium phosphoricum Juglans regia
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TRAUMA
EXTERNAL CAUSES = MUSCULAR CONTUSION :

MUSCULAR MUSCULARLESIONS LESIONS

acute pain, swelling, hematoma

THERAPY

- GUNA-MUSCLE AMPOULES + GUNA-NEURAL AMPOULES - GUNA-TRAUMA DROPS - GUNA-MATRIX DROPS - GUNA-FLAM DROPS
DROPS: 20 drops 2 times a day

INTERNAL CAUSES =

MUSCLE ELONGATION

MUSCULAR CONTRACTION

STRETCHING

THERAPY
- GUNA-MUSCLE AMPOULES + GUNA-NEURAL AMPOULES - GUNA-TRAUMA DROPS - GUNA-LYMPHO DROPS
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TRAUMA
TENDONITIS: edema, heat, tendon stiffness tendonitis
tendosynovitis tendoperiostitis etc. THERAPY

TENDONITIS TENDONITIS

80% in Sport Medicine

1) CALCANEAL TENDONITIS:
- GUNA-HAND/FOOT AMPOULES - GUNA-MATRIX DROPS - GUNA-FLAM DROPS

2) BICIPITAL TENDONITIS:
- GUNA-SHOULDER AMP. + GUNA-MUSCLE AMP. - GUNA-FLAM DROPS - GUNA-MATRIX DROPS

3) TENDON PAIN FROM CASTS:

- GUNA-HANDFOOT AMPOULES - GUNA-MATRIX DROPS - GUNA-LYMPHO DROPS

4) PUBIC PAIN:
- GUNA-HIP AMPOULES - GUNA-FLAM DROPS - GUNA-LYMPHO DROPS - GUNA-MATRIX DROPS
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TRAUMA
- OSTEOBIOSTM DROPS - GUNA-ARTHRO DROPS - GUNA-MATRIX DROPS - GUNA-FLAM DROPS

FRACTURES FRACTURES
THERAPY

+ GUNA- .. AMPOULES according to the anatomic localization (e.g. fracture of femor neck: GUNA-HIP, fracture of hand bones: GUNAHANDFOOT)

DISLOCATIONS DISLOCATIONS
- GUNA-FLAM DROPS - GUNA-ARTHRO DROPS - GUNA-MATRIX DROPS - GUNA-LYMPHO DROPS - in case of shoulder dislocation: add GUNA-SHOULDER AMPOULES

THERAPY

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TRAUMA

PERIPHERAL PERIPHERALNERVE NERVELESIONS LESIONS

THERAPY

COMPRESSION SYNDROMES SPRAIN SYNDROMES POSTOPERATIVE PARESIS

(BRACHIAL PLEXUS)

- GUNA-NEURAL AMPOULES - GUNA-FLAM DROPS - GUNA-MATRIX DROPS - GUNA-TRAUMA DROPS

SYNDROMES SYNDROMESDUE DUETO TOHYPEREXTENSION-HYPERFLEXION HYPEREXTENSION-HYPERFLEXION

- GUNA-NECK AMPOULES - GUNA-THORACIC AMPOULES - GUNA-LUMBAR AMPOULES

THERAPY

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FIBROMYALGIA
Fibromyalgia syndrome is a very common chronic illness whose pathogenesis is not understood Women are more affected than men All races are affected All ages are affected

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FIBROMYALGIA
DIAGNOSIS: the patient has to constantly experience the symptoms for more than 3-4 months and have at least 10 Trigger Points at the 18 classic sites + disturbed sleep Commonly associated conditions: irritable bowel syndrome, migraine, depression, obstructive sleep apnea, general fatigue Underlying disorders need to be evaluated and treated: B12 deficiency D3 deficiency Autimmune disorders Chronic Infections: EBV, Lyme, Chronic Chlamydia Pneumonia, HHV6, Bartonella, Babesia..... LAB TESTS AND X-RAY: NEGATIVE FOR SPECIFIC DIAGNOSIS
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FIBROMYALGIA SYNDROME

LOCAL THERAPY

GUNA-MUSCLE + GUNA-NEURAL
2 ampoules (4 ml) + 1 ampoule (2 ml) = 6 ml

INTO EACH TRIGGER POINT: 0.5 ml TRIGGER POINTS INJECTED PER SESSION: 10 - 12 NUMBER OF SESSIONS: 8 - 10
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FIBROMYALGIA SYNDROME
HOME THERAPY

Example: GUNA-FLAM DROPS GUNA-MATRIX DROPS GUNA-SLEEP DROPS

15 drops 3 times a day 15 drops 3 times a day 15 20 drops a day 9am 3pm 9pm 9.30am 3.30pm 9.30pm 10.30 pm

Duration of the therapy: 2 months

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PAIN MANAGEMENT
Practical Application

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Indications
Acute and Chronic Pain
Ankles sprains, knee sprains, all joints

Trigger Finger, Trigger Thumb Tendinitis, Tendinosis Osteoarthritis, Rheumatoid Arthritis Neuralgias, CRPS Scars

4 Key Questions
Where to inject? What to inject? How to inject? How often to inject?

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Injection Techniques
Mesotherapy -- Intradermal Subcutaneously Intramuscularly

Mesotherapy
What is Mesotherapy? The injection of very small doses of medications; allopathic, nutritional, and homeopathic, directly into the target area with a sterile needle between 4mm and 13mm long (0.15 inches-0.5 inches)

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Mesotherapy
A medical technique developed in 1952 by Dr. Michel Pistor-a French Physician Dr. Pistor passed away in August 2003 Dr. Jacques Le Coz has carried on his work in teaching and promoting Mesotherapy It is widespread in Europe-most common approach in administering GUNA injectables

Dr. Pistor
His Philosophy was to inject little, sparingly, and at the right place. GUNA Method-follows the same

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Presumed Mechanism of Action

Local Action
Vasodilatation triggered by penetration of the needle in the skin. A reflex action which reduces the production of prostaglandins.

Regional Action
Mesotherapy has been shown to activate the largest AA-beta fibers

Central Action
A beneficial reflex of short duration which involves the spinal reflex circuit.

The injected product plays an essential role

Mechanism of Action
Large molecules and compounds that are strongly lipophilic are predominantly and slowly absorbed by the lymphatic system. Small molecules are absorbed mostly through the blood stream

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Mechanism of Action
The retention of the medication in the cutaneous and subcutaneous structures allows the medication to remain concentrated in the areas where the topical application was done. This local concentration of the medication and its limited diffusion cause a local pharmacologic action without notable systemic effect. After absorption of the medication into the circulation, the medication returns directly to the heart without passing through the liver.(Wepierre J. 1980)

Mechanism of Action
Dr. Pistor-introduce the medication as close to the target organ as possible.
Local ActionAction-superficial over achilles tendon Local Regional ActionAction-over kneeknee-substance injected later is found in joint fluid Regional ActionAction-Dr. PistorPistor-I do not know, but it works works-we now know more of how it works

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Important Concepts
EmbryologyEmbryology-structures are linked TensegrityTensegrity-cellular levellevel-Ingber/Harvard Ingber/Harvard BiostensegrityBiostensegrity-entire structure interrelated and interconnnectedinterconnnected-Levin PscyhoPscyho-NeuroNeuro-EndocrineEndocrine-Immunology Reciprocal relationship between structure and functionfunctionOsteopathy

Mesotherapy
MesoMeso-meaning middle because the target of the treatment is the middle layer. MesoMeso-meaning inin-between between intermediate modes of therapy between allopathy and homeopathy. MesoMeso-effective at the level of the skin and also on other tissues derived from the mesodermis (blood vessels, tendons, connective tissues, bone, muscle) Mesoderm: the middle layer of cells in embryonic development, gives rise to: muscles, bones and structures associated with reproduction. The middle embryonic tissue layer. Cells and structures arising from the mesoderm include: bone, blood, muscle, skin and reproductive organs.

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Results are Dependent on:

Depth of Injection Choice of Medications Patient and comorbid conditions-skin, circulation, lymph, toxic matrix

Skin Preparation
Alcohol 70% Biseptine (chlorhexidine gluconate and benzalkonium chloride)-effective against mycobacteria Hibiclens

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The 4mm needle

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Needles
Needles 4mm 6mm 13mm

27G 30G 32G

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Syringes
Choice of Syringe
1ml, 3ml, or 5ml Area to be treated Ease of use for the practitioner Use of an injection device (10ml syringe) Plunger should be made of rubber for ease of glide

Type of needle Select injection site according to acupuncture points, trigger points, tender points, referred pain zones, nerve key points, Head zones or local pain points. Using a 13 mm 30G, a 4 mm 27G, or an insulin needle, make the classic intradermal or subcutaneous injection according to mesotherapy technique.

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ANATOMICAL STRUCTURE OF AN ACUPOINT

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Mesotherapy Injection Area

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Injection Techniques
Intra-epidermal injection-IED (Nappage tremor) Superficial Intradermal injection-IDS (Nappage Bouncing) Deep Intra-dermal injection-IDP** Superficial injection
Point by PointPoint-PPP** Nappage (DallozDalloz-Bourguignon and Ravily) Ravily)

Deep Intra-dermal Injection-IDP*

These injections are administered at a depth of 1mm to 3mm without papule formation and the dosage can vary from 0.1ml to 0.2ml per point. This technique depends on how deep the lesion is--good for treatment of epicondylitis or Achilles tendinitis.

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Superficial Injection

Point by PointPoint-PPP* The doctor will carry out a traditional intradermal type of injection (similar to the TB test) by injecting between 0.05ml and 0.1ml of solution at each point.

Injection Techniques
IDP*-deep intradermal-no skin wheal PPP*-point by point-traditional intradermal-like Tb skin test with wheal SSS-superficial skin saturation (for the extremely needle phobic)

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Where to Inject?
Over spots you would do Prolotherapy Over Trigger points Over accupuncture points Over peripheral nerves Over nerve ganglia (stellate gangion) Over the painful tendons, ligaments, entheses, Over the painful joint Into and around scars

Therapeutic Mixture
1.

Acuteness/Severity of pain Duration of the pain Quality of the skin at the site of the lesion Complementary test results: x-rays or scan results for calcifications, decalcifications.

2.

3.

4.

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