Alcohol sclerosing injections Vs Alcohol neurolytic injections
Not all Alcohol injections for Morton’s neuroma are the same.
Is there a difference? If so, what’s the difference? Is it important?
Yes, There is a difference and yes it is very important.
There are 2 types of alcohol injections for Morton’s neuroma:
1. Alcohol sclerosing injections
This is the “typical” alcohol sclerosing injection done by many podiatrists. This is usually done with a very low concentration of alcohol (usually around 4% alcohol) which is blindly injected into the neuroma and frequently repeated for four, five or six times. We believe that this type of injection has little effect and only results in scar tissue growth and greater discomfort for the patient. However for reasons we cannot understand, it is commonly done.
2. Alcohol neurolytic injections
The second type of alcohol injection is a neurolytic alcohol injection done with much higher concentrations of alcohol. (We use more than 10 times the dose of the sclerosing injection.) In effect these injections deaden the neuroma and completely remove the neuroma’s ability to transmit pain and stop the neuroma from growing. Since these injections are done with much higher alcohol concentrations, they should always be done under Ultrasound guidance by clinicians who are highly experienced in doing these. They are very effective and recent research shows that they have over 85% efficacy. We believe the efficacy of these is even higher when done by an experienced clinician under ultrasound guidance. This injection may shrink the neuroma but that is unlikely – it just kills it and usually results in very little complications aside for some minor numbness which is less than the size of a penny in the webspace. The numbness lasts about 6 months.
Usually one or two injections are required for full pain relief and then the pain relief is usually permanent. Rarely, the nerve can regrow and it may become irritating or painful again although if that occurs it’s usually after 6-8 years and then it requires a single repeat neurolytic injection.
To read the medical studies on the effectiveness of neurolytic injections for Morton’s neuroma click here.
Don’t Suffer Any Longer…
Janet D. Pearl, MD, MSc is the Medical Director of The Center for Morton’s Neuroma and Complete Spine and Pain Care, an interventional and integrated Pain Management program located in Framingham, Massachusetts. Previously, Dr. Pearl was the Co-Director of the Pain Management Center at St. Elizabeth’s Medical Center, where she was also the Director of the Fellowship program. She is the former Director of a satellite pain center of the Brigham and Women’s Hospital, Pain Management Center, located at the HealthSouth Braintree Rehabilitation Hospital. Dr. Pearl held academic appointments at Harvard Medical School and Tufts Medical School. She serves on the Health Care Services Board of the Commonwealth of Massachusetts Department of Industrial Accidents since 2000 as one of its physician representatives and is Chair of the Committee on Pain Management.