Homeopathic Injections for Chronic Pain: A Clinical Perspective on Trigger Point and SC Methods

Bill Caradonna, R.Ph., ND

A seasoned naturopathic physician shares a two-decade clinical perspective on using homeopathic injectables for musculoskeletal and nerve-related pain—highlighting practical methods, success rates, and training options.

Abstract

This article presents a two-decade clinical overview of using homeopathic injectables to treat chronic musculoskeletal and nerve-related pain. Drawing from extensive experience and training originally inspired by Dr. Rick Marinelli, the author outlines effective use of trigger point (TP) and subcutaneous (SC) homeopathic injections as a low-risk, highly successful modality for pain resolution. The article reviews injection techniques, safety considerations, remedy selection, and conditions treated—including sciatica, joint pain, neuropathy, frozen shoulder, and smooth muscle cramping. Emphasis is placed on the holistic mechanisms of homeopathic formulations, which offer anti-inflammatory and tissue-regenerative effects without the adverse consequences of NSAIDs or corticosteroids. With an estimated 90% success rate and growing demand, this therapeutic approach is presented as a practical, teachable, and underutilized solution for naturopathic physicians and integrative practitioners managing chronic pain conditions.

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Introduction

Like many doctors, I often encountered patients suffering from musculoskeletal pain who had tried a variety of allopathic and natural treatment modalities with limited or no success. In many cases, I too was unsuccessful in helping them. I had heard of homeopathic injections but had no exposure to them. My practice was not focused on procedures, nor did I possess specialized physical medicine equipment. However, my strong desire to help patients in pain led me to explore this treatment approach.

My introduction to homeopathic injections came in 2002, during a weekend seminar in Portland, OR, led by Rick Marinelli, ND (1955-2013), a pioneer in naturopathic pain management. The seminar focused on trigger point (TP) and subcutaneous (SC) injections using both anesthetics and homeopathic formulations. I quickly realized that the homeopathic effect – its ability to stimulate the body’s natural healing processes –was a game changer. Fast forward 20 years,  and I now have a syringe in my hand for much of the day. I estimate a 90% success rate in resolving difficult pain conditions, aside from a few occasional obstacles to cure. I’ve refined these injection methods to be low-risk, easy to learn, and straightforward to apply using basic guidelines. They function as stand-alone treatments, with no need for additional specialized ingredients or supportive supplements in most cases. Once evaluation and management have been assessed, they do not require any office treatment time outside of performing the injections. While standard familiarity with muscle and nerve anatomy and function is important, no memorization of specific nerve pathways is necessary. If dealing with a referred pain syndrome, many Trigger Point references are available, including on smartphone apps. Motivated by a desire to share this effective approach, I have trained approximately 100 doctors over the past decade in small-group, hands-on tutorials using the modified techniques I developed.

In my practice now, patients come in specifically for these treatments. For a general practitioner, while patients may have other presenting complaints, an intake review will often reveal additional musculoskeletal issues. Also, once a primary pain complaint has been treated and resolved, I will often be asked, “Can you fix this too?” The satisfaction of successfully treating these conditions is enormous. Especially rewarding to me is the ability for the patient to discontinue chronic analgesic use such as ibuprofen and/or acetaminophen.  Referrals not only come from word-of-mouth and website information, but also from other practitioners. When a practitioner is facing a lack of success or plateau of improvement and refers a patient to me, this reflects positively on them as the patient is happy to have found a solution due to their recommendation. Once improved, I can then refer the patient back to them for long-term support. Also, I have treated many practitioners for symptoms they have acquired due to their practice or other injuries, allowing them to continue to practice unimpeded. 

WHAT ARE TRIGGER POINTS?

Trigger points are muscle locations that trigger pain, whether directly or referred. A trigger point is defined as a hyperirritable region in a skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band of tense muscle fibers. These are often referred to as “contraction knots”. This location is painful on compression. Underlying mechanisms of formation have been elucidated. This includes sustained contractions, local acidosis, and decreased circulation, resulting in hyperpolarization of the motor neuron membrane, causing failed reuptake of calcium into the sarcomeres. Finding exact Trigger Points requires eliciting a “Twitch Response” in the muscle, either by inserting a needle in the muscle until the muscle fires or fasciculates, or manually through cross-fiber manipulation of the muscle fibers. This response requires an intact motor neuron. Traditional TP injections require injections deep into the muscle belly, and most often, a volume of fluid surrounding the point.^1-4

The anatomical design of the body is responsible for many painful locations in a predictable manner. This understanding and palpation skills are all that are needed to identify the treatment areas. And yet, I never find these treatments routine. Often, successful injection treatments involve thought processes that are rich in understanding the relationships between the muscles and joints. Except in a few conditions, this goes beyond “recipe” treatments into treating the individual. TPs responsible for referred pain are important to identify, especially when the specific pain location is treated without success.

INJECTION METHODS AND INGREDIENTS

Traditional injection ingredients include an anesthetic (usually Lidocaine or Procaine) and/or bulking agents such as Sterile Water or Normal Saline. These can be used successfully, but in my experience, not to the degree of using homeopathic products. Dry needling has also been used as a mechanical method to break up the TP, but it is not superior. It also results in a significant amount of post-treatment pain, as demonstrated in a comparison study with 58 patients.⁵ Aggressive acupuncture needle stimulation into meridian points and ah shi (“other”) pain points is also designed to trigger fasciculations and relax the muscle. When using homeopathic injection ingredients, the injection techniques required become much simpler since the homeopathics seem to work from the general site of administration. The need to identify the exact trigger point becomes less relevant, as do deep injections. The lack of a localized twitch reaction does not reduce the effectiveness of the treatment. While oral/sublingual remedies make up the majority of homeopathic use,  in the case of these musculoskeletal trigger points, oral forms lack the concentrated ability to provide immediate or rapid remediation.

Homeopathic low-dose complex remedies have a long history of use in Europe and have a high safety profile. A 2011 study tallied a 9-year total of an average of 33.6 million ampules used annually, with 70 ADR cases reported. The reactions primarily were puritis, localized erythema, hematuria, pain, and allergic reactions. These were classified as “Very Rare.”⁶ Effects of stimulating the body to heal are proven in my office daily using these products. In some of these combinations, mechanisms of action have been elucidated, and successful studies have been performed in comparison to a placebo or to other drug products.  A double blind crossover study was performed evaluating intra-articular applications against a placebo.^7-8 

In June of 2020, the FDA prohibited the commercial sale of ampules as the first salvo on declared intentions of limiting homeopathic products in the US.⁹ Products are still available through imports to individual practitioners via third-party pharmacies

The homeopathic injection remedies are all low dilution forms, and most often have multiple ingredients. The muscle pain/spasm products approach is most often constructed to provide global support. This can include a spectrum of muscle relaxation, inflammation modulation, increased circulation, and decreased nerve pain. It is important to point out the benefit of an inflammation modulator, not an anti-inflammatory.  An in vitro mechanism of 50-70% action in lymphocyte cultures for anti-inflammatory effects was elucidated.¹⁰ Since some inflammation is required for healing, they have none of the catabolic negatives of NSAID drugs or Cortisones. Some of these product ingredients include catabolic negatives of NSAID drugs or Cortisones. Some of these product ingredients include Arnica M, A. Belladonna, Hepar S., Aconitum N., Hypericum P., Bellis P., Echinacea A. & P., and Achillea M. Lymph formulas are often used in combination, as it helps detox the extracellular matrix, which further facilitates healing.

I had used Lidocaine and Procaine in TP injections primarily because it is the medically accepted standard. While these products seem to be a good idea, I have no difference in results when not including either in the injections. When injecting major muscle groups around an arthritic joint, I will include other products that are helpful in arthritic conditions. There are also formulations for disc support, cartilage/connective tissue support, and specific arthritic problems.

Whether pain issues are acute or present for decades makes little difference overall in treatment success. Progressive improvement occurs with repeated injections in primary issue locations, then also expanding the treatments to collateral/compensatory muscles. The modification of the TP injections also includes treating all parts of the muscle where neuromuscular tension is present, rather than just specific TPs. This results in a proper, holistic approach to correcting the painful condition. Because of the homeopathic ability to perfuse tissues, deep injections are not required. This significantly reduces any risk of injection injury.  Once significant progress has been made, patients can be referred back to massage therapists, chiropractors, acupuncturists, and physical therapists for more global support and correction of long-term issues that may further contribute to problems. After the homeopathic injection procedures, they are then able to be more successful. 

TRIGGER POINT IM INJECTIONS:

Musculoskeletal injections with homeopathics for relieving acute and chronic neuromuscular tension and inflammation are successful in most major problem areas. This includes exercise-induced muscle damage. It has been seen as a successful alternative to NSAID and corticosteroid use.^11-13 Low back pain, SI & hip pain can all be effectively treated. Sciatica/pseudosciatica particularly responds well when treating regions around the lumbar/SI/gluteus nerve pathways. Leg regions, including IT bands, hamstrings, and calf muscles, relax with the injection therapy. Leg cramping will often resolve. Upper back pain involving the trapezius and rhomboid muscles will most likely be lessened and relieved. Shoulders are particularly interesting as, due to the 360-degree range of motion, most muscles around the joint will need to be addressed. Frozen shoulder, though a more difficult condition, can often be resolved. Upper arm pain is mostly successfully addressed by treating trigger points in the infraspinatus muscles. Torso/rib strains with shallow intercostal injections relax and heal quickly.

THERAPEUTIC SUBCUTANEOUS INJECTIONS:

Therapeutic subcutaneous injections are an equally impactful approach. I use these around and over joints or tissues that are insufficient to inject into. Again, the effects are enormously helpful. Cervical complaints are common and addressed appropriately by these SC injections. I have treated multiple “bone on bone” joints with great success using arthritic and cartilage support products. No intraarticular injections are needed. Also, injecting SC over vertebrae that have arthropathies or disc issues with arthritis and disc formulas are effective ways to correct all manner of these conditions. The muscle relaxation alone around a vertebral segment with disc degeneration or displacement is often helpful, as the reduced tension likely alleviates nerve pressure. I have usually treated peripheral neuropathies successfully by treating around the nerve root. Acute joint strains/sprains (including knees, elbows, and ankles) can quickly and effectively be improved and resolved. The lymph formula is also effective in reducing edema. Plantar Fasciitis also responds dramatically to SC injections around the lateral and medial edges of the foot. Acute gout episodes can be controlled. Carpal Tunnel Syndrome can be improved or resolved, with patients often avoiding surgery. Other wrist, hand, and finger issues respond well to SC treatment. 

Another stunningly effective SC treatment is for smooth muscle cramping. Providing small needle subdermal injections for abdominal or menstrual cramps rapidly improves and resolves the episode. Retreatment may be needed the next day, but any return of symptoms is much milder. Along with a liver formula, biliary colic responds well to the smooth muscle spasm formula. A congested liver condition can be supported by subcutaneous injections of a liver formula over the organ region. Headaches and migraines can be relieved quickly and significantly with the use of the smooth muscle and headache formulas by providing SC injections along the involved head areas. Acute sinus pressure can be relieved by SC injections with a sinus formula over the symptomatic areas. One of the most significant treatments involves lymphatic congestion. SC injections with a lymph formula over a lymph chain will decrease the gland swelling significantly by the next day. I find this particularly helpful when patients have submandibular lymph swelling along with head congestion. Relieving this blockade allows the congestion to drain and provides for faster resolution of cold symptoms. I recently successfully treated a case of significant axillary lymph swelling, still present two weeks post-COVID-19 upper arm vaccination shot. 

TRAINING:

My reason for writing this article is to alert NDs to this highly effective modified injection method. A small group, concise tutorial training method is very effective, especially when a live patient supervised injection practicum is included. Over time, multiple methods of injection training have become more available, including intraarticular injections, prolotherapy, PRP, ozone, and IVs. With doctors who have had this expanded experience, video instruction would be sufficient to ensure proper injection methods, allowing for distance learning opportunities.

Disclaimer: The author has no financial or professional association with any injectable products or companies mentioned in this article.

References

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4. Barker, J., Pavone, S., Pain Medicine/Trigger Point Therapy, NDNR July 15, 2008 P.14-15
5. Hong CZ: Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response, Am J Phys Med Rehabil 73:256-63, 1994.
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7. Lozada CJ, del Rio E, Reitberg DP, Smith RA, Kahn CB, Moskowitz RW. A double-blind, randomized, saline-controlled study of the efficacy and safety of co-administered intra-articular injections of Tr14 and Ze14 for treatment of painful osteoarthritis of the knee: The MOZArT trial. Eur J Integr Med 2017;13:54-63. DOI: 10.1016/j.eujim.2017.07.005;
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9. https://www.raps.org/news-and-articles/news-articles/2020/6/producers-of-four-homeopathic-injectables-warned-b
10. Porozov S et al. Inhibition of IL-1b and TNF-a Secretion from Resting and Activated Human Immunocytes by the Homeopathic Medication Traumeel. Clin Dev Immunol 2004; 11(2):143-149.
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12. Muders K, Pilat C, Deuster V, et al. Effects of Traumeel (Tr14) on exercise-induced muscle damage response in healthy subjects: a double-blind RCT. Mediators of Inflammation. 2016;2016.
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