Perineural Injection Therapy: A New Tool for Chronic Pain Management at Symmetry Wellness Centre

I'm excited to share that Dr. Paige Weatherbee-Sakr has expanded her therapeutic offerings to include Perineural Injection Therapy (PIT)—a specialized treatment approach for chronic nerve-related pain. As naturopathic physicians, we're always seeking evidence-informed therapies that address the root causes of our patients' concerns while supporting the body's inherent healing capacity. PIT represents an excellent addition to the comprehensive care we provide at Symmetry.

Understanding Neurogenic Inflammation

When we think about pain, we often focus on tissue damage—injured muscles, inflamed joints, damaged ligaments. And certainly, addressing these tissue-level concerns is crucial. However, there's another important component to chronic pain that we sometimes overlook: the nervous system's own inflammatory response.

When peripheral nerves are compressed, stretched, or injured, they don't just passively transmit pain signals—they actively generate inflammation themselves. This neurogenic inflammation involves the release of neuropeptides like substance P, which perpetuate pain signaling and maintain inflammatory processes even after the original tissue injury has healed.

This is why some patients continue experiencing pain long after we'd expect tissues to have recovered, and why that pain often has a distinctive nerve-related quality: burning, tingling, electrical sensations, or hypersensitivity that seems disproportionate to findings on physical examination.

What is Perineural Injection Therapy?

Perineural Injection Therapy involves the subcutaneous injection of a dilute 2% procaine solution immediately adjacent to superficial nerves that are inflamed or irritated. The mechanism isn't fully understood, but research suggests that the procaine solution may help restore normal nerve function by addressing neurogenic inflammation and supporting nerve healing.

The treatment is quite gentle—injections are shallow, using small volumes just under the skin along the pathway of affected nerves. It's not a deep tissue injection, and it's generally well-tolerated with minimal discomfort.

When Might PIT Be Appropriate?

From a naturopathic perspective, PIT is most valuable when we've addressed foundational concerns—nutrition, inflammation, digestive health, stress—but patients still experience persistent neuropathic pain that limits their function and quality of life.

PIT may help patients experiencing:

• Chronic pain with neuropathic characteristics (burning, tingling, shooting, electrical quality)

• Pain that follows specific nerve distributions

• Superficial pain caused by nerve compression from underlying structural issues

• Chronic headache patterns involving nerve irritation

• Pain that has persisted despite other appropriate interventions

It's particularly effective for conditions where we can identify specific superficial nerves that are contributing to the pain pattern—occipital neuralgia, certain types of chronic neck and shoulder pain, lateral hip pain involving the lateral femoral cutaneous nerve, and various other presentations where nerve involvement is clear.

The Naturopathic Principle: Treat the Cause

It's worth noting that PIT doesn't replace our commitment to identifying and addressing root causes. If nerve inflammation is occurring, we still need to ask why. Is there structural compression that needs osteopathic or chiropractic attention? Is there systemic inflammation that requires nutritional intervention? Are there biomechanical issues that need physiotherapy? Is there fascial restriction that massage therapy could address?

PIT supports the nerve's healing while we continue addressing these underlying factors. It's not a standalone solution but rather one component of comprehensive care.

Clinical Considerations

Treatment protocols are individualized, but typically involve a series of sessions—often 4 - 8 treatments initially, though some patients respond more quickly. Response is usually gradual, with incremental improvement over several weeks as neurogenic inflammation reduces and normal nerve function is restored.

PIT works alongside other treatments. Patients continue with their physiotherapy, osteopathic care, acupuncture, massage, and naturopathic protocols. This collaborative approach is what creates the best outcomes.

Is PIT Right for You?

Dr. Weatherbee-Sakr is offering free consultations to help patients understand whether this therapy might be appropriate for your specific situation. As always, treatment decisions are made collaboratively, with full consideration of each person's unique health picture, goals, and values.

Moving Forward

The addition of Perineural Injection Therapy strengthens the already comprehensive toolkit available at Symmetry Wellness Centre. It represents another way we can support those dealing with complex chronic conditions—combining cutting-edge therapeutic approaches with the time-tested naturopathic principles of treating the whole person and supporting the body's healing capacity.

If you have questions about PIT or want to discuss whether it might benefit you, please reach out to Dr. Weatherbee-Sakr or book a free consultation.

How Your Menstrual Cycle Changes in Perimenopause - and Why tracking It Matters

Perimenopause is not a single moment—it’s a multi-year hormonal transition that unfolds in stages. One of the earliest and most reliable clues that you’ve entered this phase is a change in your menstrual cycle.

www.helloclue.com

Understanding how your cycle is changing can help you:

• Identify where you are in the menopausal transition

• Understand the hormonal patterns driving your symptoms

• Choose the most appropriate treatment strategy for your body

• Decide whether testing may be helpful (especially if you don’t bleed due to an IUD)

Let’s break down what’s normal, what’s not, and how tracking can guide care.

The First Sign of Perimenopause: A Changing Cycle

In your reproductive years, your cycle is typically predictable—often within a 2–4 day window each month.

In early perimenopause, the defining change is:

A cycle that shifts by 7 days or more—earlier or later—compared to your usual pattern.

This may look like:

• A period arriving 7–10 days earlier than expected

• A cycle that suddenly stretches 1–2 weeks longer

• Month-to-month unpredictability

This is often driven by inconsistent ovulation, fluctuating estrogen, and rising progesterone deficiency.

Later Perimenopause: Longer Gaps Between Periods

As you move further into the menopausal transition, the ovaries begin to respond less consistently to brain signals.

In later-stage perimenopause (which may last 1–3 years), you may notice:

• Skipped periods

• Cycles that stretch beyond 60 days without bleeding

• Heavier or prolonged bleeding when periods do return

At this stage, hormone fluctuations are more extreme, and symptoms such as hot flashes, sleep disruption, anxiety, and heavy bleeding often intensify.

Why Cycle Tracking Is So Powerful

Tracking your cycle is not just about dates—it helps determine:

1.  Where you are in the transition

• Shorter or variable cycles → earlier perimenopause

• Long gaps (>60 days) → later perimenopause

2.  Which treatment options may be most supportive

For example:

• Heavy + more frequent periods
  → often seen in early perimenopause
  → a hormonal IUD may be a helpful option if blood loss is leading to other issues and can’t be controlled naturally - ie. anemia!

• Heavy + infrequent periods
  → often seen in later perimenopause
  → an IUD may not be the best fit if the heaviest is infrequent and menopause is now expected in 1-3 years version who knows how many years!
  → other hormone or non-hormonal strategies may be more appropriate

Without tracking, these patterns are easy to miss—and treatment choices may not match your true hormonal stage.

What If You Don’t Get a Period Because of an IUD?

If you have a hormonal IUD and no longer bleed, cycle tracking isn’t possible—but this is when lab testing can help.

FSH Testing in Perimenopause:

FSH (follicle-stimulating hormone) rises as the ovaries become less responsive. In late-stage perimenopause and menopause:

• FSH levels are often consistently above 25 IU/L

To confirm a menopausal transition when cycles are absent:

• Two FSH levels >25 IU/L

• Drawn at least 3 months apart

This can help determine:

• Whether you are still in perimenopause

• Whether you may be transitioning into menopause

• Which therapies are safest and most appropriate

The Takeaway

Your cycle is one of your most valuable hormonal data points.

Whether you’re:

• Noticing unexpected changes

• Skipping periods

• Bleeding more heavily

• Or no longer bleeding due to an IUD

Tracking (or testing when needed) allows us to:

• Identify your stage

• Understand your symptoms

• And personalize your treatment plan

Perimenopause is not something to “wait out.” With the right insight, it can be navigated with clarity and confidence.

The Core 4: A Simple Formula for Balanced, Energizing Meals

If you’ve ever felt overwhelmed by nutrition advice, you’re not alone. Between macros, calories, food rules, and trending diets, eating well can feel complicated and stressful.

That’s why I teach my clients a simple, sustainable framework called The Core 4.

It’s not a diet. It’s not restrictive.

It’s a way to build meals that support your blood sugar, energy, digestion, hormones, and long-term health — without overthinking.

Let’s break it down.

What Is the Core 4?

The Core 4 means including four essential components at every meal:

1. Protein

2. Carbohydrate

3. Fat

4. Colour (fibre + phytonutrients)

When these four are present, your meal is far more likely to:

• Keep you full and satisfied longer

• Prevent blood sugar crashes

• Reduce cravings

• Support energy and mood

• Promote stable metabolism

This is the foundation I use in clinical practice and with those that struggle with cravings, low energy, high blood sugar, weight loss goals and much more!

1. Protein – The Muscle builder & Blood Sugar Anchor

Protein slows digestion, stabilizes blood sugar, and supports muscle, hormones, and immune health.

Examples:

• Chicken, turkey, beef, fish

• Eggs

• Tofu, tempeh, lentils, beans

• Greek or dairy-free yogurt

Aim for a palm-sized portion at meals.

2. Carbohydrates – Your Brain & Body’s Preferred Fuel

Carbs are not the enemy — they are your primary energy source. The key is choosing whole, fibre-rich carbs and pairing them with protein and fat.

Examples:

• Rice, quinoa, oats

• Potatoes, sweet potatoes

• Whole grain bread, pasta

• Fruit

Think one cupped hand per meal.

3. Fat – For Hormones, Satiety, and Brain Health

Fat helps you absorb fat-soluble vitamins and keeps you satisfied.

Examples:

• Olive oil, avocado

• Nuts, seeds, seed butters

• Butter, ghee, coconut milk

Aim for a thumb-sized portion.

4. Colour – Fibre, Antioxidants & Gut Support

This is where your vegetables and fruits come in. They provide fibre for digestion and phytonutrients for inflammation, immunity, and hormone balance.

Examples:

• Leafy greens

• Bell peppers, carrots, tomatoes

• Berries, apples

Fill at least half your plate with colour.

What Happens When You Skip One?

Skipping a Core 4 element often leads to:

• Blood sugar spikes and crashes

• Energy dips

• Increased cravings

• Feeling “snacky” shortly after eating

That’s why you may feel hungry again an hour after toast alone — but not after toast with eggs, avocado, and berries.

A Simple Core 4 Example:

Breakfast:

• Scrambled eggs (protein)

• Whole grain toast (carb)

• Avocado (fat)

• Berries (colour)

Dinner:

• Salmon (protein)

• Rice (carb)

• Olive oil drizzle (fat)

• Roasted broccoli + peppers (colour)

The Takeaway

Healthy eating doesn’t need to be complicated.

When you build meals using the Core 4, you naturally support:

• Blood sugar balance

• Energy

• Hormones

• Digestion

• Long-term metabolic health

No tracking. No perfection. Just balanced meals, consistently.

If you want a more personalized plan to support your weight, blood sugar, cholesterol or cravings reach out! Or follow me on Instagram for simple, evidence-based nutrition tips.

Fall Sheet Pan Sausage and Veggie Meal

This time of year I love warming bowls and easy meals. This combines the two together as it is a sheet pan meal that mixes fall flavours together while providing a good amount of protein and fibre. You can use any hearty vegetable you want. I just had all these vegetables to use up.

Ingredients:

• 4-5 Italian chicken (or pork) sausage, chopped into smaller pieces

• 1 sweet potato (medium or large), peeled and cubed

• 1-2 cups butternut squash, cubed

• 1.5 cups cauliflower florets

• 1 cup baby potatoes, halved

• 2 small beets, cubed

• 1 cup Brussels sprouts, sliced in half

• 2 big handfuls chopped kale

• goats cheese, to taste

• 2 tbsp olive oil

• 1 tsp garlic powder (I only estimated)

• 1 tsp smoked paprika (or regular paprika)

• 1/2 tsp dried thyme, oregano or herbs de provence

• salt and pepper

Directions:

1. Preheat oven to 425F.

2. Toss the hard veggies first: In a large bowl, combine sweet potatoes, beets, squash and baby potatoes. Drizzle with 1.5 tbsp olive oil, half the seasoning, salt and pepper. (Tip - keep beets separate if preferred as they can tint other veggies slightly.)

3. Spread on a parchment-lined sheet pan and roast for 20 minutes.

4. Add cauliflower, Brussels sprouts and sausage to the pan (or use a second pan and scatter sausage on both). Drizzle with the remaining olive oil and seasoning. Toss lightly to mix.

5. Return to the oven and roast another 15-20 minutes, until all veggies are tender and caramelized and the sausage is browned.

6. While cooking, lightly sauté kale with a little olive oil and salt until slightly wilted. OR, massage kale with a little olive oil and salt add to pan out of the oven.

7. Optional - sprinkle crumbled goat cheese or parsley on top before serving. Yum!

Enjoy!