CO2 Gas Injections (Carboxytherapy)

CO2 gas injections (carboxytherapy) involve the subcutaneous or intra-tissue injection of medical-grade carbon dioxide directly into painful areas. At Bolest Brno, the treatment is performed by the clinic's interventional algesiologists as part of the pain management programme. The physiological mechanism is well-documented: injected CO2 triggers a localised reflex response — blood vessels dilate, circulation increases, muscle spasm decreases, and local metabolic waste is cleared — all of which contribute to reduced pain intensity. Sessions are brief (around 15–20 minutes), and a course of 10 applications given 1–2 times per week is standard. At 150 Kč per application, CO2 injections represent one of the most cost-effective interventional options at the clinic and are often used as part of a multimodal treatment plan.

Carboxytherapy — the therapeutic use of injected medical CO2 — has a clinical history stretching back to the 1930s and has been used in European pain medicine, vascular medicine and aesthetic medicine for decades. At Bolest Brno, CO2 injections are applied in the pain medicine context: the CO2 is introduced directly into, or immediately adjacent to, the painful tissue structure — a joint space, a muscle belly, a trigger point, or a subcutaneous area above a painful site. **The physiological cascade:** Injected CO2 briefly acidifies the local tissue microenvironment. The body responds by: 1. Dilating local blood vessels (vasodilation) to buffer the acidity — increasing oxygen and nutrient delivery 2. Activating a local release of vasoactive mediators that reduce micro-vessel spasm 3. Mechanically disrupting fibrous adhesions and trigger-point nodules by the gas pressure 4. Triggering muscle relaxation as the spasm reflex is interrupted 5. Accelerating clearance of inflammatory mediators and metabolic waste products The net clinical result is reduced pain, improved local circulation, and decreased muscle spasm — typically perceived within one to three sessions in responsive patients. **Session structure:** Each application takes approximately 15–20 minutes. The practitioner identifies the target area through palpation and clinical assessment, prepares the skin aseptically, and uses a fine needle to deliver a controlled volume of pharmaceutical-grade CO2. The gas is rapidly absorbed by surrounding tissue — usually within minutes — and eliminated via normal respiratory exchange. Post-injection, patients may notice a mild pressure or tingling sensation at the injection site, which typically resolves within 20–30 minutes. **Course and frequency:** The standard protocol at Bolest Brno is 10 applications, given 1–2 times per week. In acute or subacute pain, twice-weekly sessions are preferred to accelerate the therapeutic response; in chronic or maintenance contexts, weekly sessions are more typical. Patients are reassessed at session 5 to evaluate progress. **Conditions:** Musculoskeletal pain with a significant component of vascular insufficiency or muscle spasm, chronic low-back pain, myofascial pain syndromes, periarticular pain, conditions where increased local circulation is therapeutically beneficial. CO2 injections are not typically used as a standalone treatment but as a component of the clinic's broader multimodal pain management approach. **Safety profile:** CO2 is a naturally occurring metabolic gas and is not toxic at the volumes used therapeutically. The most common side effects are localised bruising at the injection site (resolving within a few days) and a brief cramping sensation during gas absorption. Serious adverse events are rare in experienced hands. **Contraindications:** Recent myocardial infarction, severe cardiac arrhythmia, pulmonary embolism, severe respiratory compromise, active thrombophlebitis, known CO2 hypersensitivity, pregnancy.