Perineural Injection Therapy (PIT) for Pain

Perineural Injection Therapy (PIT) targets painful and swollen peripheral nerves with buffered dextrose 5% in sterile water (D5W) resulting in instant analgesia, reduced swelling and improved functional mobility.

What is Perineural Injection Therapy (PIT)?

Perineural Injection Therapy (PIT) is a safe and effective, non-pharmaceutical injection therapy for the treatment of acute and chronic pain.  Perineural injection therapy (previously known as Neural Prolotherapy - NPT) was discovered and developed by the clinical observations of Dr. John Lyftogt, MD in Christchurch, New Zealand.   PIT therapy is based on anatomical palpation of swollen and painful peripheral nerves.  If the peripheral sensory nerves are swollen and painful on palpation, this is an indication to treat with PIT.

What solution is injected?

PIT involves the injection of a low concentration sugar solution around inflamed pain sensitive nerves that are causing chronic pain.  Dr. Moss uses buffered D5W (dextrose 5% in sterile water) with a neutral pH of 7.4.

What happens during a PIT treatment?

Dr. Moss begins your treatment by taking a thorough history of your condition. This is followed by a physical exam to further identify the areas involved with your pain.  The treatment consists of a series of superficial injections, using a very fine needle, near the nerves that transmit pain.  Pain relief is often felt within seconds.   

How many injections can I expect to receive?

If you have a large area of pain, then more nerves are involved and you will receive more injections in order to resolve your pain.

How long does pain relief last?

You should be pain free for 4 hours to 2 weeks after your initial PIT treatment.  This is important to remember as almost certainly your pain will recur to some extent at first, and each time you come for this treatment the pain should go away for longer and longer periods.  We suggest 3 treatments not too far apart initially to see if this is an effective method for you; if you are responding we then usually lengthen the time between appointments until you are pain-free or much improved.  After each PIT treatment you will need fewer injections and your pain relief will last longer.

How often are PIT treatments recommended?

PIT treatments are most often given once a week.  

How many PIT treatments will I need?

The number of treatments will depend on the specifics of each case, however the average number of treatments is 4-8. 

How does Perineural Injection Therapy work?

PIT does not target tendons, ligaments or joints, but treats the nerves associated with painful areas.  Dr. Lyftgot’s working hypothesis is that glucose solutions help to repair inflamed nerves.  These inflamed nerves under the skin are known to cause chronic painful conditions called ‘neuralgias’ or ‘neuropathic pain’ or commonly known as ‘chronic pain’.  There is evidence that the nerves responsible for muscle, ligament and tendon are inflamed and swollen, and therefore are preventing the healing of these structures.  

What conditions may benefit from Perineural Injection Therapy?

Most painful conditions respond to these injections to some extent but they are exceptionally effective for treating pain due to nerve irritation.  This may be known as neuralgia, neuropathy, neurogenic pain or just "nerve pain" which is usually burning or sensitive.  It is also very effective for painful scars.

Some conditions treated with PIT include: headaches, migraines, post-herpetic neuralgia, fibromyalgia, neck pain, shoulder pain, elbow pain, wrist pain, hand pain, lower back pain, hip pain, knee pain, foot pain, ankle pain; tendonitis, achilles tendinopathy, osteoarthritis, bursitis, muscle strains, ligament sprains; whiplash injuries and sports injuries.

How can I learn more about PIT?

Learn more from the following resources:

• Neural Prolotherapy article in the Journal of Prolotherapy

• The founder of PIT - Dr. John Lyftogt's website

• Dr. K. Dean Reeves, MD - PIT and Prolotherapy information

• Therapeutic Injection of Dextrose by Dr. Reeves, MD and Dr. Rabago, MD

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PIT RESEARCH - Here are links to Perineural Injection Therapy research:

• Dr. Lyftogt has compiled a list of PIT research papers (RCT's), case histories and relevant research articles.   You may link to his web page here to read more.

• Effect of Perineural Injection Therapy in moderate and severe knee Osteoarthritis; a comparative study

• Perineural Injection Therapy in the Management of Complex Regional Pain Syndrome: a sweet solution to pain published in Pain Medicine October 2017

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Dr. Lyftogt explains:

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Because Neural Prolotherapy does not target tendons, ligaments or joints the question had to be asked what causes the sometimes dramatic decline in pain levels after even a few treatments.

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A working hypothesis was developed that glucose targets glucose-sensitive pain nerves called nociceptors located in nerve trunks immediately under the skin.  These nerve trunks may contain up to 30,000 small nerve fibres per mm2. Half of these small nerve fibres are a variety of 'pain nerve fibres', technically known as sensocrine nociceptors.  When injured these sensocrine nociceptors are thought to be responsible for painful conditions described as 'neuralgias' or 'neuropathic pain' or more commonly as 'chronic pain'.

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The protective sheath of the nerve trunk is structurally very similar to tendons and ligaments.  It protects small nerve fibres inside the nerve trunks from injury, friction and pressure.  Nerve trunks have their own nervous innervation, called 'Nervi Nervorum'.

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The very small nerve fibers, innervating the nerve trunk, identified as unmylenated C-fibers or 'Nervi Nervorum' are responsible for pain and swelling of the protective sheath of the nerve trunk.  This was already demonstrated 125 years ago by Professor Marshall from London and called neuralgia.  It is now called 'neurogenic inflammation'.

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It is also know that this 'neurogenic inflammation' differs from other forms of inflammation in that it does not respond to anti-inflammatory drugs or cortisone injections and this is the reason why these commonly used drugs are proving to be ineffective in many painful conditions.  In addition, there is a growing awareness that cortisone and anti-inflammatory drugs are associated with a variety of harmful side effects.

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It is clear from clinical observations on more than five thousand patients and large case series that Neural Prolotherapy effectively reverses 'neurogenic inflammation' and resolves 'neuralgia' and 'neuropathic' or chronic pain.

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After the success of Neural Prolotherapy with Achilles tendonitis, other persistent painful conditions of the neck, back, shoulders, elbows, wrists, knees, ankles and feet have been effectively treated by targeting the local inflamed and painful superficial nerves with micro-injections of low dose Glucose.

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Neural Prolotherapy is an effective, novel and evolving treatment for non-malignant persistent pain, based on sound neuroscientific principles.

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For a practitioner to be effective in treating persistent pain the first requirement is the ability to make an accurate neuro-anatomical diagnosis and secondly combining this diagnosis with training in specialized clinical skills.  This knowledge and skill can only be obtained by attending specific workshops in Neural Prolotherapy.  Most Doctors who have attended these workshops will develop confidence and experience over time.  It will allow them to approach most chronic painful conditions with understanding and competence.

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The veil surrounding the mystery of persistent pain is lifting in the 21st century.  

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