Perineural Injection Therapy
Another therapy I enjoy using, often in conjunction with acupuncture and/or bodywork, is called perineural injection therapy, or PIT. I was not initially attracted to injection therapies of any sort - in theory, I found them too invasive and didn't understand how they fit into a naturopathic model of health. I was more interested in food, herbs and homeopathy. However, during my 4th and 5th years of study, I watched with my own eyes how well PIT worked for a variety of patients while completing observation rounds with Dr. Edythe Vickers. In 2018, I was trained by Dr. John Lyftogt,* founder of perineurial injection therapy.
Perineural injection therapy is a 5% dextrose (glucose) solution that is injected near superficial nerves. When a nerve is injured, inflamed and lacks glucose, it sends continuous signals that the body interprets as pain. The superficial nerves communicate with the deeper nerves and muscles and therefore by treating the superficial nerves, PIT treats the entire muscular-neuro-vascular bundle.
Dr. Lyftogt discovered that these injured nerves can be treated with dextrose, which is a naturally occurring carbohydrate utilized by our body for energy. Dextrose enters the nerve cell receptor and restores the cell to its normal function. This process leads to the decrease and potentially the elimination of pain. The fluid in the injection helps to hydrate connective tissue and break apart fascial adhesions. Dehydrated tissue can exacerbate nerve pain by pressing tightly on the nerve passing through it.
PIT treats inflammation and injury due to trauma, arthritis, overuse, fascial adhesions and occupational, sports or surgical injuries. The pro-inflammatory substances that cause swelling, hypersensitivity and pain also prevent muscles, tendons, and ligaments from healing. PIT therefore not only treats the pain, but allows for the body to heal appropriately.
PIT is generally well tolerated and there is no need for a local anesthetic. The injection is administered with a very small and short needle just beneath the surface of the skin. The number of injections needed depend on the extent of the neuropathic inflammation and the length of time the inflammation has been present.
After the first PIT treatment, many patients notice immediate pain relief and increased mobility for a few hours to days. After subsequent treatments, pain is generally reduced, and mobility is improved as the tissue progressively heals. The pain may not be as intense, widespread, or frequent as it was prior to treatment.
*Read more about Dr. Lyftogt here.
Perineural injection therapy is a 5% dextrose (glucose) solution that is injected near superficial nerves. When a nerve is injured, inflamed and lacks glucose, it sends continuous signals that the body interprets as pain. The superficial nerves communicate with the deeper nerves and muscles and therefore by treating the superficial nerves, PIT treats the entire muscular-neuro-vascular bundle.
Dr. Lyftogt discovered that these injured nerves can be treated with dextrose, which is a naturally occurring carbohydrate utilized by our body for energy. Dextrose enters the nerve cell receptor and restores the cell to its normal function. This process leads to the decrease and potentially the elimination of pain. The fluid in the injection helps to hydrate connective tissue and break apart fascial adhesions. Dehydrated tissue can exacerbate nerve pain by pressing tightly on the nerve passing through it.
PIT treats inflammation and injury due to trauma, arthritis, overuse, fascial adhesions and occupational, sports or surgical injuries. The pro-inflammatory substances that cause swelling, hypersensitivity and pain also prevent muscles, tendons, and ligaments from healing. PIT therefore not only treats the pain, but allows for the body to heal appropriately.
PIT is generally well tolerated and there is no need for a local anesthetic. The injection is administered with a very small and short needle just beneath the surface of the skin. The number of injections needed depend on the extent of the neuropathic inflammation and the length of time the inflammation has been present.
After the first PIT treatment, many patients notice immediate pain relief and increased mobility for a few hours to days. After subsequent treatments, pain is generally reduced, and mobility is improved as the tissue progressively heals. The pain may not be as intense, widespread, or frequent as it was prior to treatment.
*Read more about Dr. Lyftogt here.
Conditions Treated
Frozen Shoulder
Migraine Headache, Jaw Pain
Back, Hip, Leg, Knee, Foot, Shoulder, Arm Pain
Sciatica
Restless Legs
Carpal Tunnel Syndrome
Complex Regional Pain Syndrome
Trigeminal Neuralgia
Plantar Fasciitis
Migraine Headache, Jaw Pain
Back, Hip, Leg, Knee, Foot, Shoulder, Arm Pain
Sciatica
Restless Legs
Carpal Tunnel Syndrome
Complex Regional Pain Syndrome
Trigeminal Neuralgia
Plantar Fasciitis
Case Examples
Frozen Shoulder: I have used PIT to treat frozen shoulder effectively – a condition that is known to be difficult to treat and often requires steroid injections for patients to return to normal function. I usually recommend twice weekly acupuncture, weekly PIT treatments and regular physical therapy to resolve frozen shoulder. Acupuncture pairs with PIT and physical therapy quite naturally. To treat frozen shoulder, PIT is injected along the nerves of the involved shoulder as well as the neck and back. I have seen frozen shoulder resolve in as quickly as two weeks with this treatment protocol when the patient is treated right at the onset of symptoms. Everyone’s body is different, and this protocol may need to be followed for several months for complete symptom resolution.
Migraine Headache: Treating migraine headaches can be challenging. I have used both acupuncture and PIT combined to successfully decrease migraine headache frequency and severity in people suffering with migraines. Injections are typically performed in the face, scalp and neck to treat migraines. In addition to acupuncture and PIT, there are a number of naturopathic treatment options to help with migraine headache pain that I recommend.
Knee Pain: As an acupuncturist, knee pain is one of the most common complaints I treat. Whether it is osteoarthritis, tendonitis, overuse, surgery or sports injury, I have used PIT to help decrease pain and increase knee and leg mobility. Injections are commonly performed on the knee joint itself as well as above and below the knee on the hip, thigh, calf and ankle. Both acute knee pain due to trauma and chronic knee pain due to overuse, aging or previous injury can be treated effectively with PIT injections.
Migraine Headache: Treating migraine headaches can be challenging. I have used both acupuncture and PIT combined to successfully decrease migraine headache frequency and severity in people suffering with migraines. Injections are typically performed in the face, scalp and neck to treat migraines. In addition to acupuncture and PIT, there are a number of naturopathic treatment options to help with migraine headache pain that I recommend.
Knee Pain: As an acupuncturist, knee pain is one of the most common complaints I treat. Whether it is osteoarthritis, tendonitis, overuse, surgery or sports injury, I have used PIT to help decrease pain and increase knee and leg mobility. Injections are commonly performed on the knee joint itself as well as above and below the knee on the hip, thigh, calf and ankle. Both acute knee pain due to trauma and chronic knee pain due to overuse, aging or previous injury can be treated effectively with PIT injections.