Perineural Injection Therapy

Perineural Injection Therapy (PIT) is one of the newest advances in Regenerative Medicine used to treat nerve pain and musculoskeletal pain due to sports injuries or chronic pain conditions.  It involves the injection of natural sugars just below the skin to promote healing of injured nerves, restoration of tissue function and elimination of pain.  PIT was discovered by Dr. John Lyftogt from New Zealand, who has been using this method to treat musculoskeletal injuries and various pain conditions over the last decade with amazing results.

Dr. Tinh Vuong and Dr. Linh Vuong with the founder of Neural Prolotherapy, Dr. John Lyftogt

What other names does PIT go by?

PIT is also known as Neural Prolotherapy (NPT), Neural Regenerative Technique (NRT), Perineual Subcutaneous Injections (PSI), Neurofascial Prolotherapy and The Lyftogt technique.

What conditions will PIT treat?

PIT has revolutionized the treatment of nerve or neuropathic pain.  At Acuprolo Institute we see many patients who have “tried everything”, including surgery, and still have persistent pain.  This is usually due to injured and non-healing sensory nerves that lead to inflammation and delay of healing.  These people tend to respond well to PIT.  PIT is very effective in treating conditions due to inflamed nerves such as trigeminal neuralgia, migraines, diabetic neuropathy, Morton’s neuroma, post herpetic neuralgia due to zoster infection, post surgical pain, reflex sympathetic dystrophy, fibromyalgia.  PIT is also used to treat pain due to musculoskeletal injuries  including shoulder, knee, elbow, neck and low back, ankle, temporal mandibular joint (TMJ), and many other conditions.

What is the solution that is injected?

PIT solution contains either 5% Mannitol or 5% Dextrose.  Mannitol is a sugar alcohol derived from the deciduous tree called flowering ash.  Dextrose is a natural sugar found in corn.  D5W is the same solution used in IV bags in the emergency room and hospitals.

How does PIT work?

Multiple shallow injections are done under the skin using a very short, thin needle to target painful sensitive nerves with natural substances aimed to stop nerve inflammation, promote healing of injured nerves, restore tissue function and eliminate pain.  Tissue injury or injury to nerves by stretching, constricting, or cutting them (such as after surgery or due to tight muscle spasms), activate a receptor on nerves called Transient Receptor Potential Cation Channel V1 (TrpV1), also known as the capsaicin or chili pepper receptor.   This results in nerve release of substances that cause inflammation, swelling, burning painful sensations (neuropathic pain) and chronic nerve dysfunction.  It is postulated that dextrose and mannitol inhibit TrpV1 nerve receptors, preventing this inflammatory cascade and restoring normal nerve function.

How is PIT different from Prolotherapy?

PIT involves shallow injections of low concentration dextrose or mannitol under the skin to heal injured superficial nerves.  Traditional Prolotherapy involves deep injections using higher concentrations of dextrose to target where ligaments and tendons attach to bone to promote regrowth and repair of these structures. Both techniques are very effective to relieve pain and restore function.

How effective is PIT?

Every treatment aims to reduce pain prior to leaving the office.  The pain relief may last hours to days after the first injection.  Then pain will recur but usually in a lesser form. With subsequent treatments less areas need to be injected and the pain free duration gets progressively longer as the nerves and tissue heal to restore function.  Success rates vary between 80-100% depending on the condition.

How often do I need these treatments?

The average number of treatments required for most conditions is 6-8 separated by 1 to 2 weeks .  This may vary for each individual depending on how long the injury has been present and the degree of tissue damage.

Is PIT safe?

PIT is very safe because it is minimally invasive and uses a natural substance.  Injections are done using a very short, thin needle injected very shallow  under the skin.  With proper technique the risk of infection and tissue injury is minimal to none. Possible adverse effects include local swelling, bruising and mild transient pain.  At Acuprolo Institute our doctors have extensive experience in PIT and train doctors from around the world how to do this amazing technique.

Is PIT treatment painful?

PIT is a well tolerated procedure compared to other types of injections.  No local anesthetic is required because the injections are superficial using a very thin and short needle is used.  Some injection points may cause mild discomfort or a sensation of initial stinging followed by complete resolution of pain.

When can I go back to work or playing sports after a treatment?

There is no “recovery time” with PIT because most patients leave the office with reduced pain.  However, depending on where in the course of treatment you are, this pain relief may last hours, days, weeks or months until the nerves and tissue completely heal.  Patients can immediately return to normal activity as long as the pain level is less than 4 out of 10.

Will my insurance cover for PIT?

No

Teaching faculty for the Neural Prolotherapy International conference 2014: Dr. Linh Vuong (California, USA), Dr. David De La Mora (Guadalajara, Mexico), Dr. Liza Smigel (Hawaii, USA), Dr. John Lyftogt (New Zealand), Dr.Stephen Cavallino (Italy)