PERINEURAL INJECTION TREATMENT

Perineural Injection Treatment (PIT) is a safe and effective injection treatment!

WHAT IS PERINEURAL INJECTION TREATMENT?

Perineural Injection Treatment (PIT) is a safe and effective injection treatment for most painful conditions due to sport and occupation or other chronic non-malignant pain related issues. It was developed by New Zealander Dr John Lyftogt who directly taught Dr Richard Pavelock and Bethany Sprague, FNP. Perineural Injection Treatment is sometimes referred to as Neural prolotherapy or Perineural Subcutaneous injections (PSI).

HOW DOES IT WORK?

PIT is a treatment that uses a dextrose solution injected with micro needles into subcutaneous skin to target small fiber sensory nerves. The small peripheral nerves communicate with the larger nerves and glucose calms the nerves reducing inflammation. When inflammation is reduced, the inflammatory substances (substance P and CGRP) are reduced, causing the nerves to return to normal size and pain to be halted.

WHAT CAN BE TREATED?

Headache, Migraine, TMJ, Trigeminal Neuralgia, Neck pain, Shoulder pain, Back pain, Costochondritis, Hip and Pelvic pain, Elbow pain, Fibromyalgia, Knee pain, Foot or ankle pain, Neuropathy, Plantar fasciitis, and many more conditions..

WHAT SHOULD I EXPECT FROM PIT?

First consultation and discussion with our providers involves taking history and diagnosing the cause of pain. This underlying cause is usually due to an injured and non-healing sensory nerve causing pain, inflammation and delay of healing. Next the treatments with PIT are focused on the nerves causing the pain or disability. Multiple dextrose injections covering the affected nerves will be placed under the skin. The onset of dextrose is very fast and one usually knows how you will respond within minutes.


Most people tolerate PIT very well with minimal discomfort. You may expect some mild tenderness or bruising at the injection site. Rarely people have an episode of getting hot and dizzy (vasovagal reaction). Very rarely there is a risk for allergic response or infection. Treatments can last hours to weeks and usually take 3-4 treatments to calm the inflamed nerves and cause long term pain relief..

WHAT TO BRING TO YOUR APPOINTMENT?

  • Wear comfortable and easy-to-remove clothes and shoes.
  • Bring your health information summary & Medication list
  • If you have pain in your shoulders, back or neck please wear a tank top and if you have long hair, be prepared to pull it back with a clip or elastic. Women, please wear a bra that can be unclasped from the back.
  • If you have pain in your hips or knees, Please wear or bring a pair of shorts or loose fitting pair of pants if we are treating your legs or hips.
  • Bring your camera! We would like to take pictures of you to point out any issues we see with your posture and for your future reference.

PRINTABLE FORMS FOR YOUR VISIT

We recommend all new patients to print and fill out this form prior to your first visit.

Research Behind It

The first 3 studies use higher concentrations of dextrose which clinical evidence and experience has shown that lower concentrations are also very effective and less painful not needing lidocaine.

Lyftogt J. Prolotherapy for recalcitrant lumbago. Australia Musculoskeletal Med 2008;13(5):18-20.

46 consecutive patients with low back pain (without leg pain) were seen. 2 were diagnosed with hip pain and sent for surgery. 2 dropped out before treatment. 1 was treated twice and dropped out in favor of a non injection treatment..Of the remaining 41 patients 24 (58%) were male and 17 (42%) female. Mean age was 48.3 (range 23-73) years. Mean duration of symptoms was 5.5 years (range 1- 264 months). The swollen and tender nerves were clinically identified and treated with "percutaneous near nerve injections" approximately 1 ml every 2 cm. The objective of the treatment was to achieve a complete local anesthetic response for all low back pain at the time of the treatment. The solution used in the earlier part of the audit was hypertonic dextrose 20-40%, mixed with 0.1% lidocaine and/or ropivacaine 0.1% in normal saline. Towards the end of the treatment the solution consisted of dextrose 20%, lidocaine 0.1% and cholecalciferol (Vit D) 1000 IU/ml in normal saline. In the earlier phase of the audit period "tender points" were targeted mainly along the latissimus dorsi tendons, the gluteus maximus origin and the supraspinous ligament. In the latter phase the focus became the "inflamed" superior and intermediate cluneal nerves and thoracic spinal nerves where clinically indicated. Mean initial VAS was 7.6 (range 5-10). Mean VAS at last treatment was 1.4 (range 0-6). Mean duration of treatment was 8.3 weeks (range 1-17). The mean number of treatments was 6.2 (range 2-16).Ninety percent of patients improved more than 50%, and 10% less than 50%. Twenty-nine percent of patients reported no pain at the last consultation. Long term follow up results were not stated.

Lyftogt J. Subcutaneous prolotherapy for Achilles tendinopathy Australas Musculoskeletal Med Nov 2007;12(11):107-109.

Different dextrose concentrations were clinically trialed over a four-year period with long-term follow up of 132 Achilles tendons. Results are broken down by year and cannot be looked at in total with information given. A representative year was 2006 in which 30% glucose was use in 0.1% ropivacaine and 0.1% lidocaine. In that year 34 tendons in 31 subjects were treated with mean age 47 (28-69) years, and mean symptom duration of 14 months (1-60). The mean length of treatment was 7.6 weeks (3-15 weeks) 84% were available for long term follow up at mean of 12 months with mean VAS change from 6.7 to 1.1 and 88% of those that were contactable at 12 months satisfied with treatment.

Lyftogt J. Subcutaneous prolotherapy treatment of refractory knee, shoulder and lateral elbow pain. Australas Musculoskeletal Med 2007;12(2):110-112.

In 2005, 127 painful knees (74), shoulders (33) and lateral elbows (20) were treated with subcutaneous prolotherapy. . The treatment was well tolerated and safe. The treatment protocol consisted of weekly treatments where possible. All active TPs were identified by palpation and injected subcutaneously with 0.5-1 ml of a Glucose 20%/Lidocaine 0.1% solution. The objective at the time of each treatment was to achieve complete local anesthetic pain relief. Treatments were continued until VAS 0-1 and/or after consultation with the patient. The combined outcome statistics for the treatment of the 2005 knee, shoulder and lateral elbow pain showed a mean length of symptoms of 23.9 months and a mean treatment length of 7 weeks. The mean initial VAS 6.7 reduced at follow up of mean 21.4 months to VAS 0.76. The combined satisfaction rate at follow up was 91.7%. However, the follow-up success was an average of about 75% so approximately 25% were lost to long term follow up..

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