Perineural Injection Therapy as a First Resort for Treating Pain

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. You will show Dr. Moss the location of your painful areas by placing your hands on these areas. These areas will correspond to the anatomical sensory fields of specific nerves. The nerves are treated with 5% buffered dextrose solution.  A very fine short ½” needle is used to do shallow injections just underneath the skin to surround the irritated nerves with dextrose. You are then asked to ‘test drive’ the area – move through your range of motion to see if any painful areas were missed, and to see how your movement has changed. Pain improvement and increased mobility can often be felt immediately. After treatment there are no restrictions, movement and return to regular daily activities is recommended.

If you have a large area of pain, then more nerves are involved and you may receive more injections. Your treatment plan (ie. number of injections, frequency of treatment, etc.) is determined through an informed consent discussion with Dr. Moss.

After your first PIT treatment pain relief can be anywhere from four hours to four days. When the pain returns we look for a reduction of pain intensity and the size of the painful area to become smaller. Initially I often suggest 3 treatments one time per week to see if this is an effective treatment method; if there is a good response, then usually the frequency of appointments will decrease over time until you are pain-free or much improved.  As tissue heals fewer injections are required and pain relief lasts longer.

Many common painful conditions include pain generated from nerves (neuropathic pain) and neurogenic inflammation; perineural injection treats these painful swollen nerves.

Please reach out if if you would like to discuss whether PIT is right for you.  We would be happy to discuss.

Some conditions treated with PIT and specific nerves often involved include:

• lower back pain (cluneal nerves, spinal nerve dorsal rami)
• headaches (occipital, trigeminal, facial nerves)
• post-herpetic neuralgia (intercostal nerves)
• painful scars (specific nerves involved will depend on the location of the scar)
• neck pain, whiplash injuries (supraclavicular, punctus nervosum, cutaneous branches of the dorsal rami and ventral rami)
• shoulder pain (musculocutanous, radial, axillary, suprascapular, dorsal scapular nerves)
• joint pain (specific nerves involved will depend on joint location)
• achilles tendinopathy (sural and saphenous nerves)
  
• Morton’s neuroma (intermetatarsal plantar nerve)
• sports injuries; repetitive strain injuries; osteoarthritis, bursitis, tendonitis, muscle strains, ligament sprains (the painful area often coincide with the anatomical field of the nerves involved)
• knee pain (saphenous, common peroneal, anterior femoral nerves)

Side effects are uncommon but may include light-headedness (not serious), bruising, brief ‘treatment stiffness’ from the process of having an injection, allergy (specifically corn), infection (very rare), and a temporary increase in pain which can be treated with pain medications or ice. 

The first visit includes a health history, review and assessment of current health concern, and if perineural injection treatment is determined to be the most appropriate treatment, then a PIT treatment can be done during an initial visit.  

An initial naturopathic visit is $180 and 60 minutes.  Initial visit plus PIT is $205.

Follow-up Perineural Injection Treatment is $120 per 30 minute appointment.

PIT uses a 5% buffered dextrose solution to decrease neurogenic inflammation in painful and unhealthy peripheral sensory nerves.  Dextrose prolotherapy uses a 12-25% dextrose solution to strengthen weak and painful ligaments and tendons.

The treatment consists of multiple injections just below the skin surface using a very fine needle.  Most people find the treatment tolerable.  Dr Moss always works within her patient comfort level and she finds that by working together the treatment experience is positive and the outcome is most often an improvement in pain and mobility.  Both the injection technique and the analgesic effect of the dextrose solution both contribute to PIT being a very tolerable treatment.  

The working hypothesis is that glucose/dextrose targets glucose sensing pain nerves called nociceptors located in nerve trunks immediately under the skin.  Dextrose pH neutral solution in near nerve injections, inhibits nerve impulse generation and TRYPV-1 ion channel up-regulation, therefore blocking neuropathic pain and reducing neurogenic inflammation.   

Dr. Lyftogt, MD the founder of PIT: “When injured or irritated these peptidergic nociceptors are activated and thought to be responsible for painful conditions described as ‘neuralgias’ or ‘neuropathic pain’ or more commonly known as ‘chronic pain’. Peptidergic nociceptors are also able to detect high acid levels or acidosis and low glucose levels or glycopenia inside the nerves and respond by causing neurogenic inflammation and increased firing, perceived in the brain as neuropathic pain. Neuropathic pain is increasingly viewed as a homeostatic alarm signal indicating critically low levels of energy or glucose in the tissues and in peptidergic small fibers. PIT returns tissue and peptidergic small fiber glucose and acidity levels to normal, reducing neuropathic pain and reducing neurogenic inflammation, allowing restoration of tissue homeostasis.”

If you wish to learn more, including published scientific journal articles, please click here to visit the founder of Perineural Injection Treatment Dr. John Lyftogt’s website.