What Is PIT (Perineural Injection Therapy)?

Perineural Injection Therapy (PIT) is a minimally invasive treatment designed to calm irritated or inflamed superficial nerves, which may be contributing to chronic pain. It involves a series of small, shallow injections of a 5% dextrose solution just beneath the skin, along the course of the affected nerves.

The technique targets neurogenic inflammation—a type of inflammation caused by dysfunctional nerve signaling—and aims to restore healthy nerve function and reduce pain. The treatment was pioneered by Dr. John Lyftogt, a New Zealand physician, and has since gained international use in managing chronic pain conditions linked to nerve irritation. [1]

How Does PIT Work?

The primary therapeutic agent in PIT is 5% dextrose in water (D5W). Research suggests that dextrose may inhibit overactive pain receptors (such as TRPV1 receptors) and help restore normal nerve signaling without suppressing the immune system. [2]

The treatment may help by:

Reducing neurogenic inflammation through modulation of TRPV1 and other pain receptors [2]
Interrupting chronic pain signaling from unmyelinated C-fibers [3]
Hydrodissection: Physically separating entrapped or adhered nerves from surrounding tissues [4]
Desensitizing nerve trigger points (often referred to as Valleix points)
Improving cellular energy availability through glucose metabolism, supporting nerve healing [5]

Injections may include a local anesthetic (e.g., lidocaine 1–2%) to improve comfort, though the healing effect is believed to come primarily from the dextrose. Sodium bicarbonate is added for pH balance.

What Conditions Can PIT Support?

While more research is needed to fully validate its use across all conditions, PIT has shown promise in addressing:

Neuropathic pain
Post-surgical nerve irritation
Frozen shoulder (adhesive capsulitis)
Carpal tunnel syndrome
Chronic migraines and tension-type headaches
Sciatica and peripheral nerve entrapments
Diabetic or metabolic neuropathy
Complex Regional Pain Syndrome (CRPS) [6]

Please note: While studies and case reports suggest benefit, PIT is still considered an emerging therapy and is not a first-line treatment in all medical guidelines.

Why Choose PIT?

Unlike corticosteroid injections, which suppress inflammation, PIT supports regenerative healing. For many patients, this approach provides a gentle yet effective option for managing pain without the systemic effects of NSAIDs or steroids.

PIT may be a good fit for those looking to:

Reduce chronic nerve-related pain
Recover from surgical or traumatic nerve injuries
Avoid long-term use of pain medications
Explore natural, body-based healing approaches

Clinical studies continue to explore the long-term efficacy and mechanisms of PIT, and it’s best used as part of a comprehensive care plan. [7]

Integrating PIT with Acupuncture & Chiropractic Care

PIT complements other modalities like acupuncture and chiropractic care. Here’s how they can work together:

Before PIT: Gentle chiropractic adjustments and acupuncture may improve circulation and reduce compensatory muscle tension.
After PIT: It’s best to avoid direct treatment over the injection sites for 5–7 days, but other body areas can still benefit from care.
Between PIT Sessions: Ongoing acupuncture and bodywork can support the nervous system, help reduce muscle compensation, and enhance healing.

What to Expect During PIT Treatment

Visit Length: 30–60 minutes depending on areas treated.
Number of Injections: 10–60+ very shallow injections per session.
Patient Feedback: You’ll be asked to identify painful areas and movements. Treatment is guided by your feedback and physical exam findings.
Relief Timeline: Some patients experience relief within minutes to a few days, with cumulative benefits over several sessions.
Follow-up: Email check-in at 1 week and in-person follow-up at 4–6 weeks help track your progress.

Ready to Try PIT?

To begin PIT at Inner Gate Health & Wellness:

You must be an established patient.
The initial PIT session is a 60-minute visit, with follow-ups scheduled based on your response.

📩 Questions? Reach out to Dr. Heather Krebsbach:

📧 [email protected]

References:

Lyftogt J. “Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain.” Australas Musculoskeletal Med. 2007.
Lee JW, et al. “Analgesic effect of dextrose prolotherapy in chronic low back pain.” Anesth Pain Med. 2017.
Bertrand, L., et al. “TRPV1 functions and expression in pain.” Cell Calcium. 2018.
Lam K, et al. “Ultrasound-guided hydrodissection for entrapment neuropathies.” Radiographics. 2020.
Habib, G., et al. “Mechanism of action of prolotherapy for chronic musculoskeletal pain.” PM&R. 2016.
Lyftogt, J. “Neurofascial Prolotherapy in the Treatment of Complex Regional Pain Syndrome.” Int Musculoskelet Med. 2007.
Linetsky, F., et al. “Regenerative injection therapy: dextrose prolotherapy and P2G in musculoskeletal pain.” PM&R. 2016.