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WHAT IS PERINEURAL INJECTION THERAPY? (PROLOTHERAPY)
NATURAL PAIN RELIEF
Perineural Injection Therapy (PIT) is one type of Prolotherapy. PIT uses 5% glucose in a saline solution that is injected just under the skin to relieve pain.
The goal of Prolotherapy is the resolution of pain and dysfunction and the optimizing of health by the individual regaining the ability to do activities of daily living and exercise. Once this is achieved, the individual will potentially no longer need medical care for pain and disability. When this goal is not possible, Prolotherapy aims to help improve one’s quality of life by diminishing pain and improving mobility, activities of daily living, and/or exercise.
Prolotherapy, is an umbrella term that covers the following regenerative therapies.
1. Neural Prolotherapy, Perineural Injection Therapy (PIT), Lyftogt Technique or Glucopuncture are different names for the same treatment.
Mechanism: Targets superficial nerves using low-concentration dextrose injections to reduce inflammation and neuropathic pain.
Applications: Particularly effective for chronic pain syndromes, neuropathic pain and tendinopathy.
Treatment Mechanism: Involves subcutaneous injections of 5% glucose to modulate neurogenic inflammation, improve pain control and to stimulate tissue healing.
Other types of Prolotherapy
2. Platelet-Rich Plasma (PRP) Therapy
3. Stem Cell Therapy
4. Ozone Prolotherapy
5. Bone Marrow Aspirate Concentrate (BMAC) Therapy
6. Prolozone Therapy
Perineural Injection therapy, or Neural Prolotherapy, is a procedure aimed at stimulating the body's natural healing processes to treat musculoskeletal conditions.
WHAT DOES PROLOTHERAPY TREATMENT INVOLVE
Prolotherapy injections are administered with very small short needles just beneath the surface of the skin. Multiple injections are performed along the course of subcutaneous nerves and damaged tissues. Some points may result in mild discomfort but generally, the discomfort only lasts a few minutes.
Most patients notice an immediate reduction of pain after the first injection treatment session. Most patients respond to 3-8 treatments depending on how long the injury has been present as well as the degree of the damage.
TREATMENT USES -
Perineural Injection Treatment is effective in treating many painful musculoskeletal conditions, including:
Shoulder pain, tendinopathy or frozen shoulder
Hip and knee osteoarthritis
Tennis or golfers elbow
Headaches and migraines
Neck and back pain
Achilles tendinopathy
Scars from injury or surgery that stay red, swollen and tender.
Recent soft tissue injuries, such as calf strains and ankle sprains.
THE PAIN CRISIS
Chronic pain is a common problem, affecting one in five adults in the United States (Dahlhamer, et al. MMWR Morb Mortal Wkly Rep 67(36):1001–1005, 2018) and one in six adults in New Zealand.
Despite the substantial healthcare resources and the availability of pharmacological treatment many patients still experience pain. (Dahlhamer, et al. MMWR Morb Mortal Wkly Rep 67(36):1001–1005, 2018).
Opiate addiction for pain, has become a global epidemic, and drug overdose deaths have increased twofold in the last decade (Scholl, et al. MMWR Morb Mortal Wkly Rep 67(5152):1419–27, 2018).
National organizations have called for new therapies to treat chronic pain.
Perineural injection treatment (PIT), is a treatment that is rapidly increasing in popularity and appears to be a valuable option in the treatment of particularly challenging chronic pain.
It consists of a buffered isotonic dextrose solution (5% dextrose in water; D5W) injected adjacent to peripheral nerves; it reduces pain, often instantly (Reeves, et al. Phys Med Rehabil Clin N Am 27(4):783–823, 2016).
With repeated treatments, it has a cumulative effect, in reducing pain and the improvement of function.
Clinical improvement is thought to be due to a sensorineural effect of dextrose on neuropathic pain generators. It is proposed that neuropathic pain is perpetuated by compression-related ischemia, relative hypoglycemia, and acidity effects, all of which affect the firing rate of peptidergic C fibers.
Buffered glucose will resolve neuropathic pain through correcting abnormal metabolic homeostasis.
POTENTIAL BENEFITS OF PERINEURAL INJECTIONS
Potential Benefits of 5% Glucose Treatment
Natural Healing: By supporting the body’s own healing processes, glucose therapy may lead to long-lasting improvements.
Fewer Side Effects: Since glucose is a naturally occurring substance in the body, the risk of adverse effects is low compared to other treatments.
Accessibility: This method is performed in an outpatient setting without the need for imaging, extensive preparation or recovery time.
TREATMENT SCHEDULE
Following a detailed history and examination, tender points in the field of the irritated nerve and tissues are identified.
A small amount (typically 0.2ml - 1ml) of buffered 5% glucose solution is injected at each of these points. The number of injections per treatment varies from just a few to more than twenty, depending on the condition being treated.
The technique aims to improve movement and reduce pain in the area treated to the lowest possible (ideally no pain) at the time of treatment. This analgesic, pain-relieving effect can last from a few hours to a few days. When pain returns, it is often substantially less severe.
Treatments are repeated until all the pain has resolved. Typically, patients require between 4-8 treatments in total.
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