What is Perineural Injection Therapy (PIT)?

Perineural injection therapy (PIT), formerly known as neural therapy or neural-prolotherapy, has a history of use in traditional prolotherapy procedures with subtle but distinct and significant differences to prolotherapy. The goal of PIT is to reduce hyperexcitability of specific peripheral nerves that are overactive, with an emphasis on resolving chronic neurological inflammation that results in neuropathic pain.


PIT is most commonly used to treat chronic persistent pain syndromes such as peripheral neuropathies, neuralgias, complex regional pain syndrome, and post-injury neuropathic pain. These include specifically

  • Chronic injury related pain such as from scar tissue or degenerative arthritis

  • Radiating pain from diseases such as osteoarthritis

  • Pain related to degenerative disc disease

  • Tendinopathy, resulting from tendinitis lasting more than 6 weeks

  • Chronic sinusitis that is resistant to standard treatments or recurring

  • Trigeminal neuralgia

  • Complex regional pain syndrome

  • Dysautonomia due to upper cervical instability

  • Failed surgeries or post-surgical pain syndrome

How does perineural injection therapy work?

PIT has the potential to resolve chronic nerve inflammation and facilitate nerve repair. You can read more detail on this at another website, click this link here. When nerves are injured they may create a metabolic state that perpetuates and prolongs nerve inflammation, resulting in hyperexcitability of pain pathways and abnormal tissue function. The epigenetic mechanisms involved in the propagation of neuropathic hyperexcitability include the expression of the neuro inflammasomes, specifically NLRP3, which is a DNA response that causes inflammatory changes in the metabolism and excitability of nerves. NLRPs can be triggered by a number of things including direct compression injury and systemic inflammatory diseases such as infections or autoimmune disease.

PIT uses a mild sugar solution (pharmaceutical buffered 5% dextrose injectable solution) to be administered around an into the peripheral nerve to produce anesthesia and initiated a metabolic shift through downregulation of neurological inflammatory hyperexcitability. By placing the weak sugar solution in and around the nerve, the inflamed and overactive nerve is safely anesthetized and more importantly the TRPV4 receptor is triggered.

The importance of a holistic approach

Medications/Supplements that may support perineural injection therapy also support the metabolic and hyperexcitability of nerves. Specifically these medications reduce nerve inflammation, help to resolve the neuroinflammasome expression, increase potassium in the nerve reducing excitability, and enhance mitochondria and membrane function. These include:

  • Ketone salts, such as Go-BHB containing products

  • Specialized pro-resolving mediators (SPMs) such as Resolvin D1

  • Omega-3 fatty acids

  • Medium chain triglycerides, especially C8-10

  • NT factor lipids energy chewables

  • Berberine

  • Cannabidiol

  • Low dose naltrexone

How long will it take to complete a course of treatments?

The response to treatment varies depends upon the individual healing ability, based on factors such as poor sleep, toxicity, malnutrition, and chronic stress. Some people may only need a 1-2 treatments while other may need 10 or more, and severe patients are sometimes happy with the results to continue treatments while other options are explored. The average number of treatments is 4-8 for an area treated. Once you begin treatment, we can get a better sense of how are you responding and give you a more accurate estimate. There are many other tests and treatments that may be recommended for you based on your individualized need.

The scientific evidence for PERINEURAL THERAPY:

There is a clear scientific understanding underlying PIT. The founder of perineural injection therapy, John Lyftgoft, MD has listed 5 randomized control trials (RCTs) showing efficacy, which can be found here.

Also referred to as “Neural Prolotherapy,” this treatment is more fully explained in the Journal of prolotherapy (with reference to many more articles) at the following link: http://journalofprolotherapy.com/neural-prolotherapy/


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