Perineural Injection Therapy (PIT) is a type of injection therapy using a 5% glucose solution in sterile water that is used to treat the cutaneous nerve fibers sending pain signals to the brain. It is a technique that was developed by Dr. John Lyftogt after thoroughly researching the mechanisms by which damage occurs to these nerve fibers. To read my earlier blog post on PIT, please click here.
Is There Research On PIT?
What do we really know about PIT? Not all that much, right? Is that because “sugar-coated nerves” is pseudoscience, or is it because there just hasn’t been enough funding to more thoroughly research the implications that PIT can have on more conditions that just pain?
What About Motor Nerve Paralysis?
Well, we know a little bit has been studied about its use in radial nerve palsy, which is a weakness in the muscles of the wrist due to the loss of function of the radial nerve. One case report showed that there was a significant improvement in both the motor and sensory function of the radial nerve after a series of treatments with 5% dextrose injections (i.e. PIT) .
This is not the only instance where an improvement in motor nerve function has been observed after treatment with PIT. Dr. John Lyftogt, the New Zealand doctor who developed perineural injections, along with other practitioners around the world, have observed significant improvement in motor function in case after case of peripheral nerve palsies, such as Bell’s palsy for example.
Bell’s palsy is where the facial nerve, which is responsible for the movement of the muscles of the face, becomes paralyzed. This typically occurs on only one side of the face; however, the cause is often unknown, and sometimes the paralysis can last for months to years, or even recur after recovery.
What About Sensory Nerve Damage?
What I can tell you from my own clinical experience is that I have personally seen a case of significant lumbar disc herniation, which would have required an epidural steroid injection and surgery, result in significant improvement by a series of PIT injections, along with an anti-inflammatory diet and supplemental therapy. This particular patient was terrified of having an injection in her spine, and was even more concerned about the potential of surgery; however, initially, the disc herniation had left her with sensory loss to the lower portion of her left leg, as well as an inability to lift the weight of her body onto the ball of her left foot. After working together for a period of a few months, not only had the range of motion of her lumbar spine significantly improved, but she had also regained sensation in her left leg, and gradually regained her ability to lift the heel of her left foot higher, and hold it by a few extra seconds, after each session.
Potential Implications in ALS?
As if this was not enough of a success story, I later treated a patient who had been diagnosed with atypical amyotrophic lateral sclerosis (ALS), where the symptoms were only affecting her ability to speak and swallow. She did not have paralysis in her arms or legs at all; however, she was gradually losing the motor function of the muscles of her tongue and throat. After using a series of PIT injections to treat the specific nerves that send motor signals to the muscles responsible for these movements, her ability to swallow and eat her meals improved significantly. Prior to treatment, it would take close to 1 to 1.5 hours for my patient to be able to eat a meal due to her difficulty with swallowing; however, after a series of treatments with PIT, she was able to eat a meal that was similar in volume within approximately 30 to 45 minutes. We of course have continued to work on other aspects contributing to her condition; however, having been able to provide her with the ability to eat her meals more efficiently, as well as to partially regain her ability to swallow, felt like a success in and of itself.
So, What Does This All Mean?
I’ll be honest and say that I am not really sure I know what it all means; however, there is something to be said about using therapies that provide patients with relief, whether it comes in the form of pain reduction, regaining motor ability and function, or regaining their ability to feel sensations where they had once been lost.
Is additional research required to assess the potential implications of PIT on motor and sensory loss? Absolutely; however, it is still an unfortunate truth that some of the therapies with the greatest potential for benefit are oftentimes the least funded because realistically, when you compare sugar water to pharmaceutical drugs that have had billions spent on them in research and development, is anybody really going to want to fund the former? Is it possible that such therapies might even lead to fewer surgeries and less of a profit for orthopedic surgeons in this country? Will we ever know for sure?
 Ultrasound-Guided Perineural Injection with Dextrose for Treatment of Radial Nerve Palsy: A Case Report.