Perineural Injection Therapy (PIT) Training

Course Details

Empire has developed this course to enhance our other pain courses and give additional tools for a practitioner to diagnose, treat patients portraying pain for a variety of peripheral neuralgias without the investment of additional capital. This is a 1-Day Course which will include didactic in the morning and a “hands-on” element in the afternoon including protocols associated with the procedure as well as “standard of care” considerations.

The course is taught by Board Certified Physicians who have incorporated these procedures within their practice and will share their results in addition to reviewing the numerous studies on the topic. These studies are evidence-based peer to peer articles that will give the attendee the insights as to the effectiveness of the procedure to set patient expectations. A full color manual illustrating the procedures and multiple uses for Neural Prolotherapy is given as well as pricing for this “cash basis” procedure.

Perineural Injection Therapies can also be combined with other mechanical technologies (i.e. 3-Channel Ultrasound Combo-Stim devices) and biologics (Prolo-PRP IV) to further enhance the treatment and create a comprehensive treatment approach. All practical combination therapies will be discussed including newer technologies being utilized in a medical practice. Not only will patients benefit from the procedure but will enhance patient care in association with the pain management for several medical conditions.

The procedure involves a series of prepared dextrose injections administered through short needles just below the surface of the skin. The treatment is very similar to the TB test as it involves getting a small prick along the course of the affected nerve. The injection does not require any local anesthetic as it is generally well-tolerated. The number of injections needed depends on how long the patient has been experiencing pain and the severity of it. Most patients need 4-6 PITs spaced from 1 to 4 weeks apart. The number of injections depends on how many nerves are inflamed, how long they have been inflamed, and how much of the nerve is inflamed.

Perineural Injection Therapy (PIT) involves multiple small injections along the path of tender superficial nerves in the area of the patients pain with a small amount of 5% Dextrose. The dextrose solution works by immediately blocking the nerve endings (TRPV-1 or Capsacin receptors) that are responsible for the nerve pain and inflammation with the associated superficial nerves. This leads to healing beneath the nerve to deeper structures like the associated muscles, tendons, ligaments, and cartilage of involved joints associated with certain chronic pain.

Pain will decrease incrementally with each treatment with the goal is relief of all pain and improvement in function. In various studies up to 85% of patients can respond to PIT, however opioid users do not respond well to the therapies due to opiods competing with dextrose at the receptor site.

Conditions treated by perineural injection therapy (PIT) include, but are not necessarily limited to:

• Neck pain
• Occipital neuralgia
• Tension Headaches
• Migraine headaches
• TMJ
• Trigeminal neuralgia
• Thoracic pain
• Fibromyalgia
• Radiculopathy
• Lower back pain
• Sciatica
• Shoulder pain
• Frozen shoulder
• Knee pain
• Hand osteoarthritis
• Morton’s neuroma
• Coccydynia
• Complex regional pain syndrome (CRPS, RSD)
• Carpal tunnel syndrome
• Plantar fasciitis
• Medial / lateral epicondylitis

What is perineural injection therapy (PIT)?

Certain patients with chronic pain are not candidates for joint replacement, PRP or stem cell therapies and other patients are non-responsive to conventional medicine solutions. Common problems such as trauma, arthritis, sports injury, overuse, occupational or surgical injuries can cause nerve injury may benefit from Perineural Injection Therapy (PIT).

Perineural injection therapy (PIT), aka neural prolotherapy, is one of the latest advancements in regenerative medicine. It targets cutaneous nerves as a potential pain generator. Perineural Injection Therapy (PIT) targets neurogenic inflammation in subcutaneous nerves that potentially generates pain providing substantial pain control for neurogenic / neuropathic pain.

PIT therapies reduce target pain that is caused by inflamed or injured nerves which relay distressed cell signals to the brain resulting in persistent pain that may be unresponsive to pain medication. Secondary, injured nerves release a series of substances known as Nerve Growth Factor (NGF), substance P (P for pain) and calcitonin gene related peptide (CGRP) and others inhibiting the healing of affected muscles, tendons, and ligaments, resulting in chronic inflammation, sensitivity, and pain (neurogenic / neuropathic).

When injured or inflamed, nerve cells signal the brain by producing biological substances causing pain sensation and release out of the cell signaling the brain. The injured nerve continues to send a pain message to the brain even though the nerve is not being stimulated by pain. This creates a “short circuit” much like an open wire lying on the floor with electricity flowing through it. The substances that cause pain also prevent tissues such as muscles, tendons, and ligaments from healing. The term used to describe these inflamed nerves is called neurogenic inflammation.

How does peri-neural injections work?

Any sensation that is perceived by the brain is transmitted to the brain via the sensory nervous system. This is true for sensations like pain, temperature, vibration, or pressure. When a nerve is stimulated by pain, the individual nerve cells generate an electrical current that is carried by the nerve to the spinal cord and then to the brain. When the nerve cell is stimulated, receptors open and let sodium, potassium, calcium, and other molecules in and out of the cell. When this occurs, an electrical current is created termed an action potential. When the stimulation is complete, the receptor once again closes. If the nerve is injured for whatever reason, this mechanism is disrupted.

Dextrose is a naturally occurring carbohydrate and is used in a nearly isotonic solution (5% dextrose in water; D5W) in which Dextrose is concentrated at 5% and with the pH adjusted to around 7.4, can be used to stop the release of neurogenic inflammatory substances and the transmittance of pain signals.

Concentrated dextrose acts by dehydrating the cells near to where it is injected causing localized tissue trauma. This in turn triggers the local inflammatory process resulting in the release of growth factors by the injured cells. These growth factors function to promote the body's natural healing ability in the affected region and can reduce some of the contributing factors to chronic nerve pain by causing healing and tissue regeneration. In addition, dextrose binds to the TRPV1 nerve cell receptor, which transmits pain signals and releases pain-inducing substances through the TRPV1 channel. Once bound to the TRPV1 receptor, dextrose inhibits the transmittance of pain signals and the release of these pain- inducing substances, restoring the nerve cell to its normal function. The program will review evidence- based studies substantiating the use of dextrose injections at a specified concentration has resulted in the relief of chronic pain symptoms secondary to nerve entrapment.

Empire Medical Training has created the Perineural Injection Therapy course for all physicians to enhance patient care for medical practices that encounter neuropathic pain within their clinical setting. This is a very safe procedure to perform with no real complications associated with the injections while offering long-term or permanent relief for patients.