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Perineural Injection Therapy: A Revolutionary Way to Treat Chronic Pain - by Dr. Tam Bui

Updated: Dec 28, 2023

Have you suffered a major or minor injury and it doesn’t seem like it is back to the same afterwards? Are you now stuck with constant stiffness and/or pain that it periodically flares up causing the area to swell, weakness, or increase in your pain that limits your activities with no good reason? It’s likely that the nerves are irritated.


Chronic pain can feel like an unending battle, a persistent force that disrupts your life and clouds your days with discomfort. Chronic pain doesn't discriminate - it can have various origins. It often kicks in as a result of an initial injury, like a back sprain or a pulled muscle, but instead of waving goodbye like a polite guest, the pain sticks around. Other causes are trauma, arthritis, sports, overuse, occupational, and surgical injuries. Despite advanced medical technologies like MRIs, EMGs, and CT scans, patients may be informed that 'nothing is wrong' as these imaging methods may not detect abnormalities. Yet, we know through cadaver dissection that many small and superficial peripheral nerves do exist and they can get inflamed or damaged. The picture below show the sensory nerves (yellow structure) passing through connective tissue called fascia and when nerves pass through fascia they can get injured, called “chronic constrictive injury” resulting in chronic and cyclical inflammation of the area.


These sensory nerves sends hundreds of tiny nerve endings that reach just below the skin as shown below. The treatment we'll discuss below directly treat these nerves by injection a natural substance just below the skin to reach the individual nerve fibers.  




A nerve can become inflamed or injured in many ways. A nerve can become inflamed as it courses through a tunnel in a bone such as the cluneal nerves, this is a frequent source of low back pain. When a nerve moves back and forth over the surface of a bone, it can become irritated and inflamed such as in ITB friction syndrome, which is a common cause of knee pain in runners and cyclists. Nerves endings that become entangled in scar tissue that develops in tendons such as the achilles or patellar tendons become chronically inflamed, commonly seen in overuse injuries.


What is Perineural Injection Therapy (PIT)?

Perineural Injection Therapy is a minimally invasive procedure designed to tackle chronic pain at its roots. It involves the precise injection of natural substances, specifically dextrose, around nerves (hence 'peri' mean around and 'neural' means nerves) with small needles to reduce inflammation and promote healing. Dr Bui realized the huge overlap between these nerves and Acupuncture points that he has spent the last 10 years and going thru a second residency, Physical Medicine & Rehabilitation, to refine his technique. The treatment encourages patients to RESUME activity right away versus standard treatments that recommend patients to not do anything for the next 3 days and to slowly progress activity.


How Does Perineural Injection Therapy Work?

It targets the small nerve endings responsible for transmitting pain signals. Inflammation is a common source of pain and over time it can break down tissue. The dextrose in the solution serves to reduce inflammation around the nerve.  By addressing it directly, PIT creates a favorable environment for the nerves to heal naturally. This will lead to a reduction in pain and improved function.


Perineural Injection Therapy involves the physician's deep understanding the anatomy of the sensory nerves as they course throughout the body. A series of injections containing the dextrose solution is placed underneath the skin using very small and short needles along the nerve pathway.


The number of injections that are given depends on various factors such as how much and how long the nerve(s) have been inflamed, the number of different nerves inflamed, how other areas have compensated due this nerve injury. A simply treatment can take a few minutes but a complex case involving multiple areas such as hip, back, and knee) may be very lengthy.


Most patients will require 6-8 Perineural Injection Therapy treatments spaced out anywhere from 1-2 weeks apart depending on their condition. No pain medications or local anesthetics required.


After the first Perineural Injection Therapy treatment, the pain relief may lasts a few hours to a few days. After the second treatment, there is a higher degree of improvement and although the pain returns, it may not be as intense, widespread, or frequent as it was prior to the treatment.  As the patient receives subsequent treatments, the pain eventually goes away and normal function returns.


There are no medication restrictions for patients receiving PIT and well over 85% of patients respond.  Anti-inflammatory medicines taken for other conditions do not need to be stopped.

For patients taking narcotics (opiates) and nerve pain medications, once you are pain free, you can stop your pain medications but do so gradually to avoid withdrawal symptoms.


There is no activity restrictions, patients are encouraged to RESUME activity and to observe when and where the pain is. It helps me to hone in which nerve is affected and fine tune your treatment. Dextrose is a part of normal human function so side effects are rare, occasional small bruises may occur at the injection site. Allergy is not an issue. Although infection is a potential side effect anytime the skin is infiltrated, we have not had any occur in our patient population.


If you've explored various treatments such as Physical Therapy, Chiropractic Adjustments, Pain Pills, Steroidal Injections, Nerve blocks, or Radiofrequency Nerve Ablations, or even Surgery without finding permanent relief, it's because these treatments don’t address the underlying injury. It’s time to consider a game-changer: Perineural Injection Therapy (PIT).


What conditions can be treated by PIT?

  • Neuropathic Pain: Pain related to damaged or irritated nerves.

  • Musculoskeletal pain: Pain originating from muscles, tendons, or ligaments.

  • Chronic pain: Long-lasting pain that has not responded well to other treatments.

  • Nerve Entrapment Syndromes

  • Joint Pain

  • Tendinitis/Tendinopathy

  • Scar Tissue Pain

  • Sports Injuries

  • Arthritis

  • Migraines/Headaches

  • And more


BENEFITS OF PIT

NON-SURGICAL

MINIMALLY INVASIVE

RAPID PAIN RELIEF

REDUCED INFLAMMATION

IMPROVED FUNCTION

MINIMAL DOWNTIME


Perineural Injection Therapy is performed at Simply Health DP3 by Dr. Tam Bui. For more information or to schedule a consultation, please call/text (206) 659-1841.  If you wish to read more, including published scientific journal articles, please click here to visit Dr. Lyftogt’s website.

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