Perineural Injection Therapy (PIT)

Perineural injection therapy (PIT), also known as the “Lyftogt technique”, is an injection treatment for nerve pain, for example in sciatica, herniated disc pain, wrist complaints and headaches. Research on it is still small and mainly observational.

On this page11

1. How does it work?
2. What can you expect?
3. Scientific substantiation
4. More about this treatment
5. What goes wrong in an irritated nerve
6. Why glucose calms the nerve
7. Difference with prolotherapy
8. Complaints that we handle with it
9. Number of treatments
10. This is how a session goes
11. Frequently asked questions

How does it work?

The doctor identifies painful “trigger points” along nerve pathways by palpation. Using very thin needles (27-30G), multiple superficial injections (0.3-1 ml per site) of isotonic 5% glucose are placed directly under the skin, right next to the nerve.

The body-warm glucose solution is thought to calm the nerve via the TRPV1 receptors; some people notice less pain right after the injection. For some indications, mannitol is added.

What can you expect?

A session takes 15–30 minutes with several small injections (often 5–25, depending on the area). The injections feel like short mosquito bites. Some patients notice less pain within a few minutes; that suggests the treated nerve is the source.

There is usually no after-pain as with prolotherapy, because no inflammatory response is triggered.

Scientific substantiation

Lyftogt publiceerde meerdere case series met gunstige resultaten. Een gecontroleerde studie (Maniquis-Smigel et al.) toonde verbetering bij chronische lage rugpijn met subcutane (onderhuidse) dextrose. Evidence-basis bestaat vooral uit observationele studies.

More about this treatment

We also call this treatment neuroprolotherapy. The name immediately says something: it resembles prolotherapy, but the treatment does something completely different. To understand why a little sugar water takes away pain, you first need to know what goes wrong in the nerve itself.

What goes wrong in an irritated nerve

A nerve that is damaged — by an accident or by long-term strain — becomes more sensitive than average. That's called sensitization. Such a nerve will report pain where it did not occur before. The irritation around it also has a name: neurogenic inflammation.

This is a different type of pain than the pain of a worn joint or a broken tendon. And so it requires a different approach.

Why glucose calms the nerve

The idea is that glucose acts on the TRPV1 receptors of the nerve: a kind of switch that plays a role in that irritation. In this way, the glucose would dampen the inflammation and give the nerve the chance to recover. This is an explanation from research, not a proven mechanism.

Note what does not happen. Glucose does not work as a painkiller or as an anaesthetic. So it does not suppress your pain signal; the aim is for the irritated nerve to calm down, so that the pain decreases.

Difference with prolotherapy

The names are similar and glucose is injected in both cases. That's where the similarity ends.

Prolotherapy uses a high concentration of glucose in ligaments, tendons and muscle attachments. The aim is to provoke an inflammation and healing response. Neuroprolotherapy uses a mild concentration around the nerve, and aims to dampen a reaction.

Two opposite routes to the same goal: tackling the cause of the complaints instead of suppressing the pain. We therefore regularly combine both treatments.

Complaints that we handle with it

Small, mainly observational studies suggest that neuroprolotherapy can help with chronic low back pain, Achilles tendon pain, knee pain, shoulder pain and elbow pain. In our practice we also use it for other pain complaints, such as neck pain, headache and Maigne syndrome.

Number of treatments

We treat weekly. On average, about 6 treatments are needed, but that depends greatly on your condition.

This is how a session goes

Every course of treatment is tailored, but this is what a typical course looks like — from the first intake to recovery and maintenance; how quickly that goes differs from person to person. You always know exactly where you stand.

1. Locate trigger points

   Doctor palpates exactly which skin nerve is irritated — often along fixed anatomical routes. You provide pain feedback.

2. Series of subcutaneous injections

   Very thin needles (27-30G). Multiple injections (5-25) of 0.3-1 ml 5% glucose directly under the skin, next to the nerve.

3. Instant pain relief?

   Many patients experience pain reduction within minutes — characteristic of PIT. Helps confirm diagnostically that we are hitting the right nerve.

4. No after-pain

   Unlike prolotherapy: no inflammatory reaction, no after-pain. You can function again immediately. 1-2 sessions weekly in the start phase.

Frequently asked questions

Is this the same as prolotherapy?

No. Prolotherapy goes deeper into ligaments/tendons and uses higher concentration; PIT is superficial and uses 5% glucose.

Immediate pain relief possible?

Yes — that is characteristic of PIT and is used diagnostically.

How many injections per session?

Often 5-25 depending on the size of the area.

Do they hurt?

Minimal — many patients find it less annoying than a tattoo.

Does it work for everyone?

No. It mainly suits pain that comes from an irritated nerve, and even then it varies from person to person. For purely mechanical complaints we often choose a different treatment.

Not suitable for local skin infections, blood clotting disorders, allergy to lidocaine (with combined preparations), or uncontrolled diabetes. Often works well for neurogenic pain components; less suitable for purely mechanical complaints.