Turning Your World Upside Down
Edie Vickers has seen a lot in her 30+ years as a Naturopathic Physician. She’s built a reputation in the NW Portland community as a specialized practitioner able to help people that other providers could not with their complex medical conditions. However, Edie had to experience her own issue to be introduced to Perineural Injection Therapy (PIT).
Perineural injection therapy (PIT) has changed the way I deal with pain, both for myself and my patients. I started to learn this medicine back in 2012 with Rick Marinelli ND, LAc. I had the residuals of a frozen shoulder and within 2 treatments I could laterally rotate my arm to 85% (it had been stuck at 45 degrees). Since then, I have studied with Dr. John Lyftogt (Lyftogtmed.com) multiple times and earned my master of PIT therapy certification. At age 60 I use PIT to help me stay active; for my knees, neck, low back, and diaphragm spasms. The possibilities are unlimited when it comes to fascial tension and pain. As you can see, I am a big fan of PIT!
The further that we delve deeper into the nature of pain through pain science, the more and more we continue running into nerves contributing to some of the underlying symptoms. For years, we’ve talked about muscles, tendons, and ligaments, but nerves were rarely discussed and that is because we had a hard time measuring the nerve’s effect on our sensation of pain and what treatments could actually help the nerve to recover from its inflamed state. We asked Dr. Edie and Dr. Anemone Fresh to share with us what exactly PIT is and when is it utilized.
WHAT IS PERINEURAL INJECTION THERAPY?
By Anemone Fresh ND, LAc, LMT and Edythe Vickers Nd, LAc
A nerve cell, like other cells in the body, needs several nutrients to keep it healthy, including glucose. When a nerve is injured, inflamed and lacks glucose, it sends continuous signals that the body interprets as pain.
Perineural injection therapy is a 5% dextrose (glucose) solution that is injected near superficial nerves. The superficial nerves communicate with the deeper nerves and muscles and therefore by treating the superficial nerves, PIT treats the entire muscular-neuro-vascular bundle. PIT treats inflammation and injury by feeding and hydrating the injured nerve. This pain can be due to trauma, arthritis, overuse, fascial adhesions and occupational, sports or surgical injuries. The pro-inflammatory substances that cause swelling, hypersensitivity and pain also prevent muscles, tendons, and ligaments from healing. PIT therefore not only treats the pain, but allows for the body to heal appropriately.
Dextrose is a naturally occurring carbohydrate utilized by the body for energy. Dextrose enters the nerve cell receptor and restores the cell to its normal function. This process leads to the decrease and eventual elimination of pain. The fluid in the injection helps to hydrate connective tissue and break apart fascial adhesions. Dehydrated tissue can exacerbate nerve pain by pressing tightly on the nerve passing through it.
PIT is generally well tolerated and there is no need for a local anesthetic. The injection is administered with a very small and short needle just beneath the surface of the skin. The number of injections needed depend on the extent of the neuropathic inflammation and the length of time the inflammation has been present.
After the first PIT treatment, many patients notice immediate pain relief and increased mobility for a few hours to days. After subsequent treatments, pain is generally reduced, and mobility is improved as the tissue progressively heals. The pain may not be as intense, widespread, or frequent as it was prior to treatment.
CONDITIONS TREATED
Frozen Shoulder
Migraine Headache, Jaw Pain
Back, Hip, Leg, Knee, Foot, Shoulder, Arm Pain
Sciatica
Restless Legs
Carpal Tunnel Syndrome
Complex Regional Pain Syndrome
Trigeminal Neuralgia
Plantar Fasciitis
CASE EXAMPLES:
Frozen Shoulder: I have used PIT to treat frozen shoulder effectively – a condition that is known to be difficult to treat and often requires steroid injections for patients to return to normal function. I usually recommend twice weekly acupuncture, weekly PIT treatments and regular physical therapy to resolve frozen shoulder. Acupuncture pairs with PIT and physical therapy quite naturally. To treat frozen shoulder, PIT is injected along the nerves of the involved shoulder as well as the neck and back. I have seen frozen shoulder resolve in as quickly as two weeks with this treatment protocol when the patient is treated right at the onset of symptoms. Everyone’s body is different, and this protocol may need to be followed for several months for complete symptom resolution.
Migraine Headaches: Treating migraine headaches can be challenging. I have used both acupuncture and PIT combined to successfully decrease migraine headache frequency and severity in people suffering from migraines. Injections are typically performed in the face, scalp and neck to treat migraines. In addition to acupuncture and PIT, there are a number of naturopathic treatment options to help with migraine headache pain that I recommend.
Knee Pain: As an acupuncturist, knee pain is one of the most common complaints I treat. Whether it is osteoarthritis, tendonitis, overuse, surgery or sports injury, I have used PIT to help decrease pain and increase knee and leg mobility. Injections are commonly performed on the knee joint itself as well as above and below the knee on the hip, thigh, calf and ankle. Both acute knee pain due to trauma and chronic knee pain due to overuse, aging or previous injury can be treated effectively with PIT injections.
Chronic pain is a complex, multi-faceted issue that has been frustrating to treat. This frustration can come both from the people experiencing the pain but not receiving any relief medical interventions, and from practitioners, who are trying their best, but quite frequently find themselves scratching their heads as their treatments don’t seem to have long-term benefit. PIT offers hope to a lot of people experiencing chronic conditions and a window into a new tool that practitioners can employ in their quest to help all of their clients.