Perineural Injection Therapy
Targeted injections intended to calm irritated superficial sensory nerves and reduce nerve-related pain patterns by addressing neurogenic inflammation.
Book an initial visitWhat is Perineural Injection Therapy?
Perineural Injection Therapy (PIT), also known as neural prolotherapy or Lyftogt technique, is a treatment for chronic pain caused by inflamed or dysfunctional nerves. It was developed by Dr. John Lyftogt in New Zealand.
The treatment involves injecting a dilute dextrose solution (typically 5%) just beneath the skin along the path of affected superficial nerves. This solution helps reduce neurogenic inflammation - inflammation caused by the nerves themselves.
Unlike deeper injections, perineural therapy targets the small sensory nerves in the subcutaneous tissue that can become chronically inflamed and cause persistent pain patterns.
How Perineural Therapy Works
Perineural injection therapy targets superficial nerves to reduce chronic neurogenic inflammation.
Identifying Nerves
Using careful palpation and anatomical knowledge, the affected nerves are identified along their course.
Subcutaneous Injection
A dilute dextrose solution is injected just under the skin along the path of the affected nerve.
Reducing Inflammation
The solution is intended to reduce neurogenic inflammation, helping to calm the irritated nerve and ease pain patterns.
Benefits of Perineural Therapy
Targets nerve-related pain at its source
May help reduce neurogenic inflammation
May help calm irritated superficial sensory nerves
May reduce nerve-related pain patterns
Minimally invasive with minimal discomfort
May be considered when other treatments have not provided relief
Conditions Treated with Perineural Therapy
Perineural injection therapy may be considered for a range of nerve-related and neuropathic pain conditions.
Perineural Injection vs. Nerve Hydrodissection
Both are nerve-targeted treatments, but they work in different ways and address different types of nerve pain.
Perineural Injection Therapy
- →Anti-inflammatory: Uses dilute dextrose to calm irritated superficial sensory nerves
- →Surface-based: Targets small sensory nerves just beneath the skin without ultrasound
- →Best for: Superficial nerve irritation and neuropathic pain patterns
Nerve Hydrodissection
- →Mechanical release: Uses fluid to physically separate compressed nerves from scar tissue and surrounding structures
- →Ultrasound-guided: Real-time imaging ensures precision at the entrapment site
- →Best for: Nerve compression and entrapment (carpal tunnel, sciatica, cubital tunnel, etc.)
Evidence-Based Research
Perineural injection therapy is supported by emerging clinical research.
Perineural Dextrose for Carpal Tunnel
Prospective, randomized, double-blind controlled trial (Wu et al., Mayo Clin Proc, 2017) showing 6-month benefit of 5% dextrose perineural injection.
Read on PubMedDextrose vs Corticosteroid Injection
Randomized double-blind clinical trial (Wu et al., Ann Neurol, 2018) comparing 5% dextrose and triamcinolone perineural injections for carpal tunnel syndrome.
Read on PubMedPerineural Dextrose for Ulnar Neuropathy
Randomized, controlled, double-blind study evaluating perineural dextrose injection for ulnar neuropathy at the elbow.
Read on PubMedPerineural PRP vs Dextrose
Prospective randomized head-to-head trial (Shen et al., 2019) comparing perineural platelet-rich plasma and 5% dextrose for moderate carpal tunnel syndrome.
Read on PubMed5% Dextrose Prolotherapy for Chondromalacia Patella
Randomized controlled trial (Bayir, Koroglu & Demir, PM&R, 2026) comparing 5% dextrose prolotherapy with saline injections for chondromalacia patella, supporting dextrose as an effective option for this common source of anterior knee pain.
Read on PubMedPerineural Dextrose for Upper Limb Compression Neuropathies
Systematic review and meta-analysis (Azizi et al., Heliyon, 2025) confirming the effectiveness of perineural dextrose injection across peripheral compression neuropathies of the upper limbs.
Read on PubMedHydrodissection of Cervical Nerve Roots for Cervical Radiculopathy
Ultrasound-guided nerve hydrodissection study (Lin, Yen & Wu, Sci Rep, 2023) demonstrating meaningful pain and function improvements in cervical radiculopathy, supporting hydrodissection as an effective approach for fascial entrapment neuropathy along multiple sites.
Read on PubMedPerineural Injection Therapy: Common Questions
What is perineural injection therapy?
Perineural injection therapy (PIT), also known as neural prolotherapy or the Lyftogt technique, is a treatment in which small amounts of a dextrose solution are injected just beneath the skin around inflamed superficial nerves. This is intended to reduce neurogenic inflammation and ease chronic nerve-related pain.
What conditions does perineural injection therapy treat?
PIT is used for chronic neuropathic pain, peripheral nerve entrapment and compression neuropathies, chondromalacia patella, and persistent regional pain that involves irritated superficial nerves.
How does perineural injection therapy work?
Irritated superficial nerves can drive ongoing pain and inflammation. The dextrose solution used in PIT is thought to calm these inflamed nerves, interrupting the pain cycle and allowing the nerve to settle and function more normally over a series of treatments.
Does perineural injection therapy hurt?
The injections are shallow and use very fine needles, so most patients tolerate them well. You may feel brief stinging with each injection and some mild tenderness afterward, which typically resolves quickly.
How many perineural injection treatments are needed?
PIT is usually performed as a series of sessions, often spaced about a week or two apart, with the number tailored to your response. Dr. Borys discusses a personalized plan at your consultation — call (360) 738-3230 for details.
Ready to explore perineural therapy?
It starts with an initial visit to discuss whether perineural injection therapy is the right option for your nerve-related pain — a standard medical evaluation that is typically billable to insurance, including plans such as Regence and Premera.