This treatment, first discovered and later further developed by Dr. John Lyftogt, MD, New Zealand, consists of a series of small volume injections of D5W subcutaneously targeting painful superficial nerves (neurogenic pain). D5W (dextrose 5% in sterile water) has a strong safety profile and is used in hospitals for varying indications worldwide.
P.I.T. may be an effective treatment for painful conditions due to sport and occupation or other chronic non-malignant pain related issues. It involves first making an accurate diagnosis of the cause of pain, which is usually due to an injured or non-healing sensory nerves causing pain and inflammation.
Every treatment aims to extinguish the pain, which at the firist treatment may initially last for a period of four hours to four days. Repeated treatments usually done weekly, result in gradual reduction of the overall pain, with the aim of complete resolution – a zero pain score – and allow return of full function. For most conditions recurrence is unlikely. It is key to select the ideal patients suffering with neurogenic pain for best results.
There are so many exciting and cutting-edge treatments and therapies that will be showcased at TOBI this year. We have heard that P.I.T. is of particular interest to you. What is it about P.I.T. that is so revolutionary?
Our team has been performing perineural injections for many years. It’s a very helpful tool to have when the right patient presents with neurogenic pain. Our patients appreciate when we can offer a wide variety of injections that may help based on each individual case. An appealing aspect is the safety aspect and short time for symptomatic relief to take place. Physicians can quickly learn the basic fundamental aspects of P.I.T. and then with time advance applications and training to handle more complex presentations. A small 27g needle is used and treatment is well tolerated by patients of all activity and age spectrums. Some of our elite athletes have seen practitioners around the globe with continued pain despite comprehensive imaging and treatments. In the right circumstances P.I.T. has been a game changer to relieve symptoms stemming from neurogenic pain. It’s important for us to have many tools to get our patients better. P.I.T. fits in nicely with our arsenal of natural based injections.
In looking at the application of buffered Dextrose, this is certainly a significantly more natural approach to clinical pain abatement. To what does Lyftogt attribute the efficacy of D5W?
Dr Lyftogt has presented compelling research and basic science that the D5W acts to block the TRPV-1 (Capsaicin) receptor. Also Na (Sodium) and K (Potassium) channels play a key role in neurogenic pain and are influenced by D5W.
What sets P.I.T. apart from other nerve block treatments and injection therapies?
Unlike cortisone, Dextrose is generally not associated with negative side effects like fat atrophy, tissue degeneration, or stem cell death.
What are other applications that you hope to see P.I.T. useful for in the future?
A promising application is in post op pain. Patients following knee or hip surgery may suffer with neurogenic pain. They may have a large scar or a painful region where the superficial nerves may have been incidentally traumatized. When they follow up with their surgeon, they receive an x-ray that looks great, yet they may have tremendous pain and limited function. The cutaneous nerves can’t be visualized by most imaging technology, but can frequently cause pain. My hope is that more physicians become aware of neurogenic pain post op and adapt treatments like P.I.T. to address it, to promote more activity and less prescription pain meds post operatively. Also P.I.T. may be useful to calm occasional symptomatic flare ups following PRP injections to tendons.
P.I.T. has a high success rate in providing pain relief. Do you think treatments such as these hold the key for reducing American opioid dependence in pain management?
A nice benefit to this treatment is it does not have the side effects associated with most prescription drugs. Simply by injecting D5W (sugar water) we have seen notable effects on pain abatement for superficial cutaneous nerves. When successful, the relief is instant following injection, without using any local anesthetic! Patients are often shocked when their chronic nerve pain is “numbed” or gone immediately. Patients require a series of treatments after some early relief has been demonstrated to ensure long term benefits.
What can TOBI attendees look forward to learning about P.I.T. from Dr. Lyftogt this year?
The exciting thing about having Dr Lyftgot back is that he is always advancing his technique and understanding of how P.I.T. is best administered. I’m excited to hear about his new publications this year. Unlocking new concepts in neurogenic pain has potential to open our minds for other applications like radiofrequency ablation and highlighting new anatomical targets for cell therapies. This year at TOBI Workshops and Labs, Dr. Lyftogt’s team is also teaching P.I.T. with MSK ultrasound to reach deeper nerves. In the past most P.I.T. injections were performed blindly, but with new technology we can visualize many of the superficial nerves to enhance accuracy and efficacy. This is new and very exciting, as it broadens the application of this treatment further.