Perineural Injection Therapy (Lyftogt Method)

Introduction

Perineural Injection Therapy (PIT), developed by New Zealand physician Dr John Lyftogt, is a safe, highly effective treatment for persistent neuropathic pain caused by irritated superficial sensory nerves.

Using tiny subcutaneous injections of sterile buffered 5% glucose, we target sensitised C-fibres, which are the small, unmyelinated pain nerves responsible for dull, burning, aching and deep pain.

The treatment rapidly calms nerve inflammation, restores normal nerve gliding, and frequently produces substantial pain relief within minutes of the first injection.[1][2]

How It Works

C-fibres are the slowest-conducting sensory nerves in the body. They transmit dull, burning, aching or throbbing pain and are extremely sensitive to mechanical pressure, friction, stretching and low-grade ischaemia.

When repeatedly irritated they swell, lose their ability to glide (“floss”) through surrounding tissue, and enter a state of chronic neurogenic inflammation driven by the TRPV1 receptor (the capsaicin or “heat” receptor).[3]

A 5% buffered glucose solution injected immediately adjacent to these irritated nerves:

Supplies glucose to fuel the sodium-potassium pump and repolarise the nerve membrane[1]
Instantly reduces TRPV1 receptor activity and neurogenic inflammation[4]
Decreases perineural oedema and restores smooth nerve gliding[2]

The result is fast, cumulative and often permanent pain relief without steroids, local anaesthetic or anti-inflammatory drugs.

A Deeper Look at the Biochemistry of Perineural Therapy

Chronic irritation keeps the TRPV1 receptor on C-fibres in a persistently open state, leading to ongoing release of substance P and CGRP (calcitonin gene-related peptide). This sustains local inflammation, tissue oedema and persistent pain signalling.[4]

Buffered 5% glucose raises local pH, provides immediate substrate for the Na+/K+-ATPase pump, and repolarises the axonal membrane. This closes the TRPV1 channel, halts neuropeptide release, and switches off the pain signal within seconds to minutes. Repeated small-dose treatments (usually weekly) progressively “reset” the sensitised state, often leading to complete and lasting resolution.[1][5]

The Process

Tender points along superficial C-fibre pathways are carefully palpated and marked.
Using an ultra-fine 30-gauge needle, 0.2–0.6 ml of sterile buffered 5% glucose is injected just under the skin at each point. Most patients feel only a brief pin-prick.[6]
Immediate pain reduction of 30–80% is common within minutes.[7]
No downtime — normal activities can be resumed immediately.[1]
Treatments are repeated weekly for 3–8 sessions until pain is resolved or plateaus.[1]

Who It Helps

Perineural Injection Therapy is particularly effective for conditions driven by irritated C-fibres, including:

Chronic low back pain and sciatica of nerve-irritation origin[8]
Burning or aching neck pain and tension/migraine headache[9]
Tennis/golfer’s elbow and other superficial nerve entrapments[10]
Persistent post-surgical or post-traumatic nerve pain
Knee pain from infrapatellar saphenous nerve irritation
Achilles tendinopathy and plantar heel pain from tibial nerve branches
Any dull, burning, aching or throbbing pain that follows a nerve distribution and worsens with movement or stretching
It works best for mechanical/neuropathic pain mediated by sensitised C-fibres and is not intended for primary inflammatory arthritis, fibromyalgia or cancer pain.[1]

Results

In Dr Lyftogt’s published series and our clinical experience, 70–85% of correctly selected patients achieve 80–100% long-term pain relief after 4–8 sessions.[11] Many remain pain-free permanently. The treatment is extremely safe with virtually no side effects beyond occasional mild bruising.[4]

We commonly combine Perineural Injection Therapy with osteopathic treatment, ultrasound-guided prolotherapy, and high-intensity laser therapy for mixed or complex pain conditions.

References

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