Perineural Injection Techniques (PIT)

Glucose was first recognised as effective in pain relief 16 years ago. Understanding the glucose-pain relationship requires a shift in perspective. This is a paradigm. Pain lasting longer than 6 months becomes chronic.

The prevalence of neuropathic pain:
30 years old => 34 %
75 years old => 88 %

Glucose is a source of energy for movement; in other words, it is cellular fuel. Its numerical expression is known as Gibbs energy. Potential energy is expressed as a negative value.

The Gibbs energy of glucose is -910.56 kJ/mol.
1 mol of glucose produces 38 ATP in cellular respiration.
1 mol of glucose produces 34 ATP in the electron transport chain.
Bicarbonate = -586 kJ/mol
Water = -237 kJ/mol
In PIT solution = water, glucose, bicarbonate = -1700 kJ/mol

Glucose is produced and stored within the cell, just like electrical energy, in the mitochondria. Glucose injected between cells is taken into the cell via special transporters (Glut Receptors); our target is the nerve cell. (Glut1, Glut3 for neurons)

Hypothesis: Chronic neuropathic pain may be a signal for low energy levels in small (C-type) nerve fibres.

With PIT management, we treat energy-deprived nerve cells; low energy levels cause nerve cells to burn out; somatosensory nerves are treated with PIT.

In particular, fibres known as C fibres represent nerve cables that transmit biological information (homeostasis) from the tissue, such as low acid-base balance (acidosis), to the dorsal roots of the spinal cord.

The nerves responsible for pain (i.e. C fibres) constitute only 4% of all nerves.

The significance of the hypothesis in pain treatment, i.e. in clinical practice, is based on the Valleix phenomenon. This description refers to a situation where long nerves resembling cables are compressed at any point, causing the electrical current (axoplasmic current) flowing through them to be interrupted due to the compression. This is called "tactile allodynia" or "entrapment neuropathies".

The cell bodies of the thin C fibres that transmit chronic pain are located in the spinal cord. Their extensions can range from a few centimetres to a metre in length. They are 1 micrometre thick. Their extensions terminate freely and are sensitive to the most important pain-producing substances that increase during inflammation (i.e. sterile inflammation), such as Substance P and CGRP.

Another feature is that these nerves are present at birth and remain with us throughout our lives. They contain Glut 3 receptors. This means they are sensitive to glucose.

Clinical anatomy knowledge is crucial when applying the PIT Method. This is because the method is based on Hilton's laws and the distribution of sensory nerves. Chronic pain is always related to sensory nerves. The brain's representation area is a region in the frontal lobe known as the insula. One of the important characteristics of the insula is its connection to emotions. In treatment, a 13mm 27G needle is used (Botox needle), and the injection depth is approximately 2-3mm. That is, it is administered just beneath the skin.

PIT is effective in practically all conditions accompanied by pain. It is a highly effective and equally reliable method, particularly for all conditions involving nerve entrapment.