How Sugar Heals Pain Discover Perineural Injection Treatment Dr. Laurie Steelsmith, N.D., L.Ac.

Laurie Steelsmith, N. D. , L. Ac. www. DrSteelsmith. com www Laurie Steelsmith, N.D., L.Ac. www.DrSteelsmith.com www.SteelsmithHealth.com B.S., M.S., and Doctorate in Naturopathic Medicine from Bastyr University, 1993 Private practice in Honolulu since 1993 Author of Natural Choices for Women’s Health (Random House, 2005), and Great Sex, Naturally (Hay House, 2012) No Professional Conflicts of Interest

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Your Foundation of Health DETOXIFI- CATION EXERCISE DIET MIND AND SPIRIT

Primary Objectives: Discover how D5W can stop pain. Know indications and contraindications for PIT. Learn how to set up an effective treatment plan. Discover how to give multiple injections in a relatively pain-free manner. Learn areas of injection for trigeminal neuralgia, achillodynia, and chronic whole body pain.

Dr. John Lyftogt

How Does PIT Stop Pain? The technique uses near-nerve subcutaneous injections with a buffered solution of D5W, 5% dextrose in water with neutral pH. This solution has two effects: 1) It blocks chronic pain up to 4 days, and 2) It reduces inflammation over a 4 to 5 week period.

“This nerve inflammation is caused by small nerve fibers carrying the TRPV1 ion channel. Activation of the TRPV1 ion channel causes release of proinflammatory neuro-peptides Substance P and CGRP, responsible for chronic pain and degeneration. D5W down-regulates the TRPV1 ion channel, reducing inflammation and allowing physiological healing to take place.” —Dr. Lyftogt

TrpV1 = Transient Receptor Potential Cation Channel Subfamily V Member 1, also known as the Capsaicin Receptor

How PIT Stops Pain, continued Buffered D5W also stops pain by resolving neuropathic pain associated glycopenia in tissues. It changes the potassium and chloride ions across cell membranes, which decreases inflammation. It frees up entrapped nerves, or areas of chronic constrictive injury where nerves run through sheaths.

How PIT Stops Pain, continued Finally, this treatment allows for chronically “sick” nerves to heal. When a peripheral nerve is injured, surrounding nerves hyper-upregulate, causing painpain cycles. By injecting buffered D5W into the area of an injured nerve, the upregulated nerves down-regulate and halt the inflammatory cycle.

Indications for PIT Chronic neurogenic inflammation as seen in achillodynia, trigeminal neuralgia, post herpetic neuralgia, Morton's neuroma, plantar fasciitis, carpal tunnel syndrome, neurogenic itching, and chronic pain syndromes. I have also used it to treat acute muscle tension and strains.

Contraindications for PIT Infection of any kind, e.g., cellulitis, skin rash, or joint infection Autoimmune arthritis Extreme phobia of needles or injec- tions, or highly sensitive patients Allergy to corn?

Materials Needed for PIT D5W and sodium bicarbonate 8.4% ½ inch 27- and 30-gauge needles 3 cc, 5 cc, and 10 cc syringes Gloves, 70% alcohol Cotton balls Willing patient

PIT Solution Recipe for D5W Bags For a 500 mL D5W bag, add 4 mL of 8.4% sodium bicarbonate. For a 1,000 mL D5W bag, add 8 mL Check pH; it should be >6.9.

PIT Solution Recipe for Sterile Water Bags For a 500 mL sterile water bag: Remove 50 mL sterile water, then replace with 50 mL of 50% dextrose. Add 6 mL of 8.4% sodium bicarbonate. Check pH; it should be >6.9.

PIT Solution Recipe for Sterile Water Bags For a 1,000 mL sterile water bag: Remove 100 mL of the sterile water, then replace with 100 mL of 50% dextrose. Add 8 mL of 8.4% sodium bicarbonate. Check pH; it should be >6.9.

Injections For most body areas, inject .5 cc of fluid. For some areas of the body, inject 3 cc, 5 cc, and 10 cc of fluid to impact deeper structures by flooding the area being treated. Use 30 g needles on face, hands, feet, and other sensitive areas. To spare your hands, use 27 g needles everywhere else. Become proficient at painless injections.

How to Inject Relatively Painlessly Let alcohol dry before injecting! Distract by gently pinching skin or applying pressure with fingernail near site of injection. While injecting, wiggle injecting hand slightly and inject fluid at the same time. Be Quick!

Treatment Protocols Typically 4 to 6 treatments needed for full recovery. Some patients get well so fast that they only need 2 visits. Others may need 12 or more visits. The good news is that the first 2 treat- ments are diagnostic. If a patient doesn’t get any improvement in 2 visits, they don’t have neurogenic inflammation and another therapy is indicated.

Post-Treatment: What to Expect? Area injected has less pain and feels lighter, looser, and has increased ROM. Improvement can be immediate or take 12, 24, or 48 hours. Some patients may experience an aggravation followed by improvement a few hours later. Most experience some pain relief before leaving your office.

Videos of Treatments First video is on treating trigeminal neuralgia. Treat the foramina with .5 cc buffered D5W with a 30 g ½ inch needle. Use a 3 cc syringe to prevent hand strain. Second video is on treating achillodynia. Inject with 27 g ½ inch needle. Treat deep tibial point with 3 cc of buffered D5W. Treat other points along sural and saphenous nerves.

Final Video on Treating Whole Body Pain Treatment of dorsal rami from C2S2. Inject .5 cc buffered D5W with 27 g needle. In TCM these are located where the T1L5 Huatuojiaji points are (.5 cun lateral to the lower border of the spinous process).

Resources John Lyftogt, M.D.: Contains research articles, courses, and background on PIT. www.Lyftogtmed.com Laurie Steelsmith, N.D., L.Ac. Personal contact information for questions/comments: info@drsteelsmith.com (808) 943-0330