Small Injections, Big Difference for Stubborn Pain
Some pain hangs on because a ligament is loose or a nerve just under the skin stays irritated. Dr. Spiegel uses two gentle injection treatments, prolotherapy and PIT, to calm the pain and help your body repair the area.
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What Are Prolotherapy and PIT?
Prolotherapy and perineural injection therapy (PIT) are injection treatments that use a simple dextrose (sugar) solution. Prolotherapy is injected where ligaments and tendons attach to bone to help strengthen loose or injured tissue. PIT is injected just under the skin along small irritated nerves to calm nerve-related pain. At the Osteopathic Center for Healing in Rockville, MD, both are performed by Dr. Neil Spiegel, DO, MBA.
How Are Prolotherapy and PIT Different?
Prolotherapy
- What It Targets
- Loose, weak or injured ligaments and tendons
- Where It Goes
- Where ligaments and tendons attach to bone, guided by ultrasound
- How It Works
- A mild irritation tells your body to send healing to the area and tighten the tissue
- What You'll Feel
- Soreness for a few days, then gradual improvement over weeks
PIT (Perineural Injection Therapy)
- What It Targets
- Small, irritated nerves just under the skin
- Where It Goes
- Tiny, shallow injections along the painful path
- How It Works
- Dextrose helps calm the nerve so pain signals settle down
- What You'll Feel
- Many people feel some relief within minutes to days
What Do They Treat?
Prolotherapy
- Low back and sacroiliac (SI) joint pain
- Neck pain and whiplash
- Loose or unstable joints
- Old ankle sprains
- Knee ligament injuries
- Shoulder and elbow tendon problems
PIT
- Pain that feels burning, achy or "everywhere"
- Tender spots along the skin
- Nerve-related pain in the back, neck, shoulders, knees and feet
- Pain that stays after an injury has healed
Many people have both a loose ligament and an irritated nerve, and treating one without the other leaves pain behind.
Why Does Pain Hang On?
When a ligament heals loose after an injury, the joint moves more than it should, and the muscles around it tighten to protect it. That's where prolotherapy helps.
Small nerves can also stay irritated long after the original injury, sending pain signals even when the tissue below has healed, and that's where PIT helps. Dr. Spiegel often uses them together or alongside osteopathic treatment.
What Does a Visit Look Like?
Exam
Dr. Spiegel finds the loose ligaments and irritated nerves by hand and with ultrasound.
Injections
A series of small injections of a dextrose solution, placed with ultrasound for prolotherapy.
Back to Your Day
Most people drive home and go back to normal activity.
A Series of Sessions
Most people need several visits. Dr. Spiegel sets the schedule based on how you respond.
Is It Right for You?
- Pain that's lasted months
- Pain that didn't respond to rest, PT or cortisone
- Joints that feel loose or give way
- Pain that feels nerve-like or burning
No Steroids
These treatments use dextrose, not steroids, so they can be repeated without the tissue weakening that repeated cortisone can cause.
Where Do They Fit With Other Treatments?
What Do People Ask About Prolotherapy and PIT?
What's in the Injection?
Both treatments use dextrose, a simple sugar solution. Prolotherapy also includes lidocaine, a numbing medicine, to keep you comfortable.
Do I Need an MRI First?
Not always. Dr. Spiegel starts with an exam and ultrasound here in the office. If those don't tell the whole story, he'll order an MRI or other diagnostic testing, or refer you to get it. If you already have imaging, bring it.
Does It Hurt?
Prolotherapy brings a few days of soreness as your body starts the healing response. PIT uses very small, shallow injections, and most people tolerate it well.
How Many Sessions Will I Need?
It varies. PIT is usually done weekly, and prolotherapy every three to six weeks. Most people need a series of visits, and Dr. Spiegel adjusts the plan based on how you respond.
How Fast Does PIT Work?
Many people feel some relief within minutes to days. Lasting results usually build over a series of sessions.
How Is Prolotherapy Different From PRP?
Both help your body heal. Prolotherapy uses dextrose and is often used for loose ligaments. PRP uses your own platelets and is often used for tendon injuries. Dr. Spiegel will tell you which fits.
Is It Covered by Insurance?
Most plans don't cover these injections. We'll go over costs at your consult.
Request an Appointment
Tell us where it hurts and what you've tried so far, and our team will reach out to schedule your consult.
Let's Find What's Keeping Your Pain Going
Book a consult with Dr. Spiegel in Rockville, MD.
Not ready to book? Start with a free 15-minute call