Perineural Injection Therapy for Pain: What You Need to Know
Learn how perineural injection therapy works, what it may be used for, and how dextrose injections and nerve hydrodissection may help certain types of nerve pain.
Perineural Injection Therapy: A Treatment Option for Pain
Persistent pain does not always come from a joint, tendon, ligament, or muscle. In some cases, peripheral nerves may become irritated, sensitized, compressed, or restricted by surrounding tissues, contributing to symptoms such as burning, tingling, shooting pain, tenderness, or unusual sensitivity.
Perineural injection therapy (PIT) is a minimally invasive treatment that involves placing an injectable solution around an affected peripheral nerve. One commonly studied solution is 5% dextrose in water (D5W). PIT may be considered as part of a broader treatment plan for certain types of nerve-related or neuropathic pain. Research has investigated perineural D5W for several neuropathic pain presentations.
What Is Perineural Injection Therapy?
“Perineural” simply means around a nerve. During perineural injection therapy, a solution is delivered into the tissues surrounding a peripheral nerve rather than into the nerve itself. Depending on the nerve and treatment area, injections may be performed superficially or with ultrasound guidance. Ultrasound allows the practitioner to visualize the nerve and nearby anatomical structures in real time and is particularly useful when treating deeper nerves or performing nerve hydrodissection.
PIT may also be referred to as perineural injection treatment, perineural therapy, perineural dextrose injection, neural prolotherapy, or simply PIT.
How Does Perineural Injection Therapy Work?
Nerves can contribute to pain when they become irritated, sensitized, or entrapped. Symptoms can include burning, tingling, shooting or electric-like pain, sensitivity to touch, or pain that travels along the course of a nerve.
D5W has increasingly been studied as a perineural injectate. Exactly how dextrose affects nerve related pain is still being investigated. Proposed mechanisms include effects on pain-signaling
pathways and neurogenic inflammation. When hydrodissection is performed, physically separating a nerve from surrounding tissues may also contribute to symptom improvement.
Research is currently strongest for certain peripheral nerve entrapments, particularly carpal tunnel syndrome. A 2025 systematic review and meta-analysis found that perineural dextrose injections showed benefits for pain and function in upper-limb compression neuropathies, while also emphasizing the need for further high-quality research and standardized treatment protocols. Read the systematic review here.
Importantly, not every case of tingling, burning, numbness, or radiating pain is caused by a peripheral nerve entrapment. Proper assessment is necessary to identify other possible neurological, spinal, vascular, or musculoskeletal causes. Working with your naturopath, physiotherapist, or chiropractor can help further determine if this may be indicated for you.
What Happens During Perineural Injection Treatment?
Treatment begins with a medical history and physical examination. The practitioner may assess the location and distribution of symptoms, nerve sensitivity, strength, sensation, and possible sites of irritation or compression.
For deeper perineural injections, ultrasound may be used to identify the nerve and surrounding structures and guide needle placement.
The treatment itself involves placing the chosen solution around the targeted peripheral nerve. Treatment technique and the number of injections required depend on the nerve involved and the patient's individual presentation.
How Many Treatments Are Needed?
There is no universal number of perineural injection treatments. A treatment plan may depend on the diagnosis, duration and severity of symptoms, nerve involved, underlying mechanical factors, and individual response.
PIT may also be combined with appropriate rehabilitation, mobility work, strengthening, ergonomic modifications, or treatment of contributing musculoskeletal injuries. This usually involves working with physiotherapists, chiropractors, and/or kinesiologists.
Are Perineural Injections Safe?
As with any injection procedure, PIT is not risk-free. Potential risks can include temporary discomfort, bruising, bleeding, infection, irritation of surrounding tissues, and injury to nearby nerves or blood vessels.
The specific risks depend on the treatment area, injection technique, and solution being used. Ultrasound guidance can help practitioners visualize relevant anatomy during deeper injections, but it does not eliminate all procedural risks.
Is Perineural Injection Therapy Right for You?
Persistent nerve-like pain deserves a thorough assessment. Burning, tingling, numbness, or radiating pain may originate from a peripheral nerve, the spine, or another condition, and treatment should be directed toward the underlying cause.
When peripheral nerve irritation or entrapment is identified, perineural injection therapy may be one option to consider alongside rehabilitation and other conservative treatment strategies.
If you are experiencing persistent nerve-related symptoms, book an assessment to determine the source of your pain and whether perineural injection therapy may be an appropriate treatment option.
References:
1. Kim H, et al. The effect of perineural injection therapy on neuropathic pain. Journal of Dental Anesthesia and Pain Medicine. 2024. Full text
2. Azizi F, et al. A systematic review and meta-analysis of the effectiveness of perineural dextrose injection in peripheral compression neuropathies of the upper limbs. Heliyon. 2025. Full text
3. Sveva V, et al. Safety and efficacy of ultrasound-guided perineural hydrodissection as a minimally invasive treatment in carpal tunnel syndrome: a systematic review. 2024. Full text
4. Wu YT, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial. Mayo Clinic Proceedings. 2017. PubMed