Perineural Injection Therapy Training for Chiropractors

Perineural injection therapy (PIT) involves the subcutaneous injection of a low-concentration buffered dextrose solution (typically 5% dextrose) along the course of superficial peripheral nerves that have become chronically irritated and inflamed. The dextrose interacts with TRPV1 receptors on sensory nerve fibers, reducing neurogenic inflammation and restoring normal nerve function. This mechanism addresses the underlying neural dysfunction rather than simply masking pain.

PIT has demonstrated clinical efficacy for chronic neuropathic pain conditions including headaches and migraines, chronic neck and back pain, lateral epicondylitis, Achilles tendinopathy, knee pain, post-surgical pain syndromes, and various other chronic musculoskeletal pain conditions that have a significant neuropathic component. It is particularly valuable for patients who have not responded adequately to conventional pain treatments.

Most patients require a series of four to eight treatment sessions spaced one to two weeks apart, though significant pain reduction is often noticed after the first two to three treatments. Some chronic conditions may require additional maintenance sessions. The course teaches you how to structure multi-session treatment protocols and track clinical outcomes to guide treatment duration.

PIT has an excellent safety profile because the injections are performed subcutaneously (not deep) using a very low-concentration dextrose solution rather than corticosteroids or other medications with systemic side effects. The most common side effect is mild, temporary discomfort at injection sites. The superficial injection depth and benign injectate make PIT one of the safest interventional pain procedures available.

Traditional prolotherapy (regenerative injection therapy) uses higher-concentration dextrose solutions (typically 15-25%) injected into ligament and tendon attachments to stimulate a healing inflammatory response. Perineural injection therapy uses much lower concentrations (5%) injected subcutaneously along superficial nerve pathways to reduce neurogenic inflammation. The targets, mechanisms, and concentrations are distinctly different despite both using dextrose.

Yes, PIT integrates well with other pain management modalities including joint injections, trigger point injections, physical therapy, regenerative medicine treatments, and chiropractic care. Many practitioners use PIT as part of a comprehensive, multi-modal pain management approach that addresses both neuropathic and nociceptive pain components simultaneously.

PIT requires minimal equipment — small gauge needles (typically 27-30 gauge), sterile buffered dextrose solution, syringes, and standard injection supplies. The low equipment cost and absence of expensive imaging or specialized devices make PIT one of the most accessible interventional pain procedures to add to a practice, with virtually no barrier to entry beyond proper training.

Yes, Empire Medical Training's Perineural Injection Therapy Training is fully CME/CE accredited. You receive certification documenting your training in PIT techniques along with earned CME/CE credits applicable to license renewal and professional development requirements for your specific healthcare profession.

Chiropractic authority for injection procedures varies by state. PIT's use of subcutaneous buffered dextrose makes it among the lowest-risk injection procedures available. In states that authorize chiropractic injection procedures, PIT's safety profile and conservative approach align well with chiropractic practice philosophy. Verify your state's specific regulations regarding injection procedures for chiropractors.

PIT and chiropractic adjustments address different components of chronic pain. Adjustments correct biomechanical dysfunction and joint restriction, while PIT targets neurogenic inflammation along irritated peripheral nerves. When combined, the two approaches create a comprehensive treatment that addresses both structural and neurological pain drivers — often producing outcomes that neither modality achieves alone.

PIT aligns with the chiropractic philosophy of conservative, patient-centered care. The technique uses no drugs, no steroids, and no deep injections — just buffered sugar water delivered subcutaneously. This natural, non-pharmacological approach resonates with patients who seek chiropractic care specifically because they prefer conservative treatment approaches. PIT also requires minimal equipment investment, making it financially accessible for any chiropractic practice.

Chiropractic scope of practice regarding injection procedures varies significantly by state. A growing number of states authorize chiropractors to perform trigger point injections, joint injections, PRP treatments, and other injection-based therapies with proper training and certification. It's essential to verify your state chiropractic board's specific regulations before adding injection services. Empire's certification documents your hands-on training competency for credentialing purposes.

Interventional pain management techniques like trigger point injections, joint injections, and PRP therapy directly complement chiropractic adjustments by addressing soft tissue and joint inflammation, promoting healing, and providing pain relief that enhances the effectiveness of manual therapies. Functional medicine services expand your ability to address root causes of chronic conditions. Together, these integrated approaches deliver superior patient outcomes compared to any single modality alone.

Empire's course provides comprehensive hands-on training and certification in the specific procedures covered. Depending on your state's requirements, you may also need to complete additional hours of injection-related continuing education, obtain specific state certifications, or establish a practice protocol review with a medical director. Empire's team can help you understand the requirements in your specific state and practice context.