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Overview

Trigger point injections are an effective treatment modality to inactivate trigger points and provide prompt relief of symptoms from myofascial pain syndrome. Myofascial pain syndrome is a common painful muscle disorder characterized by myofascial trigger points. It is distinguishable from fibromyalgia syndrome, which involves multiple tender points, although these pain syndromes may be concurrent. They produce pain focally and in a referred pattern and often co-occur with chronic musculoskeletal pain disorders.

Indications

Various modalities for the treatment of trigger points include spray and stretch, ultrasound, manipulative therapy, and trigger point injections. Not all trigger points require injection or needling. Many active trigger points will respond to physical therapy, especially in the early stages of trigger point formation. However, for chronic trigger points, trigger point injection and needling is an effective treatment.

Trigger point injections are indicated for patients who have symptoms and examination findings consistent with active trigger points. Latent trigger points are clinically asymptomatic and do not require treatment. Trigger points should be limited in number and should be appropriate for injection.

Conditions involving widespread pain complaints, such as fibromyalgia or endocrine disorder, are not suitable for injections. Treatment is indicated for endocrine diagnoses or fibromyalgia before considering trigger point injections. In addition, the finding of tenderness alone is not an indication for trigger point injection because patients with fibromyalgia may also have myofascial pain trigger points.

What to Expect

Trigger point injections are done as an outpatient in office procedure. Once access to the affected site is obtained, the skin aseptically cleaned, all after proper identification of the trigger point site the injection will precede. Sometimes the procedure is done with ultra sound guidance to avoid complications of injection too deep or puncture of the plural (lung) lining. Small amounts of local anesthesia and/or steroid mix are injected into the trigger point area to help break up the hard fibrous area. This may be seen with ultrasound use as well. Multiple areas can be done during the same session.

Outcomes

Some patients receive immediate relief from the injections and most will note the effects are long lasting as the steroid provides anti-inflammation response. With the recurrence of the trigger point the injection may need to be repeated.