Trigger Point Injections (TPI)

Trigger points or myofascial trigger points are areas of muscle pain and muscle spasm within muscle fibers. Trigger points are prevalent in the muscles of the neck and shoulder regions and the lower back and hip region.

 

Trigger point injections are a beneficial pain management technique that involves injecting medication directly into the trigger points resulting in pain relief.

 

Trigger point injections can treat various conditions, including fibromyalgia, tension headaches, and myofascial pain syndrome. In addition, they can significantly improve the flexibility and range of motion of muscles and enhance an individual’s quality of life.

What is a trigger point?

In skeletal muscle, trigger points are focal areas of muscle pain and muscle spasm that cause inflammation. The rhomboid and trapezius muscles found in the upper back and shoulder areas are the most common trigger points. These trigger points can cause neck pain, shoulder pain, and headaches. Trigger points can also occur in the lower back or the upper spine resulting in low back pain and pain down the leg that can resemble sciatica.

 

Trigger points are palpable nodules. There is tenderness in the area, and pain radiates from the trigger to the surrounding area when pushed. For example, the pain can radiate down the arm or leg. Fibromyalgia, neck pain, myofascial pain syndrome, neck pain, and low back pain are commonly associated with trigger points. In addition, trauma or repeated minor injuries create the perfect conditions for trigger points to develop.

Why do trigger points form?

Trigger points form in patterns across your body, usually in places where circulation is compromised. Scientists are not sure why these structures are susceptible or the exact mechanisms that cause them.

 

Researchers believe these hyperirritable spots may result from acute trauma or repetitive minor traumas that place too much stress on muscles. Trigger points are also widespread in people with chronic musculoskeletal disorders, such as:

 

Chronic neck and low back tension

Rotator cuff tendonitis

Epicondylitis of the elbow (tennis or golfer’s elbow)

Carpal tunnel syndrome

Muscle or tendon sprain

 

Trigger points can also develop in people who:

 

Lack regular exercise

Suffer from vitamin deficiencies

Have poor posture

Have poor sleep

 

Additionally, trigger points are more likely to develop if you have a desk job, sit in an uncomfortable chair, or perform manual labor with poor posture.

Is it possible to tell what is a trigger point and what is not?

 

Trigger points produce both local tenderness and a local twitch response when touched. They can occur in one point or multiple points. Although they are more common around the neck and shoulders as well as the lower back and hips, they can appear in any skeletal muscle. Trigger points can result in a specific pain pattern that an experienced healthcare professional can immediately recognize.

What is a trigger point injection (TPI), and what pain medications are used in a trigger point injection?

 

An injection of medication into a trigger point is called a trigger point injection (TPI). It is used when pain limits daily activities or if physical therapy is limited by pain. A local anesthetic called lidocaine is the most common medication used in a trigger point injection. Corticosteroids can also be used, although they provide no additional benefit. Trigger points needled without the help of local anesthetics is called dry needling. Dry needling is a more painful way to treat trigger points without any additional benefit.

What technique do physicians use to administer a trigger point injection?

 

The trigger point injection is typically performed in the doctor's office.  The patient usually lies on the exam table on their stomach or sits on the table. The exact method varies. An expert performing the procedure locates the trigger point with palpation or with the use of ultrasound guidance. The injection site is then cleaned with alcohol. Afterward, a small needle is placed into the trigger point and passed several times through the muscle while the medication is injected. An adhesive bandage is placed after the injection. Pain following the procedure can be quickly relieved with ice, heat, acetaminophen (Tylenol), or over-the-counter nonsteroidal anti-inflammatory medications such as ibuprofen (Advil) or naproxen (Aleve).

When should patients receive a trigger point injection?

 

Trigger point injections treat painful trigger points, especially when the pain radiates from the trigger point. Trigger point injections can be beneficial for fibromyalgia and myofascial pain syndrome. However, with chronic pain syndromes, trigger points commonly recur and need to be treated repeatedly.

What's the difference in a patient’s experience?

The more experience your healthcare provider has, the better your overall experience will be and the better your overall chance of success. The most experienced specialists that provide trigger point injections are physical medicine and rehabilitation physicians. They have more intensive training and experience than any other medical specialty. If you do not find success, it may mean that your condition requires a more aggressive treatment approach.

What are the potential complications of trigger point injections?

Post-injection pain is a potential complication of trigger point injections. It is relatively rare, but it can happen. The soreness or pain usually subsides on its own within several days. Pain after injections may be relieved with ice, heat, or over-the-counter medications such as acetaminophen, ibuprofen, or naproxen.

 

When steroid medication is used, there is a risk of shrinking the fat under the skin, leaving a dent in the skin. This problem does not occur when the only anesthetic is injected. Other side effects are rare with trigger point injections but can arise whenever a needle punctures the skin, including allergic reaction to the injected medication, infection, and bleeding. The most infrequent complications include spinal cord injury or internal organ damage.

 

How often will patients need trigger point injections?

A trigger point can resolve after one injection. This occurs only if a patient has one isolated trigger point, especially if the trigger point's cause has been removed (such as a trigger point caused by repetitive minor trauma or movement that will no longer be performed). The underlying cause of chronic conditions like fibromyalgia and myofascial pain syndrome can result in recurring trigger points. Depending on the circumstances, trigger point injections may be administered frequently or periodically. Trigger point injections using only local anesthetics can be administered as often as several times per week.