Trigger Point Injections

How does it work?
A trigger point is a spastic muscle band or palpable knot in a muscle that can cause localized pain or referred pain. Trigger points are due to localized muscle injury, stress, poor posture, or as a secondary response to an underlying pain generator such as a disc herniation. Often the spasms worsen the pain, which leads to a cycle resulting in more spasms and pain. If the trigger points are confined to the same or limited muscle groups, the disorder is referred to as Myofascial Pain. Fibromyalgia is a syndrome involving trigger points throughout the musculoskeletal system. The pain is most often described as an achy pain or stiffness. Other symptoms of Fibromyalgia may include insomnia, anxiety, fatigue, depression.

Trigger point injections are injections of a local anesthetic agent, such as lidocaine, into the trigger points. The goal for a trigger point injection is to cease the conduction of pain signals from the spastic muscle in order to break the cycle of the muscle spasms.

Stretching is encouraged immediately following trigger point injections to improve range of motion. Heat application and TENS (trans electrical nerve stimulation) may also help prolong the relief. The addition of cortisone may provide benefits though anti-inflammatory properties.

Potential complications of trigger point injections (as with any invasive procedure) include: worsening of pain, nerve damage, allergic reaction, and infection. Trigger point injections involving muscles over the ribs have the potential for a complication called tension pneumothorax, which is the buildup of air between the inside lining of the chest wall and the lungs. This is an extremely rare complication; however, it can require hospitalization and the placement of a chest tube between the ribs for several days to decrease the air pressure between the inner lining of the chest wall and the lungs.

If repeated trigger point injections provide excellent short term relief, botulism toxin injections may be an option to provide more prolonged relief.