Trigger Point Injections
1. What is a Trigger Point?
There are many causes of back and neck pain. They include bulging and herniated discs, spinal stenosis, and sacroiliac joint disease and muscular or myofascial pain. Myofascial pain is a common painful muscle disorder caused by muscular trigger points. Trigger points are discreet, focal, hyperirritable spots located in a taut band of skeletal muscle. The spots are painful on compression and can produce referred pain, tenderness, muscle weakness and autonomic dysfunction. Trigger points can be located almost anywhere in the body and can cause a variety of painful symptoms. Trigger points can be described as active or latent. Active trigger points cause pain at rest. Latent trigger points do not cause spontaneous pain but may cause muscle weakness or restrict motion.
2. What causes trigger points to develop?
There are several possible causes of trigger points. Repetitive trauma or injury to an area may cause trigger points. Lack of exercise, poor posture, vitamin deficiencies and joint problems may also cause or contribute to the problem. Occupational or recreational activities that produce repetitive stress on a specific muscle or group of muscles may cause trigger points to develop.
3. How are trigger points treated?
Factors that tend to produce or worsen trigger points are noted and are eliminated if possible. Some medications may be helpful such as non-steroidal anti-inflammatory medications and muscle relaxants. Some other modalities may be useful including massage, acupuncture, ultrasound, heat and ice or physical therapy. When these methods are no longer effective, then injection into the trigger point is the next step.
4. How is the injection done?
First, you will have a consultation with the pain specialist. Once he determines that you are a candidate for the injection, he will schedule your procedure. If you are taking any medications, such as blood pressure medications or blood thinners, you will need to discuss this with the doctor to determine whether or not to continue with them prior to the procedure. If you are diabetic, the doctor will need to know that as this injection may cause a rise in blood sugar several days after the procedure. The injection is usually quick, only several minutes for each area. The doctor locates the painful areas. The overlying skin is cleansed with alcohol. A very thin needle is placed in the painful muscle and a dilute solution of a local anesthetic (numbing medication) is injected and the needle is then removed. Some patients have more than one painful area that may need to be injected. The number of injections that can be done at one time is limited by the amount of local anesthetic that can be safely given in one session.
5. What should I expect after the procedure?
Immediately after the procedure, you may feel that your pain is less. This is due to the local anesthetic. After the local anesthetic has worn off in several hours, the pain will return. You may have some slight soreness at the injection site for several days due to the irritation from the needle. The medication itself may take several days to work. The duration of pain relief is different for each patient. For some patients, the pain relief may last from several days to as long as several months.
6. How many injections do I need?
You may get significant pain relief from the first injection and a second injection may not be necessary. If the first injection does not completely relieve your pain, a second may then be given. Trigger points can be difficult to treat. Many times injections are given in a series, usually twice a week, and may be followed by physical therapy. Once the area is numbed, physical therapy is much less painful and may be more successful in the treatment of the problem.
7. What are the risks of the injection?
Generally speaking, this is a simple and safe procedure. The most common side effect is pain at the site where the needle was inserted. This should resolve within several days. Bleeding and infection are a risk of any injection at any site.
8. Should I get the injection?
That decision can only be made after you see the pain specialist. He will discuss all of your options for treatment including injections. After the evaluation, he will determine if a trigger point problem is the likely source of your pain and if you are a candidate for the procedure