360° Approach To Wellness

Trigger Points

Trigger point injection (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that are in a knot or trigger point.  These trigger points when pressed often refer pain to other areas distant from the trigger points location, like pushing the door bell and hearing the ring in the hallway of the house.

Diagnosing Trigger Points

Trigger point diagnosis can be as simple as pressing on the knot and seeing if pain travels away from the site.  Instruments can be used to assess the amount of pressure required to activate the trigger point or a diagnostic ultrasound can be utilized to visualize the muscle and determine the exact spot, depth and size of a trigger point.  Diagnostic ultrasound is the method we use here at Pivonka Health and Wellness.

What is a trigger point injection? What medications may be in a trigger point injection?

A trigger point injection (TPI) is an injection that is given directly into the trigger point for pain management. The injection may be an anesthetic such as lidocaine (Xylocaine) or bupivacaine (Marcaine), a mixture of anesthetics, or a corticosteroid (cortisone medication) alone or mixed with lidocaine. Sometimes, a needle alone is inserted into the trigger point, and no medication is injected. This may be helpful and is referred to as "dry needling." With the injection, the trigger point is released and the pain is relieved.  In most cases it may take a series of trigger point injections to achieve complete resolution of the trigger point and pain relief.

When do patients need a trigger point injection?

Trigger point injection is used when a patient has a painful trigger point, especially when pain radiates from the trigger point to the surrounding area. Trigger point injections may be used as a treatment for conditions such as fibromyalgia and myofascial pain syndrome. However, the trigger points commonly recur with chronic pain syndromes.

What are complications and side effects of trigger point injections?

A potential complication from the trigger point injection procedure is post-injection pain. This is relatively uncommon, but it can occur. This pain usually resolves by itself after a few days. It is more common when no medication is injected into the trigger point (dry needling). Ice, heat, or over-the-counter medications such as acetaminophen, ibuprofen, or naproxen sodium may be useful for post-injection pain.

If a steroid medication is injected into the trigger point, there is a risk of shrinkage of the fat under the skin, leaving a dent in the skin. This does not occur when only anesthetic is injected without any steroid medication. Other side effects are rare with trigger point injections but can occur anytime a needle punctures the skin, including infection and bleeding.

How frequently will patients need trigger point injections?

Optimally, a trigger point resolves after one injection. This may happen when a patient has one isolated trigger point, especially if the cause of the trigger point has been removed (such as a trigger point caused by a repetitive minor trauma or movement that will no longer be performed). Trigger points caused by chronic conditions such as fibromyalgia and myofascial pain syndrome tend to recur due the underlying problem. In these cases, trigger point injections may be administered on a regular or as needed basis. The frequency of trigger point injections depends on the medication being injected. If only lidocaine or a mixture of anesthetics is injected, then the injections can be administered as ongoing therapy as frequently as monthly. If a steroid medication is injected, TPIs should be administered much less frequently, at the discretion of the treating health care professional, because of the risk of tissue damage or shrinkage from the steroid medication.

We'll be able to locate the trigger point that is the cause of your pain, and determine the best course of action to relieve your pain and get you on the road to healing. Stop suffering with pain, call for a consultation today 480-892-0022.