Trigger Point Injections


Trigger point injections are injections of local anesthetic (numbing) medication, saline, and/or cortisone , and/or Botulinum Toxin A into the trigger point(s). The aim of a trigger point injection is to relax the area of intense muscle spasm.

A trigger point is a knot or a tight, ropy band of muscle that forms when muscles fails to relax as normal muscle should.

The trigger point can trap or irritate surrounding nerves and cause referred pain, which is felt in another part of the body. Scar tissue, loss of range of motion and weakness may also develop over time.

Trigger-point injections (TPI) have been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms.

Many muscle groups, especially those in the arms, legs, lower back and neck are treated by this method. TPIs can also be used to treat Fibromyalgia (myofacial Pain Syndrome) and tension headaches.

There are two broad types of TPIs, namely injection by manual palpation and needle EMG-guided injection.

What is the procedure?

TPIs can only be administered by medical specialists such as Pain Management Specialists and Orthopaedic Physicians. Sterile precautions are taken by wearing sterile gloves and using antiseptic solution over the site.

Once done, a small needle is inserted into the trigger point and a local anesthetic such as lidocaine is injected, with or without a corticosteroid. Injection of such medication inactivates the trigger point and thus alleviates pain.

Trigger point injections should ideally be administered to patients who have not responded in the first four to six weeks to a properly planned treatment program and suitable pharmacologic intervention.

The injection might cause a twitch or pain that lasts for few seconds to a few minutes. The whole process takes around 30 minutes.

Side effects of TPIs

Side effects of TPIs are minimal though they commonly occur. The main side effects are:

· Tingling or burning as the anesthetic begins to take effect

· Bruising around the injection point

· Pain around the injection site

· Bleeding and infection

When to seek help?

Though side effects are quite expected after a TPI, the patient should seek medical help if severe redness or swelling develops. When a muscle near the ribcage receives a trigger point injection, at times there is a risk for puncturing of a lung or the membrane that surrounds the lung, known as the pleura.

Botulinum Toxin A Trigger point injections

Often where trigger points are refractory or alleviated for only a short period of time, Botulinum Toxin A can be injected into a trigger point to produce a longer lasting trigger point injection.

Botulinum toxin A acts in two ways- it has local activity in muscle relaxation as well as an analgesic activity.

Botulinum toxin A is often a second line agent due to its expense. Nonetheless, when it works it can be highly efficacious in reducing the pain from trigger points, and, in reducing analgesic consumption and physician visits can be viewed as cost-effective.

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