FAQs on Trigger Point Injections

For painful muscle areas, trigger point injections (TPIs) are often used. A trigger point is a ropy, tight band of muscle that forms when a muscle does not or cannot relax. This knot will twitch and contract when the skin is palpated (touched).

What conditions can cause trigger points?

Trigger points develop from:

  • Poor posture
  • Sitting in a chair
  • Sports injuries
  • Emotional stress
  • Poor back support
  • Grasping a mouse

How does the trigger point cause pain?

A trigger point can irritate and trap surrounding nerves, which leads to referred pain. In addition, trigger points cause loss of range of motion, limited mobility, muscle weakness, and scar tissue.

Why use trigger point injections?

Trigger point injections are used to alleviate myofascial pain syndrome, which is chronic pain involving tissue that surrounds the muscle. The muscle groups most involved include those of the arms, legs, neck, and lower back.

What conditions are associated with trigger points?

Trigger points develop due to muscle tissue injury. This occurs from:

  • Whiplash
  • Migraine headaches
  • Fibromyalgia
  • Osteoarthritis
  • Herniated discs
  • Scoliosis

How common are trigger points?

Myofascial trigger points are quite common. While an exact prevalence rate is not known, one report estimates that around 30% of adults have trigger points at some time during life.

How are trigger points diagnosed?

The doctor diagnoses trigger points during physical examination. This involves palpating the muscles for tight bands of muscle and tender regions. There is no diagnostic or laboratory test used to diagnose trigger points.

How are trigger point injections given?

There is no preparation for trigger point injections, but you should tell the doctor if you are taking blood-thinning medications, or if you have a bleeding disorder. When you arrive at the doctor’s office, a nurse goes over the risks and benefits of the procedure, and you must sign a form of informed consent. The doctor will have you change into a procedure gown and palpate the trigger points. Once the areas are identified, the skin is cleaned with an antiseptic. The needle is inserted into the trigger point and medication is injected. A small Band-Aid is applied over the area.

What medications are used for trigger point injections?

The medication choice is up to the physician. Options include corticosteroids (betamethasone and triamcinolone), anesthetics (lidocaine and bupivicaine), and botulinum toxin type A (Botox).

After the TPI procedure, what can I expect?

After the trigger point injection, expect some bruising, increased pain, and soreness. These side effects are temporary and will resolve after a 1-2 days. We recommend use of stretching exercise, heat packs, or cold packs to alleviate pain.

What are the risks associated with the TPI procedure?

As with any simple office procedure, some risks are to be considered. These include bleeding, infection, and nerve damage. The procedure is quite safe, and it takes around 2-4 days for effectiveness to occur.

How many TPI procedures will I need?

Not every patient responds to TPIs. Many trigger points are injected during one procedure session. Some patients respond well, so the doctor will do another series of TPIs in 1-3 months.

What are the benefits of TPIs?

The main benefit of trigger point injections is pain relief. Other benefits include improved mobility and less muscle spasm. Many patients report increased ability to sleep and improved mood, as well.

Do trigger point injections work?

Clinical studies support the effectiveness of TPIs. According to a recent research study, Botox TPIs had a 90% success rate. The efficacy rate of anesthetic trigger point injections is around 85%, according to clinical reports.

Resources

Esenyel M, Caglar N, & Aldemir T (2000). Treatment of myofascial pain. Am J Phys Med Rehabil, 79: 48-52.

Garvey TA, Marks MR, & Wiesel SW (1989). A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain. Spine, 14:962-964.

 

Wong CSM & Wong SHS (2012). A new look at trigger point injections. Anesthesiol Res Pract: 492452.