Trigger Point Injections

What is a trigger point?

A trigger point is an irritable, painful, taut muscle band or palpable knot in a muscle that can cause localized pain or referred pain (figure 1). Referred pain from trigger points can mimic pinched nerves in the neck or low back. They can occur from direct muscle injuries, poor posture, repetitive strain, or secondarily from spine conditions such as a herniated disc.

Figure 1. The X represents the trigger point in the trapezius muscle. The referred pain radiating up the neck and into the head is seen in bright red.

Myofascial pain syndrome is a chronic pain condition in which there may be several trigger points limited to a particular area of the body. The pain and spasm associated with trigger points can lead to a vicious pain cycle in which pain causes more spasm and spasm causes more pain.

Myofascial pain syndrome is not to be confused with fibromyalgia. Myofascial pain syndrome is a regional or localized pain syndrome in contrast to FMS (fibromyalgia syndrome) which is a widespread musculoskeletal pain syndrome.

What are trigger point injections?

Trigger point injections are injections of local anesthetic (numbing) medication, saline, and/or cortisone into the trigger point(s). The basis for a trigger point injection is to relax the area of intense muscle spasm. By relaxing the muscle spasm, blood flow to the area is improved thus allowing the washout of irritating metabolites. Trigger point injections are an important part of treating myofascial pain syndrome and, in some cases, fibromyalgia. Many times multiple injections are performed in series. Trigger point injections can be done in an office setting or in an outpatient setting under IV sedation. Other treatments for trigger points include stretching exercises, heat, improvements in posture, electrical stimulation, and stress reduction.

Diagram of a trigger point injection.

What happens after trigger point injections?

You may experience soreness, bruising, or even an increase in pain for a few days until your body has time to recuperate from the injections. Heat and stretching exercises may help to lessen the discomfort.

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