What You Need to Know About Trigger Point Injections

J.Adderton, BSN, MSN

We have all experienced the discomfort of muscle pain. As nurses, we often overuse our musculoskeletal system during the workday and experience the consequences later. Intense pain can occur from simply sitting, standing or sleeping in the wrong position. Fortunately, most muscle aches and pains are usually relieved after a few days of rest and good self-care. But, some are not as lucky. Muscle pain can become chronic (myofascial pain syndrome) and significantly impact a person's function and quality of life. In these cases, trigger point injections (TPIs) may be used to help ease pain in muscles and surrounding tissue.

What Are Trigger Points?

Trigger points are focused areas of spasm and inflammation in skeletal muscle. You can often feel a knot in the muscle where the trigger point is located. The primary site and surrounding area is usually tender with pain that radiates when pushed. The upper back and behind the shoulder areas are common sites and can cause headaches and neck and shoulder pain. However, trigger points can be found throughout the musculoskeletal system.

What Are Trigger Point Injections?

TPIs are injections of medication given directly in the painful trigger point for pain management. The medication makes the trigger point inactive and relieves the spasming muscle. It is an outpatient procedure and performed by a doctor, usually in their office or clinic.

Medications Used for TPIs Include

Local anesthetics

Used alone, mixed with other anesthetics or with corticosteroids
Xylocaine (Lidocaine), bupivacaine (Marcaine)

Corticosteroids- dexamethasone

Used alone or mixed with an anesthetic

Botox (botulinum toxin A)

Interferes with nerve signals and prevents muscle contraction

What Conditions Are Typically Treated With TPIs?

TPIs are used to help relieve pain in conditions that affect our musculoskeletal and nervous systems.

Myofascial pain syndrome

TPIs may help relieve symptoms of myofascial pain syndrome, a chronic pain syndrome affecting muscles and their surrounding tissue (referred pain). Myofascial pain syndrome may be caused by:

Muscle trauma or injury
Repetitive motions
Poor Posture
Psychological stress

Fibromyalgia

Fibromyalgia is a chronic condition that has some of the same symptoms as arthritis, but affects our soft tissue instead of our joints.

Headaches

Trigger points in the shoulder, neck and head can contribute to tension headaches and migraines.

Endometriosis

A small study, published in PM&R, found TPIs may help with pelvic floor pain that is common with endometriosis. However, the authors recommend further research before firm conclusions can be drawn.

A Word About Dry Needling

Dry needling for easing muscle pain is gaining in popularity. The procedure uses filiform needles and is referred to as "dry" because it does not inject any medications into the body. The needles are inserted into the knot, or affected area, to relieve muscle pains or spasms.

What Are The Side Effects?

Some people experience pain and/or tenderness at the injection site that typically resolves after a few hours. Other side effects include:

Lightheadedness, dizziness
Discoloration or dimpling of skin around the injection site
Bleeding at the injection site (rare)

What Are The Risks?

TPIs rarely cause serious complications, however, in rare cases they may lead to:

Infection at the injection site
Bruising
Muscle or nerve damage
Pneumothorax
Needle breakage

Who Should Not Have TPIs?

TPIs should not be administered in the following circumstances:

Presence of systemic or local infection
In pregnant patients
Person who feels or appears ill

Precautions should be taken when administering TPIs in people with:

Bleeding disorders or anticoagulation therapies
Debility
Diabetes
Current steroid medications

Do They Work?

In people with chronic muscle pain, TPIs may provide immediate pain relief and improved range of motion. However, everyone does not respond to the injections the same way. Researchers have found that some people do not benefit at all.

What do you think? Do TPIs have a place in pain management?

Resources

A New Look at Trigger Point Injections

Trigger Point Injections

Everything You Need to Know About Trigger Point Injections