BACK PAIN
What is a trigger point?
A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band, which may be spontaneously painful, or painful only with compression/palpation. They can be treated with physical therapy, Chiropractor, massage therapy, tens unit, heat, topical creams, ultrasound, medications and more. For procedural interventions, injection vs dry needling vs acupuncture have all shown equal efficacy. For some individuals, injections were preferred as both acupuncture and dry needling required multiple/frequent visits compared to a single injection for the same results.
How does it work?
The mechanism of how trigger point procedures and injections work is not fully clear, however, the physical act of placing a needle into the muscle triggers a response in which improvement can be made just from the physical reaction to the needle. Additionally, there is improving/increasing blood flow to the area to help with the healing process. These injections provide immediate relief by releasing muscle tension and reducing inflammation. Lidocaine works by blocking the sodium channels in nerve fibers within the muscle, preventing pain signals from being transmitted to the brain, interrupting the pain cycle at the source and inhibiting the transmission of electrical impulses along the nerve fiber.
So what exactly is a trigger point injection and what is used for the procedure?
The injection involves the insertion of a needle into muscle bands, muscle knots and trigger points with typically with 1-2mL of Lidocaine 1% (or 0.25% bupivacaine). They can be performed every 4-6 weeks as needed for relief (insurance typically covers 10-12 injections/year without corticosteroids and 3-4 with use of a steroid). Some literature and experts report there is little evidence to support corticosteroids alone or in addition to local anesthetic (lidocaine) to improve outcomes. Concerns for side effects associated with corticosteroids include hyperglycemia, weight gain, effect on bone mineral density if long term and increased blood pressure. Long-term risks associated with only lidocaine trigger point injections are minimal; potential for localized tissue irritation when injected repeatedly in the same area.
What is the benefit and how long does it last?
Tigger point injections can help restore range of motion and flexibility to affected muscles. By deactivating trigger points, the muscles can relax and regain their normal function. This can allow individuals to perform daily activities and exercise without pain or discomfort. The duration of effect after a trigger point injection is variable. Many will experience relief for only several days while others will find relief for many weeks or more.
Why perform these procedures?
Trigger point injections are a safe and minimally invasive procedure that can be performed in a doctor’s office, making it a convenient and accessible treatment option for many individuals. Side effects include soreness, bruising, bleeding, hematoma, worsening pain, infection, discomfort or tenderness at the injection site. They can benefit individuals of all ages and activity levels who are experiencing muscle pain, stiffness, and limited mobility. Following the procedure individuals should take it easy for 24-72 hours.
What causes trigger points and conditions treated?
Our muscles may develop trigger points due to stress, acute trauma, or prolonged muscle tension. Additional causes include, myofascial pain syndrome, chronic pain, fibromyalgia, neck and back pain, etc……………………. so ask your provider if trigger point injections are right for you and sign up for your path to a reduced pain future today!
