Trigger Point Injections

Today I’m going to be focusing on a common office-based procedure for pain management physicians: trigger point injections. These injections are commonly abbreviated as TPIs.  Trigger point injections are a treatment targeted to address pain coming from muscles, specifically, muscle spasms.

If you’ve ever had a bad muscle spasm in your neck or back before, you might notice that when you push on the area with your finger, you can feel a firm tender lump, often described as a “knot”.  These are painful areas of tightness that form when the muscles do not relax, and are known as trigger points. Common areas for trigger points to develop are along the sides of the neck, across the tops of the shoulders, down in between the shoulder blades and in the low back.  Patients who have fibromyalgia (which I will discuss in another post) are particularly prone to areas of muscle tightness, but almost anyone can get them.

I describe trigger point injections to patients as a way that I can use a needle, instead of fingers, to do a really deep tissue release and help the muscles relax.  Ok, maybe it’s not quite as enjoyable as a nice deep tissue massage, but a lot of times it works better and for longer!

A variety of different medications can be used in the injections.  Some physicians use saline, some use numbing medication known as local anesthetic, and some add steroids.  If no medication and just the needle itself is used, this is known as “dry needling”. Out of personal preference, I normally use a mix of two different types of local anesthetics without steroids.  In my mind, if I can spare someone the risks of steroids, it is worth it, and I’ve found no difference in how effective the injections are without the steroids.

When trigger point injections are performed, the area of the patient’s body to be treated is cleaned off with cleaning solution.  Next, the physician will feel with his or her fingers to locate the trigger points. I usually confirm this with the patient by asking them if the area that I am pressing on is tender, but a lot of times it is obvious.  Grasping the trigger point with the other hand, I use a very tiny needle to go into the area of the trigger point, and gently break the area of tightness up. I inject a small amount of numbing medicine to the area to help make the procedure less uncomfortable and also to help the muscle relax.  Most patients wind up getting somewhere between 4-10 trigger point injections done at a time, depending on how many areas are bothering them.

Normally, patients should feel relief pretty quickly from the trigger point injections- often times before they leave the office.  The duration varies depending on what the underlying issue is. If the patient is just dealing with a sprain of their back, it is possible that one series of trigger point injections will cause the issue to go away for good.  If the patient has underlying issues causing the muscle pain,they may need to be repeated intermittently.

Trigger point injections work best when they are used in conjunction with a full treatment plan, usually involving some sort of physical therapy or home exercise program and sometimes medications.  If you are wondering if you might be a candidate for trigger point injections, the best way to find out is to make an appointment with a pain management specialist!