Trigger point injections are a popular option for treating pain in many patients. These injections can calm irritated nerves, take care of muscle weakness, improve range of motion, and improve posture.

Trigger point injections are a popular option for treating pain in many patients. These injections can calm irritated nerves, take care of muscle weakness, improve range of motion, and improve posture.

What is a Trigger Point?

A trigger point is an area of muscle, or knots of muscle, that form when muscles do not relax. These knots can usually be felt under the skin but are oftentimes discrete. These trigger points may irritate the nerves around them, especially when touched or compressed, possibly causing pain that is felt in another part of the body.

Trigger points are mainly located on the backside of the body along the spine and pelvis or the shoulder girdle. They can arise from nerve, muscle, or ligament irritation. Trigger points can also arise because of traumatic tissue injury, spinal abnormalities, whiplash, degenerative disorders, or a viral syndrome. They tend to be persistent and aggravating rather than disabling. Treatment methods have included heat or cold, stretching and strengthening, physical therapy, massage, even acupuncture.

What is a Trigger Point Injection?

A trigger point injection is a procedure that must be performed by a qualified healthcare provider. The provider inserts a small needle into the trigger point. The injection includes saline or a local anesthetic, and possibly a corticosteroid. This injection is administered to sooth muscle pain associated with trigger points. The trigger point is made inactive, the stiff muscles relax, decompress, and pain is relieved.

The best part, aside from their pain relief capabilities, is that trigger point injections only take a few minutes.

When is a Trigger Point Injection Used?

Trigger point injections are used to treat many muscle groups, but especially arms, legs, lower back, and neck. Trigger point injections may also be used to treat fibromyalgia and tension headaches.

After the injection, rest is advised and patients are also encouraged to used ice packs on the injection site. This ice therapy reduces inflammation and soreness. Stretching is also helpful in overcoming muscle stiffness after the injections.

Types of Medications Used for Trigger Point Injections

Dextrose

Hypertonic dextrose has been used for decades to create an inflammatory response and stimulate the injured tissue to heal using the body’s own repair pathways. It is commonly referred to as prolotherapy. Dextrose tends to be more effective over ligaments and muscles rather than by nerves. Six weeks between injection is the norm to allow the body time to generate a healing response.

Bupivacaine

Bupivacaine is a common, long-acting anesthetic agent in the Novocain family which numbs the tissue around the trigger point. In theory, the vicious circle of pain then spasm and more pain can be broken thus creating a cure. Bupivacaine works equally well around nerves and other tissues, but its strength lies in its numbing abilities and in its long-lasting effect, up to 12 hours, as opposed to one hour for Novocain. It can be injected daily if needed.

Neuromodulators

(Botox) For persistent spasm which is not solved with the above medications, Botox has been increasingly used for trigger point pain. By paralyzing the muscle spasm over trigger points for longer periods than a few hours with cortisone preparations, these neuromodulators have shown great promise in more complete pain relief and longer lasting relief, lasting up to three months.

Sarapin

Sarapin is an aqueous solution derived from the pitcher plant. It is effective in pain management due to its ability to initiate the body’s own natural healing properties. It does have anesthetic properties similar to procaine. It is thought that sarapin has selective action on the C pain fibers and lacks effect on the motor fibers making it excellent for treatments of neuralgic pain without creating a motor deficit such as procaine might. Toxicity testing revealed that it is essentially harmless, similar to dextrose.

Cortisone

Cortisone is a naturally produced human steroid which is also commercially made for medical use. It has highly anti-inflammatory properties, but it does have a certain degree of tissue toxicity. It has been a standard in the medical community to reduce local inflammation, but it is usually injected with a Novocain-type anesthetic agent because it tends to burn when injected. However, cortisone gives excellent results in trigger point injections. But with this effectiveness comes some potential side effects. This may include local subcutaneous fat destruction and skin thinning or even local tendon damage if injected too frequently. It has also been implicated in raising blood sugar in diabetics although this is uncommon.