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Trigger points are central regions of spasm and inflammation in skeletal muscle. The rhomboid and trapezius back muscles, located in the upper back and behind the shoulder regions, are a frequent spot of trigger points. Trigger points in these areas can result in neck pain, shoulder pain, and migraines. Besides the upper spine, trigger points could also occur in the low back or less commonly in the extremities.

Typically there is a palpable nodule in the muscle where the trigger point is positioned. The area is sensitive, and often when pushed, pain spreads out from the trigger point itself to a region surrounding the trigger point. Trigger points often accompany chronic musculoskeletal disorders like fibromyalgia, myofascial pain syndrome, neck pain, and lower back pain. These might also occur with tension headaches and temporomandibular pain. Acute trauma or recurring minor injury can result in the development of trigger points.

Trigger point injection (TPI) simple facts

  • Trigger points are central areas of muscle spasm, often located in the upper back and shoulder areas.
  • A trigger point injection consists of medication straight into the trigger point.
  • Trigger point injections are used to treat a range of conditions including fibromyalgia, tension headache, and myofascial pain syndrome.

Trigger Point Injections for Pain Management

Peripheral nerve pain, or neuropathy, may possibly be debilitating. It can react well to simple treatments such as trigger point injections with anesthetic medicines and cryoablation (a clinic based solution which involves freezing the nerves). Examples of peripheral nerve pain consist of intercostal neuralgia, ilioinguinal neuroma, hypogastric neuroma, lateral femoral cutaneous nerve entrapment, interdigital neuroma and related nerve entrapments.

What is a trigger point injection? What medications may be in a trigger point injection?

A trigger point injection (TPI) is an injection that is administered directly into the trigger point for pain management. The injection may be an anesthetic for example lidocaine (Xylocaine) or bupivacaine (Marcaine), a combination of anesthetics, or a homeopathic solution alone or blended with lidocaine. Sometimes, a needle on its own is inserted into the trigger point, and no medicine is injected. This could be helpful and is described as “dry needling.” Using the injection, the trigger point is deactivated and the pain is alleviated.

What kinds of doctors provide trigger point injections?

Trigger point injections are often offered by rheumatologists, pain-management doctors, and physical healthcare and rehabilitation medical professionals. Some internists, family practice doctors, generalists, and neurologists conduct trigger point injections.

How do medical care providers perform trigger point injections? What method to physicians use to administer a trigger point injection?

The trigger point injection is completed in the medical professional’s clinic, generally with the patient either laying on the exam table on the stomach or resting on the exam table. The exact procedure varies. The healthcare qualified professional performing the method locates the trigger point by manual palpation and denotes the site. Ultrasound guidance is not usually required. The injection site is then cleansed. Alcohol or another skin cleanser like betadine is usually used to sanitize the injection area.

Routinely, a numbing spray for example ethyl chloride is used to anesthetize the skin and make the actual injection less distressing. The needle is then inserted into the trigger point and the medication is injected. Shortly after the injection, a simple adhesive bandage may be used. If the area hurts after the injection, ice, heat, acetaminophen (Tylenol), or over-the-counter nonsteroidal anti-inflammatory medications; for example ibuprofen (Advil) or naproxen sodium may be used.

When do patients need a trigger point injection?

Trigger point injection is employed when a patient has a painful trigger point, especially when pain propagates from the trigger point to the neighboring area. Trigger point injections may be used as a solution for conditions including fibromyalgia and myofascial pain syndrome. However, the trigger points often recur with chronic pain syndromes.

What are problems and negative side effects of trigger point injections?

A plausible side effect from the trigger point injection treatment is post-injection pain. This is fairly uncommon, but it can happen. This pain usually resolves by itself after a few days. It is more common when no medication is injected into the trigger point (dry needling). Ice, heat, or over-the-counter medications for example acetaminophen, ibuprofen, or naproxen sodium can be useful for post-injection pain.

If a steroid medication is injected into the trigger point, there is a chance of shrinkage of the fat under the skin, leaving behind a dent in the skin. This does not develop when only anesthetic or a homeopathic solution is injected with no steroid medication. Various other side effects are infrequent with trigger point injections but can arise anytime a needle punctures the skin, including infection and bleeding.

How routinely will patients need to have trigger point injections?

Ideally, a trigger point fixes after one injection. This may occur when a patient has an individual isolated trigger point, especially if the root cause of the trigger point has been eliminated (for example, a trigger point brought on by a recurring minor strain or movement that will never be performed). Trigger points brought on by chronic conditions including fibromyalgia and myofascial pain syndrome often recur due the underlying condition.

In these situations, trigger point injections can be administered on a routine or as needed basis. The regularity of trigger point injections depends upon the medication being injected. If solely lidocaine or a blend of anesthetics is administered, then the injections might be administered as recurring therapy as regularly as monthly. If a steroid medication is injected, TPIs should be administered much less regularly, at the discretion of the treating healthcare professional, as a result of the risk of tissue injury or shrinkage from the steroid medication.

Here at Infusion Health TeleMedicine Clinic, we can assist you to find out which Trigger Point Injection treatments would be most advantageous for your condition. Contact our office for a consultation.

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