Every 4 months, I go to see my Pain Specialist and he gives me Trigger Point Injections (TPIs). The areas that he focuses on are my neck, shoulders, back (both upper and lower), my jaw and occasionally the muscles in my chest. I find these injections very painful and they often put me in a flare up which can last quite long. A lot of people find that they work very well for them and so I have decided to write up a post about them.
Trigger points are the focal areas of a skeletal muscle spasm. They are knotted up pieces of muscle fiber. The common sites that they are found in are the Rhomboid and Trapezius back muscles, located in the upper back and behind the shoulder.
These trigger points cause pain in the neck, shoulder and can cause headaches. They are also found in the lower back. They can irritate nerves around them and cause referred pain, i.e. pain felt in another part of the body.
Where the trigger point is located, there is a palpable nodule that when pushed, causes pain from the trigger point itself to radiate to the surrounding area.
Trigger points are often found in chronic Musculoskeletal disorders such as Fibromyalgia, Myofascial Pain Syndrome, neck pain and low back pain. As a result this treatment is used.
The injection is part of pain management. It can contain anesthetic such as Lidocaine or Bupivacaine or a mixture of anesthetics. It can also contain Corticosteroid alone or mixed with Lidocaine. Sometimes only a needle is used, with no medication. This is called dry needling.
The types of doctors that perform this treatment are Rheumatologists, Pain Management Specialists, Physical Medicine and Rehabilitation doctors.
The procedure is performed in the doctors office. The patient lies down on the exam table, either lying on their stomach or sitting up. The doctor finds the trigger points manually. The injection site/s are cleaned. The needle is then inserted into the trigger point and the medication is injected. Several sites may be injected in one visit. With the injection, the muscles relaxes, blood flow is restored to the area and the pain is relieved. This relief can last for weeks.
Trigger Point Injections are used when you have a painful trigger point which radiates pain to the surrounding areas. The trigger points commonly recur with chronic pain syndrome. Optimally the trigger point should resolve after one injection but with Fibromyalgia and Myofascial Pain Syndrome, trigger point injections are done regularly or as needed.
Common complications are post injection pain which resolves after a few days and rarely, infection and bleeding.
While some people get the pain relief they sought, other people, often with Fibromyalgia, state that the TPIs put them into a flare up and they feel physically ill and the body wide pain worsens.
The theory is that this happens as a result of the following:
The knotted up pieces of muscle fiber called trigger points are found in Myofascial Pain Syndrome and not in Fibromyalgia. The two conditions are distinctively different. Trigger and tender points are not the same. Trigger points can be felt by the doctor and pain felt by the patient. Tender points, however, cannot be felt by the doctor and are identified by the patient who reports pain.
Trigger point and tender points are affected by different parts of the nervous system. Trigger points are self sustaining irritable area in a taut/tight band of muscle fiber. It can be felt as a nodule/bump. The spot creates shortening of the muscle, interferes with movement and causes pain and weakness. When pressed it radiates pain. The muscle pain and dysfunction occurs in the peripheral nervous system which relays messages to the brain. Tender points do not radiate pain and occur body-wide in Fibromyalgia because of centralized pain, perception of pain that occurs in the brain, not pain from the muscle.
Myofascial Pain Syndrome often co exists with Fibromyalgia but they are not the same. FM and MPS together are more difficult to manage. Patients with Fibromyalgia only, do not respond to Trigger Point Injections as they have no trigger points. FM and MPS patients respond better to TPIs.
I must say that I do not agree with the above statement as I have both Fibromyalgia and Myofascial Pain Syndrome and I do not respond well to the Trigger Point Injections as they put me in a flare up.
It certainly is worth a try however. Speak to your doctor about it.