- What Is It?
- Who Needs One?
- Side Effects
- Injection Frequency
Trigger point injection (TPI) facts
- Trigger points are focal areas of muscle spasm, often located in the upper back and shoulder areas.
- A trigger point injection involves the injection of medication directly into the trigger point.
- Trigger point injections can be used to treat a number of conditions including fibromyalgia, tension headache, and myofascial pain syndrome.
What is a trigger point?
Trigger points are focal areas of spasm and inflammation in skeletal muscle. The rhomboid and trapezius back muscles, located in the upper back and behind the shoulder areas, are a common site of trigger points. Trigger points in these areas can cause neck pain, shoulder pain, and headache. In addition to the upper spine, trigger points can also occur in the low back or less commonly in the extremities.
Often there is a palpable nodule in the muscle where the trigger point is located. The area is tender, and frequently when pushed, pain radiates from the trigger point itself to an area around the trigger point. Trigger points commonly accompany chronic musculoskeletal disorders such as fibromyalgia, myofascial pain syndrome, neck pain, and low back pain. They may also occur with tension headache and temporomandibular pain. Acute trauma or repetitive minor injury can lead to the development of trigger points.
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 given directly into the trigger point for pain management. The injection may be an anesthetic such as lidocaine (Xylocaine) or bupivacaine (Marcaine), a mixture of anesthetics, or a corticosteroid (cortisone medication) alone or mixed with lidocaine. Sometimes, a needle alone is inserted into the trigger point, and no medication is injected. This may be helpful and is referred to as "dry needling." With the injection, the trigger point is made inactive and the pain is relieved.
What types of doctors administer trigger point injections?
Trigger point injections are frequently administered by rheumatologists, pain-management doctors, and physical medicine and rehabilitation doctors. Some internists, family practice doctors, generalists, and neurologists perform trigger point injections.
How do health care providers perform trigger point injections? What technique to physicians use to administer a trigger point injection?
The trigger point injection is performed in the health care professional's office, usually with the patient either lying on the exam table on the stomach or sitting on the exam table. The exact technique varies. The health care professional performing the procedure locates the trigger point by manual palpation and marks the site. Ultrasound guidance is not generally necessary. The injection site is then cleaned. Alcohol or another skin cleanser such as betadine is commonly used to clean the injection site. Frequently, a numbing spray such as ethyl chloride is used to anesthetize the skin and make the actual injection less painful. The needle is then inserted into the trigger point and the medication is injected. After the injection, a simple adhesive bandage may be applied. If the area is painful after the injection, ice, heat, acetaminophen (Tylenol), or over-the-counter nonsteroidal anti-inflammatory medications such as ibuprofen (Advil) or naproxen sodium may be used.
When do patients need a trigger point injection?
Trigger point injection is used when a patient has a painful trigger point, especially when pain radiates from the trigger point to the surrounding area. Trigger point injections may be used as a treatment for conditions such as fibromyalgia and myofascial pain syndrome. However, the trigger points commonly recur with chronic pain syndromes.
What are complications and side effects of trigger point injections?
A potential complication from the trigger point injection procedure is post-injection pain. This is relatively uncommon, but it can occur. 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 such as acetaminophen, ibuprofen, or naproxen sodium may be useful for post-injection pain.
If a steroid medication is injected into the trigger point, there is a risk of shrinkage of the fat under the skin, leaving a dent in the skin. This does not occur when only anesthetic is injected without any steroid medication. Other side effects are rare with trigger point injections but can occur anytime a needle punctures the skin, including infection and bleeding.
How frequently will patients need trigger point injections?
Optimally, a trigger point resolves after one injection. This may happen when a patient has one isolated trigger point, especially if the cause of the trigger point has been removed (such as a trigger point caused by a repetitive minor trauma or movement that will no longer be performed). Trigger points caused by chronic conditions such as fibromyalgia and myofascial pain syndrome tend to recur due the underlying problem. In these cases, trigger point injections may be administered on a regular or as needed basis. The frequency of trigger point injections depends on the medication being injected. If only lidocaine or a mixture of anesthetics is injected, then the injections can be administered as ongoing therapy as frequently as monthly. If a steroid medication is injected, TPIs should be administered much less frequently, at the discretion of the treating health care professional, because of the risk of tissue damage or shrinkage from the steroid medication.
- Attachment Theory: What It Is, Stages & the Different Attachment Styles
- Gentle Parenting: What It Is, Techniques & Discipline
- U.S. Nursing Homes Fail to Report Many Serious Falls, Bedsores: Study
- The Younger You Get Diabetes, the Higher Your Risk for Dementia Later
- FDA Grants Full Approval to Paxlovid to Treat COVID-19
- More Health News »
Health Solutions From Our Sponsors
Top Trigger Point Injection Related Articles
acetaminophenAcetaminophen is a drug that reduces fever and relieves pain. It is available alone, or in combination with hundreds of other drugs available both over-the-counter (without a prescription) or that that may require a prescription from your doctor, for example, acetaminophen and hydrocodone (Vicodin, Norco) or acetaminophen and oxycodone (Percocet). Acetaminophen treats a variety of diseases or other medical problems that cause pain or fever. Examples of conditions acetaminophen treats include headache, minor arthritis pain, back pain, tooth pain, menstrual cramps, PMS, osteoarthritis, common cold, tension headache, chronic pain, hip pain, shoulder and neck pain, sore throat, sinus infection, teething, TMJ, bites and stings, and sprains and strains. Acetaminophen generally has no side effects when taken as prescribed. When side effects are experienced, the most common are headache, rash, and nausea.
Allergy (Allergies)An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
FibromyalgiaFibromyalgia is a chronic pain condition characterized by symptoms such as fatigue, sleep disturbances, and tender points. Stress reduction, exercise, and medication are the standard treatments for fibromyalgia.
What Is Fibromyalgia (Fibro)? Symptoms, Causes, Helpful TreatmentsWhat is fibromyalgia? Learn the possible causes of fibro, along with standard and alternative treatments for this chronic condition. Relieve fibro pain and stiffness of the tendons, muscles, and joints. Learn about fibromyalgia symptoms, treatment and tender points.
HeadacheHeadaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
ibuprofenIbuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to reduce mild to moderate pain, inflammation, and fever. Ibuprofen works by blocking an enzyme that makes prostaglandin (a hormone-like substance that participates in a variety of body functions), which results in lower levels of prostaglandins in the body. Lower levels of prostaglandins reduce pain, inflammation, and fever. Ibuprofen is prescribed to treat diseases and conditions that cause mild to moderate pain, fever, and inflammation.
lidocaine injectionLidocaine HCl injection is a medication used for local or regional anesthesia to perform certain surgeries and procedures. Common side effects of lidocaine are injection site pain, feeling lightheaded, euphoria, shaking, low blood pressure, drowsiness, confusion, weakness, blurry or double vision, and dizziness. Consult your doctor if pregnant or breastfeeding.
Lower Back Pain (Lumbar Spine Pain)There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis, and abdomen, and the skin covering the lumbar area.
Muscle Pain (Myofascial Pain Syndrome)Muscle pain (myofascial pain syndrome) is muscle pain in the body's soft tissues due to injury or strain. Symptoms include muscle pain with tender points and fatigue. Treatment usually involves physical therapy, massage therapy, or trigger point injection.
Naproxen (Aleve, Anaprox, Naprelan, Naprosyn) is in the class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen is prescribed for the treatment of mild to moderate pain, inflammation, and fever. Side effects, drug interactions, and pregnancy information should be reviewed prior to taking this medication.
Neck Pain (Cervical Pain)Neck pain (cervical pain, cervicalgia) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Over-the-Counter ProductsOTC drugs are available without a prescription, simply "over the counter." Find an easy-to-follow format to help you understand which products may work better for specific conditions and how to choose the products that are most appropriate.
Shoulder and Neck PainShoulder and neck pain may be caused by bursitis, a pinched nerve, whiplash, tendinitis, a herniated disc, or a rotator cuff injury. Symptoms also include weakness, numbness, coolness, color changes, swelling, and deformity. Treatment at home may incorporate resting, icing, and elevating the injury. A doctor may prescribe pain medications and immobilize the injury.
Temporomandibular Joint Syndrome (TMJ)Temporomandibular joint (TMJ) syndrome is a disorder that causes symptoms like pain, clicking, and popping of the jaw. TMJ is caused by injury to the temporomandibular joint. Stress, poor posture, jaw trauma, genetic predisposition, and inflammatory disorders are risk factors for the condition. A variety of self-care measures (application of ice, use of over-the-counter pain medication, massage, relaxation techniques) and medical treatment options (dental splint, Botox, prescription medications, surgery) are available to manage TMJ. The prognosis of TMJ is good with proper treatment.
Tension HeadacheA tension headache is one of the most common types of headaches, and the exact cause is not known. Factors that may contribute to tension or stress headaches are lack of sleep, increased stress (referred to as a stress headache), skipping meals, dehydration, medical diseases or conditions, anxiety, or changes at home, work, or school. Treatment of tension headaches include prescription and OTC medications, stress management, and treating any underlying illness or condition.
UltrasoundUltrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as:
- heart valve irregularities,
- carotid artery disease,
- heart disease,
- kidney stones,
- liver disease,
- diseases of the female reproductive, and
- diseases of the male reproductive organs.