Trigger Point Injections

Trigger Point Injections (TPI)

Trigger points are hyperirritable spots in the fascia and muscle. They are associated with nodules or taut bands of muscle tissue. Compression of a trigger point may elicit local tenderness, referred pain, or local twitch response.

TPI involve injection of medication (often steroids and anesthetic medication) into the trigger point to help with pain relief and inflammation. This injection also involves multiple passes of the needle through the taut bands of tissue, breaking up scar tissue and creating a local inflammation response. This inflammatory response serves to bring increased blood flow into the area of pain, allowing increased supply of the body’s natural healing components to reach the area of pathology.

Your physician will talk with you about your symptoms and perform a thorough physical examination to determine the source of your pain. During your appointment in the office, your doctor will discuss the reasons he feels that your pain is related to a muscle trigger point.

The procedure does involve placing a needle through the skin, so you may feel some mild discomfort. Local anesthetic or a topical cold spray is used to lessen the pain associated with skin puncture. You can take pain medication prior to the injection if you wish. The procedure also involves several passes of the needle through the taut bands of the trigger point, which may also result in some pain. The injected anesthetic can help with any increased pain as a result of the needle. The physician will be as gentle as possible to make the injection as pain free as possible.

This varies with each patient. During the injection, a steroid medication and an anesthetic medication are often injected into the trigger point. Many patients get immediate relief due to the anesthetic medication, which partially numbs the muscle and surrounding painful structures. Unfortunately, this pain relief is often temporary, as the effects of the anesthetic usually last only a few hours. The steroid medication is a strong anti-inflammatory used to treat inflammation. Unlike anesthetic medications, steroids often do not work immediately, as removing inflammation takes time. It can take 2-3 days until steroids start to provide pain relief. Steroids and this injection will reach their maximum effect between 7-14 days.

This will vary depending on your condition and your response to the injection. After your injection, you will be seen back in the clinic in about 2 weeks to assess your response (this is the time it takes for steroids to reach maximum effectiveness). The decision to do more injections will be based off your response to the first injection.

If you have a great response to the first injection (>80% pain reduction), then there is no need to have a second injection. Injections can always be repeated inthe future if the same pain should return.

If you have had 80% improvement, but >20% improvement in your pain following your first injection, a second injection may provide some “additive” benefit. A subset of patients require two injections to see benefits of the injection. You can discuss the possibility of a second injection at your 2 week follow up visit.

If you had minimal improvement with injection (20% pain reduction), then your doctor will re-evaluate your condition to determine the next step in the treatment plan.

At most, three injections can be performed in a 6 month period. Overall, we try to limit total number of injections per year to no more than 4 for each site.

If the injection does not help your pain, then the doctor will re-evaluate you at your follow up appointment. Some people require more than one injection to get adequate pain relief. However, no pain relief from this injection could also mean that your pain is coming from a different source. If this is the case, then a different type of injection or treatment may help your pain.

If your pain is the result of trigger points, then surgery is not indicated. If you are getting muscle pain and trigger points from another source, such as spine arthritis, then surgery to correct the underlying issues may be beneficial. Most the time with adequate treatment, surgical intervention can be avoided.

Your doctor will explain all the risks and benefits of the procedure with you and you will have an opportunity to ask as many questions as you would like to ask. Once you agree to proceed with injection, you will sign a consent form authorizing the injection, stating that you understand the risks and benefits of the injection. There are no restrictions in terms of eating or taking medication prior to the procedure. You may take your pain medication prior to this procedure. These injections are performed in our office. Typically, you will be seen in the office about 2 weeks after the injection to assess the response of the injection.

What are the risks of this procedure? Generally speaking, this procedure is very safe. However, as with any procedure, there are risks, side effects, and the possibility of complications. Some of these common risks are listed below.

Pain:The injection site may be sore after the injection, due to the needle passing through painful tissue. Usually, any increase in pain is temporary. In most cases, very little discomfort is felt by the patient.

Bruising at the site of injection.

Infection:Rare. The skin is cleaned thoroughly prior to the injection to minimize this risk.

Bleeding:Usually any bleeding stops spontaneously. For most of these injections, you are not required to stop blood thinning medication.

Insurance does typically cover trigger point injections.

Post-Injection Instructions

  • Your activity level after your injection should be at the following levels:
    • Day of Injection: You can perform regular everyday activities on this day.
    • Day 2: Activity is unrestricted as tolerated.
  • You may take pain medications immediately after your injection, if needed.
  • You may use ice compresses over the injection site – 20 minutes on, then 20 minutes off. Repeat this cycle as required. If using a gel pack, make sure a towel or piece of cloth is placed between the cold pack and the skin. Do not apply the cold packs to the numb areas following injection.
  • You may shower immediately, but please avoid swimming or baths/Jacuzzis/hot tubs for the first 2 days after the procedure, to reduce the risk of infection.
  • Should you have fever, chills, drainage, excessive swelling or redness at the injection site, bladder or bowel dysfunction, or change in sensation or muscle strength, please contact our office immediately.
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