Are you suffering muscle ache in your neck, shoulder or lower back that simply will not go away. Have you tried massage, physiotherapy and applying heat packs to the region and still you suffer? In fact does the pain seem to be spreading and you now associate neck pain or headaches with the muscle ache?
Well you may be suffering from muscle trigger points, which are focal areas of muscle spasm specific to the muscle group.
What is a trigger point?
Typically trigger points are focal areas of spasm and inflammation in skeletal muscle. For example the rhomboid and trapezius back muscles, located in the upper back and shoulder areas, are a common site of trigger points. In addition to the upper spine, trigger points can also occur in the low back or less commonly in the extremities.
More often than not this is a palpable nodule in the muscle where the trigger point is located. While trigger points can occur on their own they can be related to other chronic pain conditions including fibromyalgia, myofascial pain syndrome, neck pain, tension headache and lower back pain. For this reason you should seek advice
What are the treatment options
- Firstly making the clinical diagnosis is important. Sometimes further investigations are required to establish the diagnosis
- Applying heat pads and anti-inflammatory gel is a reasonable starting point. Expect 50% reduction in symptoms that should settle over 5 days
- Combining this with regular paracetamol sounds basic but it is helpful and relatively low risk
- Your consultant could prescribe topical local anesthesia (such as a lidocaine patches). These required specific instruction regarding the expectations but at least a 30-50% reeducation in pain would be reasonable outcome.
- Examine your posture at work, at home, in the car and even at night-time in bed. Perhaps your physiotherapist could advise on this
- If these do not help then trigger point injections are the ideal option and the team at Pain Relief Ireland can provide this
What's 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 bupivacaine with a corticosteroid (cortisone medication) is usual. 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.
How is the trigger point injection procedure performed?
- The trigger point injection is performed usually with the patient either lying on the exam table on the stomach or sitting on the exam table. The exact protocol varies.
- Once the trigger point is located the procedure is usually undertaken using ultrasound guidance and in a sterile field
- After the procedure the area may be tender for 10-14 days. Your consultant will advise on possible treatment options which may include an ice pack, and use of analgesia (pain killers).
- Organizing a physiotherapy / massage session in the 7- 14 days following the injection is advised in order to maximize the benefit of the injection.
Can a Trigger point injection be repeated?
- 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 a steroid medication is injected, TPIs should be administered much less frequently, because of the risk of tissue damage or shrinkage from the steroid medication. On average 4 injections per year would be the cut off point but this is something that can be discussed as part of your pain management
So if you have ongoing pain in your muscle that does not seem to improve despite everything maybe should speak with your doctor.
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