Trigger Point Injections

What are trigger point injections?

In skeletal muscle, some focal points are used for treating the pain and inflammation; these points are termed as Trigger point. The considerable focal areas in the skeletal system are back muscles of trapezius and rhomboid which are located in the superior part of the spine and shoulder regions.

Other trigger points are located at the lower portion of the spine and in the limbs. These specific muscles are used due to the knots formed in this site are never relaxed. These knots are even sometimes felt beneath the cutaneous tissue by touching.

For managing uncontrollable spasm or pain, trigger point injection (TPI) is administered into the trigger points. The Usual medications administered through trigger point injections are anesthetics like lidocaine, bupivicaine, or combination of these, steroidal drugs like corticosteroids alone or in a combination with lidocaine.

Even sometimes without adding any medication, alone needle is injected into the trigger point for deactivating the triggering point which helps to relieve the pain symptoms. This technique is known as ‘dry needling’.

What happens during a trigger point injections?

During a triggering point injection, clinician injects a small needle into the trigger point of the skeletal system of the patient. The included medicaments may be local anesthetics, steroidal drugs (corticosteroids) or saline solution. This process inactivate the trigger point and pain is become lessen. Usually continuation of a short duration of the treatment beneficial for sustained pain management.

The procedure is not a complex, it need only few minutes in a clinic. Some times more than one injecting sites are involved in treatment process. If pain medication causes hypersensitivity to the patient, then ‘dry needle technique can be used.

Pathogenesis

The pathogenesis of the pain management by using trigger point injection is not yet having any scientific background. Many medical scientists believe that sharp strain or continual micro trauma may cause development of a trigger point.

The possible reasons of the tendency of the development of the micro trauma are poor posture maintained for prolonged periods, insufficiency of vitamin intake, and faulty posture during sleep or joint disorder. Occupational over stress or prolonged activity generates chronic stress in the muscle fibers which leads to trigger points.

Sudden strain during sports activity, surgical trauma or any repetitive stress may also affect skeletal muscle and causes development of the trigger points.

Symptoms of generating Trigger point

Usually at the trigger point, a certain nodule is manifested in the affected muscle. The site has become tender; pressing of the affected muscular region generates pain. The pain is not only restricted on the trigger zone, but it also spread to the surrounding tissues which is termed as referred pain.

The equipments required for trigger point injections

The following basics equipments are required

• Various sized needles and syringes.
• Alcohol or Betadin solution
• Sterilized gauze pieces
• Sterile and unsterile hand gloves
• Xylocaine (lidocaine)
• Bandages
• Vapocoolant spray

The procedure of performing trigger point injection

The of trigger point injection is conduction usually in the heath care professional’s clinic. The positioning of the patient is either as lying down position on the stomach on the examination table, or in sitting posture on the examination table.

The health care professional locates the trigger point by manual palpation method and marking the site. Then marked the area and after that sterilized with alcohol and then again uses the betadin solution for complete removal of germs.

Numbing spray like Vapocoolant spray is frequently administered for anaesthetized the location and to reduce the discomfort of the patient. Then an injection is administered at the trigger point and pushing the medicaments and then bring out the syringe. Application of the adhesive bandage is applied on the injected site. After injection, if any patient complains about pain, then ice compression or other analgesic medicines are prescribed for a short duration.

When trigger point injection is prescribed?

If patient is having pain at the triggering points and gradually spread to the surrounding area, then for reduction of the referred pain which is radiated from the trigger point pain, then trigger point injection is prescribed. This treatment is also applicable for fibromyalgia, myofascial pain syndrome tension headaches, neck pain and low back pain, though the recurrence of chronic pain at the trigger point is common.

How frequently do trigger point injections need to be administered?

One trigger point injection can able to resolve the pain. This is possible when the reason of micro trauma generation can be restricted. In case of fibromyalgia or myofascial pain syndrome, the recurrence of trigger point is common due to the underlying cause is not eradicate completely. In these conditions, trigger point injection need to repetitive conduction. Depending upon the medication like in case of anaesthetic medication monthly administration is required, whereas in case of steroidal drugs administration, required delayed therapy , as they associated with different side effects.

Side Effects & Complications

The included complication after trigger point injection is pain at the injection location, though this pain managed by its own way and eliminated after a few days. This pain is more frequent in case of ‘dry needle’ method.

If trigger point injection contains steroidal drugs, then prolonged therapy causes cutaneous or muscular tissue shrinkage with producing dent at the site of the injection. These side effects do not occur in anaesthetic medications. Other possible complications are skin puncture leads to bleeding and infection development.

Contraindications

For local or systemic infection, trigger point injection should not be applicable. The patient has any coagulation disorder or treating under anti-coagulant therapy for them the trigger point injection should be avoided.

In case of pregnancy and the diabetic patient, the trigger point injection use is restricted. In diabetes delayed wound healing is one of the causes of avoidance of trigger point injection.

Patient with hypersensitivity to anaesthetic drugs or having excessive fright of the needles causes contraindication of trigger point injection.

References

1. http://www.medicinenet.com/trigger_point_injection/article.htm
2. http://www.webmd.com/pain-management/guide/trigger-point-injection
3. http://emedicine.medscape.com/article/1997731-overview
4. http://www.aafp.org/afp/2002/0215/p653.html
5. http://www.achenet.org/resources/the_basics_of_trigger_point_injections_for_headache_and_migraine/