Trigger Point Injections (TPI)
Trigger points are discrete, focal, hyperirritable muscles. They produce pain locally and in a referred pattern and often accompany chronic musculoskeletal disorders. Acute trauma or repetitive microtrauma may lead to the development of a trigger point. Lack of exercise, prolonged poor posture, vitamin deficiencies, sleep disturbances, and joint problems may all predispose to the development of microtrauma. Occupational or recreational activities that produce repetitive stress on a specific muscle or muscle group commonly cause chronic stress in muscle fibers, leading to trigger points. Patients may have persistent pain resulting in a decreased range of motion in the affected muscles, including muscles used to maintain body posture. The most common areas include the muscles of the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the hips and low back pain. Palpation of the trigger point will elicit pain directly over the affected area and/or cause radiation of pain. Various modalities can be employed, such as the medications, Spray & Stretch technique, physiotherapy, manipulation, massage, dry needling, acupuncture, and trigger point injections. Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms as per the American Family Physician 2002;65:653-60. Trigger-point injections with an anesthetic (lidocaine, procaine, marcaine), steroid (kenalog), and saline are commonly used. However, botulinum toxin type A (Botox), vitamin B12 and homeopathic medicinals can also be used. Trigger-point injection has become widely accepted and is one of the most effective treatment options available to achieve the best results. A simple, nearly painless, injection can often either correct or diminish pain associated with TPI’s. Treatment time is 15 minutes and typically requires 3 sessions, 1 week apart. The treatment is very affordable and many insurance may cover the service.