Trigger Point Injections
What are trigger points?
Trigger points have been described as taut bands in muscles or fascia which, when pressed or needled, elicit characteristic pain patterns which may be referred or radiate to different locations in the body. Although in Eastern medicine trigger points have been treated for millennia, they were well described in the last century by Drs Travell and Simons and trigger point injections are considered part of mainstream conventional medicine today.
Acupuncturists have been using acupuncture needles inserted into these points for many years; physiotherapists often use Intramuscular Stimulation (IMS) or dry-needling to relieve these points, often obtaining a "twitch" response that reproduces and then relieves the discomfort. Alternatively, various different solutions can be injected into these tender points. Physicians often will inject local anesthetic, steroids, saline, 5% dextrose (glucose solution), or even an anti-inflammatory medication such as ketorolac (Toradol) into these points. Some alternative practitioners will inject vitamin B12 or homeopathic solutions. Unfortunately, some medications such as concentrated local anesthetics or steroids can cause local muscle injury and other side-effects. In 1997 a Korean peer reviewed controlled study was published in which three groups of people had trigger point injections, one group with saline (0.9% salt solution), one with lidocaine, and one with 5% dextrose (the same solution one can have in an intravenous infusion in hospital). The 5% dextrose group had the best results. Consequently, in our office we use 5% dextrose with a small amount of dilute lidocaine for trigger point injections. This is well-tolerated and gives rapid relief without the toxicity of drugs.
It is now thought by many people who have also learned Dr Lyftogt's perineural injection technique that these taut bands are actually, at least in many cases, irritated or constricted superficial skin nerves that are generating the pain. 5% dextrose gives instant relief of pain in these circumstances and is much safer than other agents.
Furthermore, it is known that acupuncture points, trigger points, and fibromyalgia tender points often are the same points, described differently, that is to say that diagrams of these different painful point concepts overlap considerably (about 75%). Having studied a variety of trigger point injection techniques, dry needling, Perineural Injection Treatment, medical acupuncture, and manual medicine, we bring all these concepts together when we do injections.
What conditions will these injections help?
Many painful conditions respond to these injections to some extent but they are exceptionally effective for treating myofascial pain syndrome and muscular pain. This technique dovetails seamlessly with perineural injection treatment.
Trigger points have been described as taut bands in muscles or fascia which, when pressed or needled, elicit characteristic pain patterns which may be referred or radiate to different locations in the body. Although in Eastern medicine trigger points have been treated for millennia, they were well described in the last century by Drs Travell and Simons and trigger point injections are considered part of mainstream conventional medicine today.
Acupuncturists have been using acupuncture needles inserted into these points for many years; physiotherapists often use Intramuscular Stimulation (IMS) or dry-needling to relieve these points, often obtaining a "twitch" response that reproduces and then relieves the discomfort. Alternatively, various different solutions can be injected into these tender points. Physicians often will inject local anesthetic, steroids, saline, 5% dextrose (glucose solution), or even an anti-inflammatory medication such as ketorolac (Toradol) into these points. Some alternative practitioners will inject vitamin B12 or homeopathic solutions. Unfortunately, some medications such as concentrated local anesthetics or steroids can cause local muscle injury and other side-effects. In 1997 a Korean peer reviewed controlled study was published in which three groups of people had trigger point injections, one group with saline (0.9% salt solution), one with lidocaine, and one with 5% dextrose (the same solution one can have in an intravenous infusion in hospital). The 5% dextrose group had the best results. Consequently, in our office we use 5% dextrose with a small amount of dilute lidocaine for trigger point injections. This is well-tolerated and gives rapid relief without the toxicity of drugs.
It is now thought by many people who have also learned Dr Lyftogt's perineural injection technique that these taut bands are actually, at least in many cases, irritated or constricted superficial skin nerves that are generating the pain. 5% dextrose gives instant relief of pain in these circumstances and is much safer than other agents.
Furthermore, it is known that acupuncture points, trigger points, and fibromyalgia tender points often are the same points, described differently, that is to say that diagrams of these different painful point concepts overlap considerably (about 75%). Having studied a variety of trigger point injection techniques, dry needling, Perineural Injection Treatment, medical acupuncture, and manual medicine, we bring all these concepts together when we do injections.
What conditions will these injections help?
Many painful conditions respond to these injections to some extent but they are exceptionally effective for treating myofascial pain syndrome and muscular pain. This technique dovetails seamlessly with perineural injection treatment.
Are there any risks associated with trigger point injections?
Side effects are very uncommon but may include the following:
· Light-headedness (not serious) or nausea (rare).
· Bruising (not serious).
· Brief “treatment stiffness” from the process of having an injection.
· Infections (very rare). Let us know if any of the sites become increasingly red or painful over the skin.
· A temporary increase in pain. This is uncommon but can occur, and should be treated with any pain medication, or ice.
What can I expect after treatment?
Your pain should be less and your range of movement improved. With our technique you don't need to restrict your activities after treatment though we recommend not having any deep tissue massage or other manual therapies in the areas teated until they settle down. Avoid public hot tubs or swimming immediately afterwards. You may experience a little "treatment stiffness" from the needles, but this does not usually last long. Rarely you may have a flare up of pain for a few days and feel worse. This is quite unusual and after it goes away, then you will notice an improvement.
Side effects are very uncommon but may include the following:
· Light-headedness (not serious) or nausea (rare).
· Bruising (not serious).
· Brief “treatment stiffness” from the process of having an injection.
· Infections (very rare). Let us know if any of the sites become increasingly red or painful over the skin.
· A temporary increase in pain. This is uncommon but can occur, and should be treated with any pain medication, or ice.
What can I expect after treatment?
Your pain should be less and your range of movement improved. With our technique you don't need to restrict your activities after treatment though we recommend not having any deep tissue massage or other manual therapies in the areas teated until they settle down. Avoid public hot tubs or swimming immediately afterwards. You may experience a little "treatment stiffness" from the needles, but this does not usually last long. Rarely you may have a flare up of pain for a few days and feel worse. This is quite unusual and after it goes away, then you will notice an improvement.
What is the cost?
Trigger point injections are an insured service in BC so there is no charge for the procedure. We combine perineural injection therapy seamlessly with trigger point injections. Medications provided in our office may be charged for on a cost-recovery basis.
Practical Advice
· Bring a hair tie if you have long hair.
· Wear stretchy, easy to remove or loose-fitting clothes/sports clothes. A tank top and loose shorts are preferred.
· Wear dark clothes – they might get a little blood-stained.
Trigger point injections are an insured service in BC so there is no charge for the procedure. We combine perineural injection therapy seamlessly with trigger point injections. Medications provided in our office may be charged for on a cost-recovery basis.
Practical Advice
· Bring a hair tie if you have long hair.
· Wear stretchy, easy to remove or loose-fitting clothes/sports clothes. A tank top and loose shorts are preferred.
· Wear dark clothes – they might get a little blood-stained.