Trigger point injections are most often given in a physician’s office by a medical specialist, who often begins with injection of a nerve block to prevent unnecessary pain. This specialist may be a physiatrist, orthopedist, neurologist or pain specialist. A TPI procedure takes about 30 minutes from start to finish.
Trigger Point Injection Medicine
Various injection contents are used, including saline, local anesthetics (most commonly procaine hydrochloride, or Novocain), steroids and botulinum toxin. Beware of a practitioner who wants to inject long-acting local anesthetics, or those that are highly concentrated, or the drug epinephrine: all can cause muscle death.
A mixture of lidocaine and bupivacaine, perhaps the most common trigger point injection substances, offers the benefit of immediate numbing along with long-acting relief of pain. Sarapin, a medication derived from the pitcher plant, can also be used.
Good news for those with insurance plans through Blue Cross, Medica, HealthPartners and more: all began covering trigger point injections in 2005.
If a numbing agent was part of your trigger point injection medicine, the effect will last about an hour. A bruise may form at the site of the injection, which can be covered alternately with ice and moist heat for one or two days. Your doctor may also recommend physical therapy or stretching exercises that you can do at home.
What to Look For
While most trigger point therapy treatments go without incident, be on the lookout for redness or swelling, which could indicate infection. Also, because these injections are given deep in the muscle tissue, there is the possibility of a punctured lung, kidney damage, or injured salivary glands, depending on the location of the trigger points that are treated. Some studies also suggest that trigger points themselves are the body’s reaction to joint instability.
TPI and Fibromyalgia
Trigger point injections (TPI) are used to relieve pain in muscle tissue that is knotted and tight. These knots are commonly associated with myofascial pain syndrome (chronic, localized pain found in skeletal muscle) and fibromyalgia (chronic but more generalized pain occurring above and below the waist and on both sides of the body).
These tight muscles can often be felt under the skin as hard and rope-like, in contrast with normal muscle tissue that is not constantly contracted. Individual trigger points can surround or put pressure on nearby nerves, which causes referred pain when pain signals travel along the nerve to other points in the body. With time, scarring, loss of strength and limited range of motion can occur and progress.
Trigger point injections are often the recommended treatment for chronic myofascial pain that doesn’t respond to other treatment. The parts of the body most often injected include the neck, arms, lower back and legs, although any muscle group can be done