Trigger point injections are a common treatment for chronic pain conditions affecting the musculoskeletal and nervous systems. The most common risks associated with these injections include bleeding or infection at the site of the injection. Common side effects that occur after a Trigger Point injection include numbness or pain at the site of the injection, which usually go away within a few days. Infection is a cause for concern when receiving any type of injection, so if the patient notices that the injection site is sore, red, oozing, or has a fever, they should contact their doctor immediately. Trigger points are often confused with the term sensitive points, but they are not synonymous.
Tender points denote a focal node that produces pain directly below the palpation area, but does not cause referred pain. The pathogenesis of activation points is believed to be related to abnormal motor plaques at the ends of the muscle, where motor and nociceptive nerves coexist, with a component of greater central sensitization in the spinal cord. EMG studies have shown that activation points show spontaneous electrical activity, suggesting an aberrant action potential generation. This concept is supported by histological evidence through muscle biopsies that show evidence of muscle hypercontracture consistent with the continuous release of calcium from the sarcoplasmic reticulum secondary to neuronal activation and the generation of action potential. Patients may experience localized pain, which can result in muscle tension and a decreased range of motion in the affected tissue.
The most common muscle groups treated with trigger point injections include the masetero, levator scapula, gluteus medius, quadratus lumbosum, trapezius, sternocleidomastoid and temporal muscles. Trigger points affecting the trapezius muscle may be clinically manifested as tension headaches, pain in the neck, shoulders and proximal arms. The iliopsoas muscle is the main muscle responsible for the trigger points that cause pain in the groin. Indications for triggering point injections include an identifiable sensitive and palpable area that produces a pattern of referred pain. Common concomitant symptoms include chronic or episodic headaches, temporomandibular joint pain, back pain, decreased range of motion secondary to trigger points, and groin pain. Musculoskeletal pain is a common complaint that many primary care providers and pain professionals regularly diagnose and treat.
Treating pain with a multimodal approach is critical to providing safe and effective results for patients. Trigger point injections can be an effective primary or complementary therapy aimed at reducing pain in the musculoskeletal system. By focusing on specific points in myofascial pain, doctors can directly treat pathological tissue, address the patient's pain generator, and break the pain cycle with few or no side effects. Patients can have a significant improvement in range of motion and overall functionality without needing to take pain medications. Significant results can be achieved with injections at the trigger point and should be considered as a treatment modality in the appropriate setting.
Patient safety is of utmost importance when it comes to trigger point injections. A detailed medical history and a musculoskeletal physical exam are essential for preventing adverse outcomes. Trigger point injections cause temporary pain for a day or two; multiple injections at a time may cause mild dizziness for several hours. Rare side effects such as bleeding, allergies, infections and nerve damage are mainly due to clinical errors and adverse reactions from these injections. Once the trigger point has been identified and the overlying skin has been cleaned, doctors should use their non-dominant index and thumb fingers to pinch the tip between their fingers and stabilize the tissue. Trigger points in the shoulders, neck and head may contribute to migraine and tension headache disorders according to the American Migraine Foundation. While trigger point injections may offer significant benefits for some people, several researchers have found that this therapy may be ineffective.
Trigger points can form after acute trauma or from repeated microtrauma causing tension in muscle fibers. Trigger point injections may provide immediate pain relief for some people while others may not respond to treatment. The benefits of triggering point injections last between a few days and months depending on the patient's condition and medication injected. Trigger point injections may also contain corticosteroids that may or may not be mixed with anesthetics. Trigger points can also cause stiffness and decreased range of motion and can sometimes be associated with chronic disorders of the musculoskeletal system. Trigger point injections can be a safe treatment for chronic pain conditions such as myofascial pain syndrome, fibromyalgia and tension headaches.
The findings suggest that myofascial trigger points influence the intensity of these types of headache. Trigger point injections can help relieve pain caused by conditions affecting the musculoskeletal and nervous systems such as those listed below. Trigger point injections can offer immediate pain relief and better range of motion for people with chronic muscle pain. Trigger points appear in muscles due to traumatic tissue injury an underlying structural problem spinal abnormalities whiplash injury degenerative disorders viral syndrome postural problems and overuse of muscles. If you use a topical anesthetic spray be sure to anesthetize trigger points before starting procedure. Common trigger points are found in trapezius and rhomboid muscles which are located in upper back and behind shoulders.
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