7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Trigger Point Injections

 

What it is used to treat?

 

Trigger point injections are used to treat areas of focused unrelenting muscle spasm that can occur in any muscle in the body.  These typically occur in areas around the shoulder blades, in the calves and forearms.  They can also occur in the abdominal muscles, low back or other areas of the body.

 

Trigger points lead to problems such as tennis elbow/lateral epicondylitis, golfers elbow/medial epicondylitis, shoulder pain, neck pain and back pain among others.  Trigger points can lead to sciatic pain due to piriformis muscle spasm.

 

What the goal/purpose?

 

The goal in doing trigger point injections is to break up small areas of chronic muscle spasm that lead to involvement of larger areas of the muscle.

 

What should I do to get ready for the procedure?

 

Stop taking any medication that thins the blood at least 5 days prior to the procedure. These medicines include Aspirin, and most over the counter pain medicines except Tylenol.   Read the list of medications that must be stopped that was given to you at your office visit.  Make sure it is ok with your prescribing doctor before you stop prescription blood thinners used for treatment of heart disease, peripheral vascular disease, irregular heartbeat or history of stroke.  It is your responsibility to clear this with your doctor.

 

Continue to take your other medications.  Do not stop blood pressure or diabetes medicines.

 

Do not eat or drink anything on the morning of your procedure.  You may eat and drink afterward.

 

How is it done?

 

Patients either lie on the treatment table or sit in a chair depending on what muscles are involved.  Monitors are attached to keep track of your vital signs during the procedure.  The area over the procedure site is prepped and draped in a sterile manner to protect against infection.  An ultrasound machine is used to locate the trigger point area.  The skin is numbed with lidocaine and a needle is advanced toward the target under x-ray guidance.

 

Use of ultrasound has greatly increased the efficacy of these procedures.  In the past, these were done primarily by feel.  Now with the advantage of ultrasound guidance, not only can the area of spasm be better located, but the needle can actually be guided directly to the target.  This level of precision has lead to a much improved level of success.

 

The trigger points are usually injected anywhere from 1-5 times over the course of several months.  Continuing with home rehabilitation and stretching is very important to getting good long-term relief.

 

What is injected?

 

For the diagnostic tests, Lidocaine/Ropivicaine and a steroid such as dexamethasone or methylprednisolone.  In highly resistant cases where patients only get temporary relief, Botox can be used.

 

Will it hurt?

 

Most people tolerate these procedures very well.  There is some discomfort associated with numbing the skin and there may be pressure during the injection.  Some patients require some sedation for the procedure, and others do not. The vast majority of patients tell us ‘that wasn’t so bad” or “I can’t believe I was worried about that;” however some people do find it painful and may require sedation.

 

Important Warning!

 

The day of the procedure you may be very sore and may have some weakness associated with the muscle injected.  Some bruising is normal with these type of injections.

 

What is the chance of success?

 

Approximately 80% of our patients get significant relief from this type of procedure.

 

How often can the procedure be repeated?

 

In the beginning, we may do one set of injections every month for several months.  This is highly dependent on the patient’s response to treatment. If one injection gives significant relief and no further treatment is needed, we would not continue injections.  For patients with severely resistant trigger points, sometimes Botox is needed.  Botox can be repeated every 4-6 months if needed.

 

In patients getting long-term relief but the trigger point returns, the injections can be repeated.

 

What can I do to maximize my chance of success?

 

Be consistent in your home stretching exercises.  Optimize your diet and drink plenty of water.  Avoid smoking or other use of tobacco.  Avoid excessive sugar.  Work to get close to your ideal body weight.  Be careful not to reinjure your muscles.  Remember that even though you are feeling better, you have to protect your gains and be conscious of how you move.  As you feel better, begin to gradually get into progressive resistance exercise.  Yoga stretches can be helpful.  Exercise and chiropractic treatment can be helpful.  Physical therapy can also be very helpful

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