Trigger Point Injections: When Should They Be Used?
If your lower back pain is muscle-related, your doctor may suggest a trigger point injection. Myofascial trigger points are felt to be hyper-irritable foci (points) in muscles and fascia (connective tissue) associated with taut muscle bands. Trigger points are diagnosed by palpation (ie, feel) and produce a local twitch response and a referred pain pattern distal to the site of muscle irritability.
Trigger point injections should be reserved for patients who have not responded in the first 4 to 6 weeks to a properly directed program and appropriate pharmacologic intervention.
How Trigger Point Injections Are Done
The trigger point injection should be carried out under antiseptic technique. There is little evidence to support any beneficial effect of adding corticosteroid to the injection. In fact, a saline injection can as effective as a local anesthetic. However, for patient comfort and to assist in deciding upon therapeutic efficacy, injecting a local anesthetic such as lidocaine and/or mepivacaine is acceptable.
Injection of multiple trigger points should be avoided.
Some trigger points may require more than one injection, but generally more than 3 injection of the same trigger point is not indicated. Repeated trigger point injections may cause local muscle damage and scarring, which may potentially lead to a poor functional outcome.
Trigger point injections should not be performed in isolation, but rather, in conjunction with a directed exercise program. Proper follow-up after injections is necessary in order to assess the patient's response to the injection and to progress the rehabilitation program.