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Trigger Point Injection

Overview and Indications for Procedure

Trigger point is a clinical finding of Myofascial Pain. Trigger points are areas in muscle that are painful and
show a palpable band of tightness in a specific portion of muscle. When pressed, trigger point will produce a
twitch within the affected muscle. In myofascial pain syndrome, trigger points have been classified into active
or latent. In an active trigger point, there is an area of tenderness at rest or on palpation, a taut band of muscle, a
local twitch response, and referred pain elicited by firm compression similar to the patient's complaint. Latent
trigger points are more commonly seen. They may display hypersensitivity and exhibit all the characteristics of
an active trigger point except that it is not associated with spontaneous pain. A trigger point pain may be
localized but can also be referred from the neck to the head cause headache, or can go from lower back to the
buttock and flank. Most common area for such muscular pain is often around the shoulders, lower neck and
lower back or mid back. Trigger points may develop because of trauma, sports injury, inflammation, or other
factors. Muscle Pain in Myofascial Pain is not the same as muscular pain seen in fibromyalgia. The diagnosis
of trigger points depends very much on the subjective experience of the physician.





Trigger point injections are commonly performed in clinics as an outpatient procedure. The pain relief should be experienced not only in the affected muscle, but in the area of referred pain as well. Serious complications, although of rare occurrence, have been reported (e.g., pneumothorax, haematoma, intravascular injection of local anaesthetics, and intrathecal injections,. Direct visualization of surrounding soft tissues and important structures can reduce the risk of such complications. In some cases US can be used to increase safety.


Procedure is done in sterile condition, the skin will be cleaned and a thin needle will be inserted into the taut band by the physician. The tight muscle will respond by a quick spasm and the needle manipulation can be repeated until the twitching stops. Then small amount of anesthetic is injected and the needle is removed and band aid is applied. Risk Associated with procedure: It is important to know the risks associated with any medical or surgical treatment. There are a few risks associated with caudal epidural steroid injections but they tend to be rare.


The potential risks include:


  • Allergic reaction to meds

  • Infection

  • Bleeding

  • Nerve Injury

  • Temporary increase in pain

  • Osteoporotic bone fracture

  • Avascular necrosis(if steroid used)

  • High blood sugar levels(if steroid used)

  • Transient vaginal spotting

  • Transient facial flushing (if steroid used)

  • A transient decrease in immunity

  • Stomach ulcers

  • Severe arthritis of the hips

  • Avascular necrosis of joints(if steroid used)

  • Cataracts (if steroid used)

  • Increased appetite

  • Agitation and irritability

  • Negative effect on bone density and fractures (if steroids used)


Prepare for your Procedure


Certain medications have to be held or before elective procedures or patient has to accept a slight increased risk of bleeding with TPI procedure


Do not hold such medication on your own. Consult your Primary Care Physician (or Cardiologist) before stopping those medications. Ask your PCP if it is safe to stop the medication. Continue to take all other medications, especially your Blood Pressure medications.


A sample of medications that have to be held includes:


  1. Aggrenox® (dipyridamole)

  2. Coumadin® (warfarin)

  3. Effient® (prasugrel)

  4. Fragmin® (dalteparin)

  5. Heparin

  6. Eliquis ® (apixaban).

  7. Lovenox® (enoxaparin)

  8. Plavix® (clopidogrel),

  9. Pradaxa® (dabigatran)

  10. Ticlid® (ticlopidine)


Please let us know if you have had fevers, antibiotic treatment, any illness, or hospitalization within the last 4 weeks. You must be healthy and off all antibiotics on the day of the procedure


Right after the Procedure


  • You will be observed for 15-45 minutes.

  • If you have an IV line, it will be removed.

  • A nurse will check your vitals and review the discharge instructions with you and will answer any questions you may have. A responsible adult must be present to drive you home after discharge.

  • You will leave with a pain log and a copy of the discharge instruction which contains Emergency contact numbers. Please do not discard your discharge instructions.

  • A responsible adult must drive you home.


Discharge Instructions


  • Take band aid off tomorrow.

  • Ice area the night of the procedure. May take Tylenol or Motrin if you have some soreness.

  • Apply heat and stretch the muscle 2-3 times a day for 10 days


Call your doctor if you develop these symptoms. You may be directed to ER:


  • Sudden weakness or shortness of breath

  • Fever over 101°F within 5 days after procedure

  • Persistent redness, increased localized pain, or discharge from the site of injection.

  • Possible allergic reaction within 5 days of the procedure

  • Significant increased pain not responding to ice, NSAIDS and pain meds or associated with fevers