What Is A Trigger Point?
A trigger point (TP) is a taut band of skeletal muscle that creates a discrete, hyperirritable area or region in the body. They can be painful upon palpation, or can produce referred pain (pain in another location) by traveling along the nerves that are intertwined within the muscle fibers.
How Do Trigger Points Develop?
Repetitive muscle strain, posture, or muscle imbalance, and acute injuries are the common causes of trigger point development. Those who suffer from chronic pain often times develop TP due to posture and muscle compensation, your body’s way of attempting to protect an injured area.
Do I Have Trigger Points?
Trigger points commonly cause:
- muscle or areas sensitive to pressure
- burning, achy, dull pain
- tight, stiff muscles
- muscle spasms
- pain that travels to the arms or legs
- headaches or migraines
- numbness
- pain that diminishes with heat application
How are Trigger Point Injections (TPI) performed?
The Nurse Practitioner will clean the area to be injected over the trigger point and use a tiny needle to inject through the skin. If you have ever had a TB skin injection, it is even smaller than this needle.
The needle can cause a small “twitch” which tells the nurse the proper placement has been reached. A small amount of numbing medication and Sarapin is then injected. The patient may feel slight burning but quickly disappears.
It is the combination of the needle itself causing the “twitch” and the injected medication that relieves the pain and muscle spasms. There isn’t research to support the effects Sarapin but this medication has been used since the 1930’s and the only reported side effects are headache and lightheadedness. The injection overall only takes a couple of minutes, afterwards pressure will be applied and massaged into the muscle with a special device called PTLMS.
What are the results of trigger point injections?
Right away patients typically feel relief as the numbing medication starts acting within a minute. This pain relief will last between 4 and 12 hours, and then it wears off. After the injections some experience soreness, just like a vaccine shot type of healing.
Stretching may help at this point, applying ice to the injected area also helpful. No heating pads for the first 24 hours and keep area clean and dry. Call your nurse if you experience rash or fever after injections. Adding a TENS unit with intermittent use may aide in pain relief. After the numbing medication wears off, pain relief from the Sarapin should “kick in” and provide additional relief anywhere from a few days to months. Most patients report long lasting relief after the treatment is completed.
Typically trigger point injections are repeated 2 times a week for 4 weeks and are often performed in conjunction with physical rehabilitation (physical therapy type exercises), chiropractic, and massage.
What are the risks of trigger point injections?
The risks of these injections are very low. There is a small risk of infection, bleeding, redness and allergic reaction to the injectables. Make sure to tell your provider if you are taking a blood thinner such as Aspirin or Coumadin.
There is also an extremely rare incident of the needle inadvertently puncturing the lung or other organ. If the patient develops chest pain, cough or shortness of breath after the procedure or severe nausea and vomiting, the nurse practitioner should be notified.
Another risk is that the injection may not work. If TPI’s are done to frequently scar tissue can form in the area being treated.
At Advanced Physical Medicine our Certified Nurse Practitioner is trained and experienced in this procedure and in all aspects of relieving pain. This often includes trigger point injections along with individualized care plans to achieve the best results for complicated patients.