What Are Trigger Point Injections?
Many people have heard of a procedure called "dry needling" but are not familiar with trigger point injections, which are used to treat what most people believe is "TMJ," when the pain is actually caused by muscles.
Trigger point injections and dry needling are the same procedure with one major difference. Trigger point injections involve the use of 1% plain lidocaine to numb the area being treated, which makes the procedure more comfortable. Nothing is injected with dry needling. The use of lidocaine provides immediate feedback that the diagnosis is truly muscular in origin.
If the trigger point injection reduces or eliminates the pain, then the source of the pain is the local muscle that was injected. However, it is not the lidocaine that provides long-term relief. It is the needling that is done.
Needling involves poking the local muscle with a very thin needle for 30 to 60 seconds, which intentionally induces inflammation into the area, which the body will repair in 24-48 hours. This is not a painful procedure as it is more of a sensation, but it is common to be sore for a day or two after the procedure.
What is a Trigger Point?
A myofascial trigger point, or knot, is a hyperirritable spot, usually located within a taut band of skeletal muscle, which feels painful upon compression and can give rise to characteristic pain, motor dysfunction and autonomic phenomena. Trigger points produce local and referred pain and often accompany chronic musculoskeletal disorders.
Knots can be felt as nodules or bands in the muscle. Stimulation of a knot may elicit a twitch response and pain, which may radiate in a distribution consistent with the affected muscle. A trigger point may produce not only pain in the affected muscle but also in a distant area, including locations in the head and neck, called referred pain. Trigger points may develop because of trauma, injury, inflammation or other factors.
What Is a Trigger Point Injection?
A trigger point injection can help soothe muscle pain, especially in your shoulders, neck and facial muscles. It also can be used to treat tension-type headaches, cervicogenic headaches, TMJ pain and myofascial pain.
Trigger points are painful “knots” in your muscles. They form when a muscle can’t relax. Sometimes you can feel these knots when you rub your muscle. Injecting small amounts of anesthetic along with "needling" into the trigger point can help alleviate the pain
Who Should Receive Trigger Point Injections?
Patients who have specific trigger points that can be elicited with palpation (a firm touch) may experience the most relief from injections. The injections may be very helpful for immediate relief for severe pain in patients with an individual headache or migraine attack, or they can help treat an overall worsening of head pain in patients with chronic headache disorders who are having an exacerbation.
How Are Trigger Point Injections Performed?
In the trigger point procedure, a health care provider inserts a small needle into the patient’s specific area of pain (trigger point) in a muscle. The injection usually contains only a local anesthetic.
This procedure can be performed in a doctor’s office and does not require sedation. The patient is positioned sitting or lying down. Your doctor will first palpate and identify the painful areas within a muscle. After identifying such trigger points, your doctor will inject those areas.
Depending on how many trigger points are identified, more than one injection may be required. Imaging is not needed to diagnose a trigger point as they do not show up on x-rays or MRIs. However, if an underlying condition is the cause of the trigger point, then these tests can be helpful.
You can have several trigger points injected during one visit to your doctor’s office. The procedure only takes a few minutes.
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