Trigger Point Injections: What They Are and Procedure?

By Dr. James Fricton

Trigger Point Injections effectively treat the common cause of persistent pain in the jaw, neck, shoulder, back, and other areas of the body.

A trigger point injection (TPI) is used as effective primary or supplemental therapy aimed at decreasing persistent pain and tightness in the musculoskeletal system. Additionally, they may be used to relieve chronic headaches associated with TMJ, migraine, and other head and neck pain conditions.

But what exactly are they, and how do you know if you’d benefit from this treatment? This article will answer your questions.

• What are Trigger Points?
• What are Trigger Point Injections?
• What Causes a Trigger Point to Develop?
• How is a Trigger Point Injection Given?
• What to Expect when Treated for Pain with Trigger Point Injections?
• How is Trigger Point Compression Different from an Injection?
• Do Trigger Point Injections Hurt?
• What are the Possible Side Effects of Trigger Point Injects?
• How Long do the Benefits of Trigger Point Injections Last?
• MN Head & Neck Pain Specialists Offer Trigger POint Injecctions

What are Trigger Points?

Trigger points are the common sensitive areas in tight bands of muscles that can occur after injury or overuse. These sensitive areas are known as trigger points. A trigger point in a muscle may generate pain both at the knot as well as throughout the muscle. When this muscle pain persists and worsens, it is termed “myofascial pain syndrome”. Myofascial pain syndrome is the most common cause of chronic pain in the jaw, head, neck, shoulder, back, and many other areas.

In simpler terms, Myofascial trigger points are painful muscle knots that develop when muscle tissue cannot relax and function normally. These knots may be felt when one rubs the affected muscle. For example, persistent neck tightness with decreased range of motion (especially in rotating the neck), sometimes accompanied by dull achy pain, often occurs due to a sensitive muscle trigger point.

Two basic types of trigger points are:

1. Active
2. Latent

If your trigger point is active, it can cause pain even at rest. Conversely, if you have a latent trigger point, it generally only causes pain if pressure is applied to the muscle knot. People who suffer from trigger point pain can also experience muscle spasms, weakness, numb feelings, and related pain in additional areas of the body. For example, trigger points in the temple muscle will cause pain behind the eye and across the forehead and are perceived as headaches.

What are Trigger Point Injections?

Trigger point injections are a type of pain management treatment that involves injecting a local anesthetic into a trigger point to relax muscles, reset the knot, and relieve pain. Once the trigger point is numb, a cold spray is used while the tight muscle is gently stretched to its normal range of motion. Taut bands and trigger points in jaw muscles often cause persistent jaw pain with tightness when moving your jaw. An orofacial pain dental specialist can treat muscle pain from trigger points in your jaw, head, and neck.

Trigger-point injections are minor medical procedures with minimal side effects and can be repeated as needed to maintain long-term pain relief.

What Causes a Trigger Point to Develop?

Common contributors to painful trigger points include:

• Injury or trauma to a specific muscle or muscle group.
• Repeated or excessive use of a muscle.
• Chronic jaw or neck muscle tensing, and teeth grinding or clenching.
• Repetitive motions that strain a muscle.
• Poor tense posture triggers pain over a sustained period of time.
• Excessive muscle overloading.
• Psychological stress and anxiety that results in tensing the muscles.
• Poor sleep quality, insomnia, or sleep apnea.
• Lack of proper nutritional health, including excessive caffeine.

Whatever the cause, the stress on muscle fibers leads to the development of these tender trigger points. Treating chronic pain with a multimodal approach is vital in providing safe and effective results for patients. Regardless of the cause, the patient should be informed about the risks and benefits of trigger point injections.

The goal is to assist in breaking the pain-tension cycle; TPIs typically have great success.

How is a Trigger Point Injection Given?

Trigger point injections are done with a thin needle which is inserted directly into a tight muscle knot. During treatment, the needle is only in your muscle and moved around for a few seconds to break up the trigger point and connective tissue that holds the muscle tight. It’s like a deep massage within the muscle knot instead of massaging only over the skin.

Communication with the patient throughout the procedure ensures that the treatment addresses an active trigger point. When the needle is inserted in the correct trigger point, patients often feel the pain and state that, “Yes, that’s the spot”.

Common steps when a trigger point injection is given:

1. Evaluation of a local and referred pain pattern from the trigger point.
2. After lying down or reclining on a procedure table, your doctor will locate and clean your trigger point and then pinch it to keep it from moving.
3. Commonly, it involves a swab or shot of local anesthetic into the trigger point(s) of the jaw, neck, or shoulder. There is less soreness after the use of an anesthetic to numb the muscle as the needle massages the muscle.
4. Then, the trigger point anesthetic solution is injected to help restore the muscle to normal and break the pain cycle. The injection delivers local anesthetic into identified trigger points, relieving local and referred pain from the trigger point.
5. After the injection, your doctor will then use a cold spray on the muscle and stretch to the full range of motion to allow the muscle to feel loose and normal.
6. Functional Improvement and follow-up measurement of pain will be discussed.
7. Since many muscle work together, most people have multiple trigger points. Thus, you may need multiple injections in one appointment. There is no downtime after injections. Most individuals experience pain relief and increased range of motion immediately or quickly after the procedure.

What to Expect when Treated for Pain with Trigger Point Injections?

Each person with persistent myofascial pain is given an individually risk assessment, and their treatment plan centers on their pain symptoms and identification of the myofascial trigger points that are causing the pain. It will start with an examination that typically includes your jaw, neck, and upper or lower extremities. Talk with your primary care provider if you are experiencing persistent or chronic pain, and it is often coming from muscle, tendon, or ligament pain. Working together, you can align your expectations with your healthcare team and know what is right for you.

Like all medical treatments, this procedure needs to have the rationale explained and risks reviewed with a signed consent before proceeding.

As always, to avoid surprises, check before your appointment with your health insurance plan for coverage information for treatments.

Chronic pain treatment with trigger point injections may also include:

• Manual pressure release and the muscle energy technique – This is a common option for treating mechanical neck pain due to upper trapezius trigger points.
• Local anesthetic injections – Little pain is involved because it causes numbness and prevents pain by blocking signals at the nerve endings. Patients do not lose consciousness, and most regard it as a simple procedure.
• Prolotherapy injection – This is an injection treatment that can be used to relieve neck and jaw pain. Your pain provider will inject a small amount of an irritant into your body. A dextrose (sugar) solution is the most commonly injected irritant. The intent is to relieve pain by jumpstarting your body’s natural healing abilities.
• Dry needling – This is an accessible and commonly offered therapy for people with muscle, ligament, or tendon pain.
• Deep pressure massage from a physical therapist – TMJ, Jaw, neck, and shoulder pain massage, and myofascial release are often used together.
• Acupuncture may be recommended. Acupuncture may also be used to deactivate trigger points and restore energy flow.

How is Trigger Point Compression Different from an Injection?

Trigger point compression or myotherapy is done without needles by a physical therapist, myotherapist, or pain specialist. It is done by applying firm pressure to the jaw and or neck muscles with the thumb or knuckle. Trigger point compression works similarly to a deep massage. The pressure may initially feel tense or uncomfortable, but as it continues, your muscles loosen and discomfort decreases. Stretching and heat applications are applied after trigger point compression.

Once a treatment plan is in place, you may gain a pain health coach who can follow up with you.

How Long do the Benefits of Trigger Point Injections Last?

Typically, an injection can provide pain relief for about a month if not longer. Most patients experience pain relief beginning between 24 and 72 hours after the trigger point injection procedure.

Successful Treatment of Myofascial Pain Syndrome (MPS) with Surgical Cauterization of Temporalis Muscle Trigger Points: A Case Report by Brendan David Moxley states that “traditional trigger point injection therapy for myofascial pain syndrome is a well-described technique with acceptable pain relief expected for a period of 8–12 weeks”. Published December 23, 2022, by the Multidisciplinary Digital Publishing Institute (MDPI), the authors cover how trigger points can form when a muscle band contracts for an indefinite period of time. This may cause the muscle to switch to anaerobic respiration, resulting in lactic acid buildup and pain when released upon palpation or exertion by the patient.

TPI patients may return for continued treatment, but the good news is that pain is typically associated with less intensity and a general improvement in the quality of life as trigger point treatment progresses.

Do Trigger Point Injections Hurt?

Although the procedure can be temporarily painful, it is not of a significant amount, nor does it last for long. If you experience unusual pain, numbness, and swelling around the injection site a couple of hours after the injection, call. If your side effects worsen or don’t go away within a couple of days, contact your provider.

What are the Possible Side Effects of Trigger Point Injects?

The benefits generally outweigh the common side effects. However, it is important that the patient is aware of common results in advance. You can reduce your risk of experiencing possible TPI complications by following your provider’s instructions exactly and informing them of any existing health conditions, concerns, or allergies you may have.

Side effects of TPIs can include:

• Pain or some tenderness around the injection site.
• Numbness following the injection at the specified location.
• Swelling around the TPI site.
• Short-term discoloration or dimpling near the injection site.
• Minimal bleeding or bruising at the trigger point.

Trigger-point injections rarely cause severe complications. Do follow up if you have concerns or experience any of the above don’t wear off within a couple of hours. Myofascial Pain and TMJ are chronic painful disorders. Unless this is addressed early, treatment regimens will continue to be for pain management specialists. Pain cure is easier when a jaw, neck, shoulder, or back injury or jaw sprain/strain is properly diagnosed early.

“Trigger point injections can be an effective primary or adjunctive therapy aimed at decreasing pain in the musculoskeletal system. By targeting specific points of myofascial pain, clinicians can directly treat pathologic tissue, address a patient’s pain generator, and break the pain cycle with little to no side effects. Patients can have significant improvement in range of motion and overall functionality, without the need for taking pain medications. Meaningful results can be provided with trigger point injections and should merit consideration as a treatment modality in the appropriate setting.” – Trigger Point Injection, by Claudia Hammi writing for NIH ^[1]

“Minimally invasive injections include botulinum toxin, corticosteroids, platelet-rich plasma, hyaluronic acid, and prolotherapy with hypertonic glucose. With many pharmacologic treatment options and modalities available to the oral and maxillofacial surgeon, mild to moderate temporomandibular joint disorder can be managed safely and effectively to improve symptoms of pain and function of the temporomandibular joint.” – Pharmacologic Treatment for Temporomandibular and Temporomandibular Joint Disorders, by Amanda Andre, writing for NIH ^[2]

MN Head & Neck Pain Specialists Offer Trigger POint Injecctions

Minnesota Head & Neck Pain Clinics provide board-certified TMJ and Oral Facial Pain Specialists in the Twin Cities and St. Cloud, MN area.

Trigger point injections are done in our comfortable office settings. Ongoing chronic pain can interfere significantly with your well-being and lower the quality of your life. Our healthcare pain treatment professionals use innovative medical technology and rehabilitative pain treatments to help you manage chronic pain. To resume your normal daily activities and go back to the life you love, contact us today!

Call and/or Conveniently Schedule a Clinic Visit

 

• Plymouth: (763) 577-2484
• St. Paul: (651) 332-7474
• Burnsville: (952) 892-6222
• St. Cloud: 763-233-7252

Written By: James Fricton DDS MS, co-founder of this pain clinic network. He is globally known for teaching orofacial pain specialists and for helping patients with simple to complex head, neck, orofacial pain, and TMJ conditions.

 

References:

[1] https://www.ncbi.nlm.nih.gov/books/NBK542196/, Last update: November 25, 2022

[2] https://pubmed.ncbi.nlm.nih.gov/34598856/, Last update: September 29, 2021