Dry Needling, Trigger Point Injections, and Botox

July 31, 2024
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Dry Needling, Trigger Point Injections and Botox

By Preetanjali Thakur, BDS, MS

Dry Needling, Trigger Point Injections and Botox: A Helpful Comparison

An overview of dry needling, trigger point injections with local anesthetics and botox therapy as treatment choices for myofascial pain, headaches and oromandibular dystonia.

Myofascial pain syndrome (MPS) is common among patients with musculoskeletal pain problems. MPS is a pain condition originating from muscle and surrounding fascia. Patients usually present with localized pain in a restricted area or as referred pain with various patterns. This article aims to explain the differences in indications, mechanisms of action, and treatment effectiveness of these therapeutic approaches to dry needling, trigger point injections, and botox.

Myofascial pain conditions have a lifetime prevalence affecting up to 85% of the general population. [1] Estimates of myofascial pain syndrome (MPS) prevalence in the United States vary widely, from 3–9 million people. Tension-type headache (TTH) is described as “a tight band around the forehead” or a dull, steady ache on both sides of the head. Tension-type headache is one of the most common types of headache, estimated to affect 2 in 3 adults in the U.S. It is, therefore, not uncommon for these conditions to overlap in the patient population.

What Is the Difference Between Dry Needling, Trigger Point Injections, and Botox?

Comparative analysis between dry needling, trigger point injections, and botox

Treatment Duration and Frequency:

• Trigger Point Injections: Provide immediate but short-term relief, requiring frequent sessions for ongoing management.
• Dry Needling: Offers both immediate and potentially longer-term benefits, with sessions spaced out based on individual response.
• Botox Therapy: Delivers long-lasting relief, with injections needed every 3-6 months.

Side Effects and Risks:

• Trigger Point Injections: Risks include infection, bleeding, and local anesthetic reactions. The procedure is generally safe with proper technique.
• Dry Needling: Minimal risk of infection or bleeding. Some patients may experience soreness or bruising at the needle insertion sites.
• Botox Therapy: Potential side effects include bruising, muscle weakness, and unintended spread of the toxin, leading to unwanted muscle paralysis.

Cost and Accessibility:

• Trigger Point Injections: Typically covered by insurance and relatively affordable.
• Dry Needling: Costs can vary, and coverage depends on insurance policies and the practitioner’s credentials.
• Botox Therapy: Often more expensive and may not be covered by insurance for all indications, leading to higher out-of-pocket costs.

What is Dry Needling?

Dry needling involves inserting thin needles into myofascial trigger points without injecting any substance. The insertion of the needles aims to elicit a local twitch response. This is typically administered by a physical therapist.

Dry needling may reduce facial pain by:

  1. Disrupting your pain cycle.
  2. Reducing muscle tension.
  3. Improving blood flow to the affected area.

Some patients experience immediate pain relief, while others may see gradual improvement over several sessions. Since no medication is injected, the risk of side effects is minimal, making it a safer option for some patients. Dry needling has demonstrated positive effects in reducing the number of active trigger points and improving the short-term headache intensity in tension-type headache and myofascial pain patients. [2]

Are trigger point Injections the same as dry needling?

Dry needling and trigger point injections have different practises; however, they typically treat the same conditions, with similar results. Dry needling is done with sterile, dry needles to stimulate the tissue; trigger point injections inject local anaesthetic and steroids into the affected area to relieve pain and help your muscles function normally.

Dry needling is a type of trigger point injection. This is whan fine needle is inserted into the skin and muscle at the site of myofascial pain. The thin needle penetrates the skin and can effectively treats underlying muscular trigger points. Dry needling’s goal is to reduce pain, calm trigger points and restore function.

An orofacial pain specialist knows the key differences to note when determining which treatment is right for you.

Trigger Point Injections with Local Anesthetics

Myofascial trigger points are focal “knots” located in a taut band of skeletal muscle first described by Dr. Janet Travell in 1942. These trigger point injections (TPI) are typically administered by an orofacial pain specialist in masticatory or cervical muscle groups. They are commonly injected with long acting anesthetics like 0.5% Bupivacaine (Marcaine). TPI procedures involve injecting medication directly into a muscle’s trigger point to inactivate it and relieve pain.

The anesthetic disrupts the pain cycle by numbing the area and reducing inflammation, which helps to alleviate muscle tension and pain. Trigger point injections can be an effective primary or adjunctive therapy aimed at decreasing pain in the musculoskeletal system and improving the range of motion. These injections are widely regarded as effective in providing immediate but often short-term pain relief in people with myofascial pain and tension type headaches. Regular treatments may be necessary for sustained benefit.

Although less common, trigger point injections can be used to manage pain associated with muscle spasms in movement disorder like oromandibular dystonia. However, they are generally considered less effective than Botox for this indication. There is still lack of objective diagnostic criteria for trigger points. The impact of trigger point injection remain obscure and its effictiveness remains mixed.

How Does Botox Therapy Relieve Pain?

Botox (botulinum toxin type A, BTX-A, or BTX) is primarily indicated for oromandibular dystonia. Its a condition characterized by involuntary muscle contractions in the lower face, jaw, and tongue. [3] Botox is clinically used for patients with TMD and myofascial pain who do not respond adequately to conventional treatments.

It is particularly effective in cases where muscle hyperactivity contributes to pain due to clenching of teeth. Botox works by blocking the release of acetylcholine at the neuromuscular junction, leading to temporary muscle paralysis. This reduction in muscle activity can alleviate pain and reduce the hyperactivity of muscles involved in conditions like oromandibular dystonia and bruxism.

National Institute of Health (NIH) studies have shown mixed results for people with myofascial pain, with some patients experiencing significant pain relief and others showing no improvement. The variability in response is likely due to the complexity of myofascial pain and individual patient differences. Botox has been found to reduce pain and improve function in patients with refractory TMD. BTX has shown reduction of TTH pain intensity and severity. [4]

A systematic review indicated that Botox injections could be a viable option for patients who do not respond to other treatments. Botox is considered the treatment of choice, providing significant relief from involuntary muscle contractions and improving the quality of life for most patients in oromandibular dystonia. Scientific evidence supports the use of BTX injections for treatment of masseter hypertrophy and equivocal evidence for myogenous TMDs, but very little for TMJ articular disorders. [7]

Studies are needed to gain better insight into the utility and effectiveness of BTX injections for treating both myogenous and TMJ articular TMDs and to establish suitable protocols for treating different TMDs. [5]

What is oromandibular dystonia?

Oromandibular dystonia (OMD)is a movement disorder that consists of involuntary spasms of jaw, mouth, and tongue muscles, producing jaw closure and trismus (jaw clenching) and bruxism (tooth grinding). It often causes secondary dental wear and temporomandibular dysfunction. These conditions are commonly observed in the patient population at the Minnesota Head and Neck Pain Clinic.

Mild oromandibular dystonia symptoms may gain significant improvement with:

However, moderate to severe symptoms may need other palliative treatment methods as well. Pharmacologic treatments may involve medication’s and injections as they may drastically affect patients’ quality of life. This is especially true in a myofascial pain flare-up and acute presentation. Among the various treatment modalities available, Botox therapy, trigger point injections with local anesthetics, and dry needling are effective treatment options.

“The prevalence of OMD has been reported to be as high as 6.9/100,000 cases, and the incidence has been reported up to 3.3 cases per million. It has been suspected that dental and oral surgery interventions or treatments can be associated with the onset of dystonia and ethical considerations in dentistry,” according to NIH’s Diagnosis and Management of Oromandibular Dystonia: an Update for Stomatologistsarticle. [6]

How Long Do Dry Needling and Trigger Point Injections Benefits Last?

How long the benefits of both dry needling and trigger point injections last varies from person to person. With dry needling, pain patients typically notice an improvement in their symptoms within a few days. After a few sessions, the benefits will usually remain aproximately a week. You can anticipate that with every subsequent session, your benefits should last longer.

Typically positive dry needling results are apparent within 2-4 treatment sessions but can vary depending on the cause and duration of your symptoms, your overall health, and experience level of the practitioner. Most people will need at least 3 sessions of dry needling to gain their maximum benefit [7].

The effects of trigger point injections commonly begin between 24-72 hours after treatment, and typically last for about 1 month. However, you may gain longer-lasting pain relief with recurring injections (injections containing just anaesthetic can be administered more frequently than those containing steroids). [7].

Should I Choose Dry Needling, Trigger Point Injections, or Botox?

The choice between trigger point injections, dry needling, and Botox therapy needs to be individualized based on the patient’s specific condition, treatment history, and response to previous therapies. These therapies can also serve distinct but occasionally overlapping roles in the management of myofascial pain, TMD, TTH and oromandibular dystonia. It is best if you make this decision with your pain provider.

Trigger point injections are preferred by some patients suffering from severe pain because they take effect so quickly. Individuals who are seeking help to relieve their pain can also find case studies signaling years of effective clinical use. Based on randomized controlled trials, trigger point injection is more practical and rapid. This is because it causes less disturbance than dry needling and is more cost effective than BTX-A injection. As well, many consider it the treatment of choice in MPS.

BTX-A could be selectively used in myofascial pain syndrome patients resistant to conventional treatments. Botox is particularly effective for oromandibular dystonia and TMD cases resistant to other treatments, while trigger point injections are primarily used for immediate relief of localized myofascial pain and TMD.

Dry Needling, Trigger Point Injections, & Botox Can Improve Your Quality of Life

Dental treatments can be the cause of onset or exacerbation of OMD or myofascial pain. This requires a cordinated, evidence-based pain treatment plan. The choice of your treatment will be tailored to your individual pain condition, response to previous therapies, and overall treatment goals.

Contact the MN Head & Neck Clinic to Gain the Pain Relief Help You Need

 

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

 

About the author

Preetanjali Thakur, BDS, MS has a Masters in Dental Science and extensive experience that supports her expertise in chronic pain disorder treatments including TMJ, dry needling techniques, trigger point injections, and Botox treatment.

 

Resources:

[1] Anuphan Tantanatip; Ke-Vin Chan, “Myofascial Pain Syndrome,” July 2023, https://www.ncbi.nlm.nih.gov/books/NBK499882/

[2] Daniel Machado, et al, “Botulinum Toxin Type A for Painful Temporomandibular Disorders: Systematic Review and Meta-Analysis,” March 2020, https://pubmed.ncbi.nlm.nih.gov/31513934/

[3] Sofia Monti-Ballano, et al., “Effects of Dry Needling on Active Myofascial Trigger Points and Pain Intensity in Tension-Type Headache: A Randomized Controlled Study,” April 2024, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11051369/

[4] Wieckiewicz M, et al. J., “Evidence to Use Botulinum Toxin Injections in Tension-Type Headache Management: A Systematic Review,” Nov 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705985/

[5] Delcanho Delcanho, et al., “Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence?,” June 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10586579/

[6] Raoofi S, et al., “Diagnosis and Management of Oromandibular Dystonia: an Update for Stomatologists,” June 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463774/

[7] Georgia’s University Health Center, “Dry Needling,” January 2023, https://healthcenter.uga.edu/healthtopics/dryneedling/

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