Efficacy Of Trigger Point Injection Research Articles

Efficacy of trigger point injection for non-malignant persistent musculoskeletal pain: a narrative review

Myofascial pain is a commonly occurring reason for pain complaints and can affect patients' daily activities, work commitments and well-being. Several non-invasive approaches practised for myofascial trigger point relief are stretching, massage therapy, ischemic compression, and heat- therapy. Invasive treatment for trigger points commonly refers to the injection of fluid directly into the trigger points using a variety of substances, such as sterile water, saline, local anaesthetics, long-acting corticosteroids, or botulinum toxin. This review evaluates the efficacy of trigger point injections (TrPI) for patients with myofascial pain syndrome compared with non-invasive management options through published studies. In accordance with SANRA guidelines, 35 studies that focused on comparing TrPI and other therapeutic interventions managing myofascial pain syndrome, were included. Results indicate that a combination of TrPI, ultrasound therapy and myofascial stretches was found to be more effective than a stand-alone trigger point intervention. Tropisetron showed a 50% decrease in pain, botulinum toxin type A (BTX-A), and lidocaine injection also demonstrated improvement, although short-term, of up to 4 weeks. Physiotherapy in conjunction with BTX-A increased the efficacy of TrPI. Ultimately, both TrPI and ESWT demonstrated comparable results in managing myofascial pain syndrome. A clear limitation was a lack of objective clinical imaging testing while identifying trigger points or tender points. Current practice in treating myofascial pain syndrome remains empirical without established clinical standards. Although, TrPI have demonstrated its value in treating myofascial pain syndrome, future research is warranted addressing its effectiveness within a multidisciplinary approach instead of a stand-alone treatment. Pain perception, culture and genetics should also be taken into consideration in future studies as other risk factors.

Efficacy of Medical Ozone for Treatment of Chronic Musculoskeletal Pain with Abnormal Mitochondrial Redox State: Prospective Randomized Clinical Trial

BACKGROUND: Chronic primary musculoskeletal pain is multifaceted and 20% of the adult population lives with severe chronic pain and experience symptoms such as intense pain, depression, weakness, sleep problems, decreased quality of life and decreased emotional well-being. OBJECTIVES: This paper studies the efficacy of trigger point injections with ozone compared to standard steroid injection or combination therapy for the treatment of chronic musculoskeletal pain in patients with abnormal mitochondrial redox state. STUDY DESIGN: This is a prospective randomized clinical study conducted with 51 patients experiencing chronic musculoskeletal pain. SETTING: Medical Research Institute Hospital, Alexandria University. METHODS: By computer-generated random numbers the 51 patients were divided into 3 groups. Group A (17 patients) received ozone injection, group B (17 patients) received betamethasone injection and group C (17 patients) received combined ozone and betamethasone injections. The groups were compared based on the intensity of pain and correction of mitochondrial redox state of the patients. RESULTS: Three days after intervention, the visual analog scale (VAS) scores reported by patients were lower in group A compared to group B (with a mean difference 1.27, 95% confidence interval (CI) of 0.15-2.39 (P < 0.02). One and 3 weeks after intervention, VAS scores of patients were lower in groups A and C compared to group B. At one week the mean difference between A and B was 1.2, with a 95% CI of 0.15-2.25 (P < 0.02) and the mean difference between C and B was 1.73 with a 95% CI of 0.69-2.78 (P < 0.001). At 3 weeks the mean difference between A and B was 1.5 with a 95% CI of 0.2-2.87 (P < 0.01) and the mean difference between C and B was 2.27 with a 95% CI of 0.93-3.60 (P < 0.0001). The reduced/oxidized glutathione ratio after intervention was higher in groups A and C compared to group B (P > 0.008). The mitochondrial copy number was higher in group A compared to group B (P < 0.002). LIMITATION: This study didn’t allow for the comparison of the experimental groups with a placebo or control group for musculoskeletal pain conditions in orderto establish the role of an abnormal mitochondrial redox state on the pathogenesis of patients from an ethical view. CONCLUSIONS: Ozone therapy or combined ozone and betamethasone treatment are effective techniques for management of pain since it produced a significant reduction of muscle pain and increase of the pain free interval experienced by patients. Ozone therapy causes pain improvement which increases with time and it improves muscle oxygenation and mitochondrial function. TRIAL REGISTRATION: This study was approved by the Ethics Committee of Medical Research Institute (IORH: IOR 00088812) and was registered at the Pan African Clinical Trial Registry (www.pactr.org) under the identification number PACTR201908620943471. The registration this experiment started on 07/08/2019. This study’s protocol followed the CONSORT guidelines and was performed under the relevant guidelines. KEY WORDS: Ozone, steroid, fibromyalgia, trigger point, redox state, antioxidant, chronic pain

Prevalence of Myofascial Pain Syndrome and Efficacy of Trigger Point Injection in Patients with Incurable Cancer: A Multicenter, Prospective Observational Study (MyCar Study).

Myofascial pain syndrome (MPS) is caused by overload or disuse of skeletal muscles. Patients with cancer are often forced to restrict their movement or posture for several reasons. The study was conducted to investigate the prevalence and risks of MPS in patients with incurable cancer. The efficacy of trigger point injection (TPI) was also explored. This was a multicenter, prospective observational study. Patients with incurable cancer who started receiving specialist palliative care were enrolled. We investigated the MPS in this population and accompanying risk factors for restricting body movement. Pre- and post-TPI pain was also evaluated using a Numerical Rating Scale (NRS) in patients who received TPI. The primary outcome was the prevalence of MPS. A total of 101 patients were enrolled from five institutions in Japan. Most of the patients (n = 94, 93.1%) had distant metastases, and half of the patients (50, 49.5%) received anticancer treatment. Thirty-nine (38.6%) patients had MPS lesions at 83 sites. Multivariate analysis revealed that the significant risk factor for MPS was poor Performance Status (PS) (odds ratio 3.26; 95% confidence interval [CI] 1.18-9.02, P = .023). We performed TPI for 40 out of 83 MPS lesions. Mean NRS for MPS before TPI was 7.95, which improved to 4.30 after TPI (P < .001). MPS was common in patients with incurable cancer and the risk factor identified in this study was poor performance status. TPI could be a treatment option.

Review of Trigger Point Therapy for the Treatment of Myofascial Pain Syndromes

Scope of the investigation: No standard protocol has been established for the treatment of myofascial pain syndrome (MPS). Invasive therapies such as dry needling and trigger point injection (TPI) with active pharmacological agents are commonly used. Growing evidence suggests the efficacy of TPI is independent of the injectate selected. Normal saline (NS) solution has been described as an efficient injectate used in TPI for the treatment of MPS. Methods: A broad literature search was performed to compare the use of NS and other pharmacological agents as the injectate in TPI for the treatment of MPS. Results: We identified 13 reports comparing the safety and efficacy of NS with that of botulinum toxin A or local anesthetic with or without steroid in TPI. Conclusion: Pain of myofascial origin can be adequately treated with TPI independent of the injectate used. The use of NS in TPI offers lower cost, safety, and a more favorable side effect profile than other TPI injectates.

Trigger Point Injections: a Systematic, Narrative Review of the Current Literature

Myofascial pain syndrome (MPS) is a frequently encountered cause of chronic pain for patients in both primary and specialty clinics. When conservative methods fail, many patients resort to trigger point injections (TPI) or needling therapies to alleviate their pain. Though MPS has a high prevalence and injections are frequently performed, there is no consensus to date regarding the optimal solution for injection or the superiority of injection versus needling alone. This narrative review includes randomized controlled trials performed over the last 15 years that evaluated the efficacy of trigger point injections of LA (LA), botulinum toxin A (BTXa), or dry needling for the relief of MPS. A total of 13 studies were included and evaluated for reduction of pain, adverse events (AE), and other secondary outcomes. Local anesthetics, BTXa, and dry needling all significantly reduced pre-treatment pain levels, but overall there was no significant difference between groups. Botulinum toxin A was the most expensive treatment and was associated with more AEs, but they were all mild and self-limiting in nature. Dry needling had a significantly higher rate of post-treatment muscle soreness than those injections that included LA. Local anesthetic, BTXa, and dry needling are all reasonable treatments for MPS. However, given the reduced cost and lower rate of muscle soreness associated with LA injection, it may be considered first line therapy for patients with MPS requiring TPI.

The Effect of Trigger Point Injections on Pain in Patients with Advanced Cancer.

BackgroundIt has been reported that in 62.5% of cases of incurable cancer pain, the complaint is due to myofascial pain syndrome. Trigger point injections using dibucaine hydrochloride help patients with such cancer pain. This study evaluated the efficacy of trigger point injections for alleviating pain in patients with advanced cancer.MethodsTwenty patients with advanced cancer who had a life expectancy of 6 months or less and had been diagnosed with myofascial pain syndrome were treated with trigger point injections. Prior to treatment, a Visual Analog Scale (VAS) was used to measure the resting pain level and discomfort upon application of pressure on the site of pain. These values were compared with last treatment measurements.ResultsThe mean pre-treatment VAS scores for pain at rest and upon application of pressure on the pain site were 7.3 and 9.0, respectively. These scores decreased significantly to 1.95 and 3.2, respectively, after the treatment (P<0.05).ConclusionTrigger point injection is an alternative and effective pain control modality for advanced cancer patients with myofascial pain syndrome.

LOW BACK PAIN;

Objectives: To know about the efficacy of trigger point injections in low back pain. Study Design: Prospective observational study. Setting: Out-patient Department of Naseer Teaching Hospital, Peshawar, and private clinic of the author. Period: March 2016 to January 2017. Materials and Methods: All patients with low back pain were evaluated. Inclusion criteria was; all patients with low back pain greater than 3 months duration whether operated or not, patients with non-radiating symptoms, patients with acceptable radiology (no listhesis, obvious stenosis/disk, albeit some degree of degeneration was acceptable), further helping points were morning exacerbations and elicitation of tender spot by the patient. The exclusion criteria was Low back pain with less than 3 months duration, obvious pathology on radiological examination, radiating symptoms, generalized low back pain without any point tenderness elicitation. The patients were sent home on medications and asked to avoid strenuous activity for a couple of weeks, they were followed after one month and asked about their pain satisfaction. Results: Approximately 2800 patients were evaluated for low back pain and of them 237 (8.46%) patients were upto the inclusion criteria, only 112 patients had agreed to have a TPI, which showed an acceptance rate of 47.25%. There were 65 males and 58 females, with a male to female ratio approaching almost 1:1. The age range was from 18 to 48 years, and the mean age was 32 years. The minimum duration of pain was 3 months and the maximum duration was 4 years, 4 patients had undergone back surgery. Almost all patients pointed out the pain spot, but a typical trigger point was elicited in 58(51.78%) patients, while morning exacerbation was present in 43(38.38%). Radiological examination was performed on all patients in the form of simple xrays and Magnetic resonance imaging scans, it was acceptable in 67%, as patients with radiating symptoms were already excluded. 10.71% (n=12) patients had some problems. Conclusion: In patients with chronic low back pain due to Myofascial Pain Syndrome (MPS) eliciting the trigger points by either elaboration through history or physical examination and treating them with a TP injection with lignocaine and a steroids has good short term results.

Efficacy of Trigger Point Injections in Patients with Lumbar Disc Hernia without Indication for Surgery.

Study DesignProspective comparative study.PurposeTo investigate the efficacy of gluteal trigger point (TP) injections with prilocaine in patients with lumbosacral radiculopathy complaining of gluteal pain.Overview of LiteratureTP injections can be performed using several anesthetic agents, primarily lidocaine and prilocaine. While several studies have used lidocaine, few have used prilocaine.MethodsA total of 65 patients who presented at the polyclinic with complaints of lower back pain with lumbar disc herniation (based on physical examination and magnetic resonance imaging) and TPs in the gluteal region were included in this prospective comparative study. Group 1 comprised 30 patients who were given TP injections, a home exercise program, and oral medications, and group 2 comprised 35 patients who were only treated with a home exercise program and oral medications. The patients' demographic data, Oswestry Disability Index (ODI) scores, and Visual Analog Scale (VAS) scores were recorded, and these data were evaluated at 1- and 3-month follow-ups.ResultsThe ODI and VAS scores of both groups significantly decreased initially and at the follow-up examinations, but the decreases were more marked in group 1.ConclusionsWe obtained better results with TP injections than only a home exercise program and oral medications in patients with radiculopathy and TPs in the gluteal region.

Factors Associated with the Efficacy of Trigger Point Injection in Advanced Cancer Patients

Few studies have reported the efficacy of trigger point injection (TPI) to myofascial trigger points (MTrPs) in advanced cancer patients. Factors that are associated with TPI efficacy have not yet been elucidated. The study was aimed at evaluating factors that are associated with TPI efficacy to MTrPs in advanced cancer patients. Factors that are associated with TPI efficacy were retrospectively identified based on a comparison between clinically relevant responders and nonresponders by using multivariate regression analysis. One hundred five advanced cancer patients who visited the Palliative Care Department with a chief complaint of pain and who received TPI treatment to the MTrP at the pain site. The TPI efficacy rate on the day after TPI treatment was 0.59 (95% confidence interval [CI]: 0.50-0.68). Significant factors associated with TPI efficacy were coexistence of cancer pain with MTrP at the pain site (odds ratio [OR]: 3.87, 95% CI: 1.21-12.4), MTrP at areas other than lower back or hip (OR: 6.45, 95% CI: 1.98-21.0), and fewer MTrPs (OR: 0.64, 95% CI: 0.42-0.99). Coexistence of cancer pain at the pain site of the chief complaint was observed in 64% of study subjects (95% CI: 0.55-0.73). The TPI efficacy is likely high when advanced cancer patients have fewer MTrPs together with cancer pain at areas other than the lower back or hip. MTrPs in advanced cancer patients are more commonly observed together with cancer pain rather than independently. Healthcare providers should recognize the relationship between MTrP and cancer pain and proactively perform physical examinations to detect MTrPs for potential TPI.

Ultrasound-Guided Myofascial Trigger Point Injection Into Brachialis Muscle for Rotator Cuff Disease Patients With Upper Arm Pain: A Pilot Study

ObjectiveTo assess the efficacy of trigger point injection into brachialis muscle for rotator cuff disease patients with upper arm pain.MethodsA prospective, randomized, and single-blinded clinical pilot trial was performed at university rehabilitation hospital. Twenty-one patients clinically diagnosed with rotator cuff disease suspected of having brachialis myofascial pain syndrome (MPS) were randomly allocated into two groups. Effect of ultrasound (US)-guided trigger point injection (n=11) and oral non-steroidal anti-inflammatory drug (NSAID) (n=10) was compared by visual analog scale (VAS).ResultsUS-guided trigger point injection of brachialis muscle resulted in excellent outcome compared to the oral NSAID group. Mean VAS scores decreased significantly after 2 weeks of treatment compared to the baseline in both groups (7.3 vs. 4.5 in the injection group and 7.4 vs. 5.9 in the oral group). The decrease of the VAS score caused by injection (ДVAS=-2.8) was significantly larger than caused by oral NSAID (ДVAS=-1.5) (p<0.05).ConclusionIn patients with rotator cuff disease, US-guided trigger point injection of the brachialis muscle is safe and effective for both diagnosis and treatment when the cause of pain is suspected to be originated from the muscle.

Detecting Local Twitch Responses of Myofascial Trigger Points in the Lower-Back Muscles Using Ultrasonography

Rha D-w, Shin JC, Kim Y-K, Jung JH, Kim YU, Lee SC. Detecting local twitch responses of myofascial trigger points in the lower-back muscles using ultrasonography. Objective To evaluate the role of ultrasonography for detecting local twitch responses (LTRs) of myofascial trigger points (MTrPs) in deeply located lower-back muscles. Design Case-control study. Active MTrP was diagnosed in all patients based on the criteria proposed by Travell and Simons in their upper-trapezius or lower-back muscles. One investigator administered trigger point injections while observing LTRs on ultrasonography. The other investigator observed LTRs visually during the procedure. Setting University rehabilitation hospital. Participants Patients (n=41; mean age, 51.8±11.8y) with MTrPs in the upper-trapezius muscles and patients (n=62; mean age, 56.8±11.9y) with MTrPs in the erector spinae or quadratus lumborum were recruited from April 29 to October 31, 2010. Interventions Ultrasound-guided trigger point injection. Main Outcome Measures LTR detection rate according to the depth of MTrPs; subjective pain intensity using a visual analog scale before and immediately after the trigger point injection. Results In upper-trapezius muscles, all LTRs were detected by means of both ultrasonographic and visual inspection. In the lower-back muscles, many LTRs were detected only on ultrasonography during the trigger point injection. For deep muscles, ultrasound helped identify LTRs that were not detected by using visual assessment. Pain was alleviated more significantly in the group with LTRs during trigger point injections compared with the group without LTRs. Conclusions These findings suggest that ultrasonography was useful for detecting LTRs of MTrPs, especially for LTRs in the deep muscles. Ultrasound guidance may improve the therapeutic efficacy of trigger point injection for treating MTrPs in the deep muscles.

Trigger Point Injections for Chronic Non-Malignant Musculoskeletal Pain: A Systematic Review

This systematic review assessed the available published evidence on the efficacy and safety of using trigger point injection (TPI) to treat patients with chronic non-malignant musculoskeletal pain that had persisted for at least 3 months. All published systematic reviews or randomized controlled trials detailing the use of TPI in patients with chronic, non-malignant musculoskeletal pain (persisting for >3 months) were identified by systematically searching literature databases and the Websites of various health technology assessment agencies, research registers, and guidelines sites up to July 2006. Although no systematic reviews were identified, 15 peer-reviewed randomized controlled trials met the inclusion criteria. However, deficiencies in reporting, small sample sizes, and marked inter-study heterogeneity precluded a definitive synthesis of the data. TPI is a safe procedure when used by clinicians with appropriate expertise and training. It relieved symptoms when used as a sole treatment for patients with chronic head, neck, shoulder, and back pain or whiplash syndrome, regardless of the injectant used, and may be a useful adjunct to intra-articular injection in the treatment of osteoarthritis pain. Although the addition of TPI to stretching exercises augments treatment outcomes, this was also true of other therapies such as ultrasound and laser. The efficacy of TPI is no more certain than it was a decade ago as, overall, there is no clear evidence of either benefit or ineffectiveness. The only advantage of injecting anesthetic into trigger points may be to reduce the pain of the needling process, which may not be an insignificant benefit.

Long-term Follow-up of Trigger Point Injections for Abdominal Wall Pain

Abdominal wall pain (AWP) is a common yet often overlooked source of abdominal pain. Trigger point injections (TPI) into the abdominal wall have been tried in the past. Few studies have looked at the long-term outcome from these injections. A retrospective chart review was performed on 110 consecutive patients who received TPI for abdominal pain at the University of Western Ontario, London, Ontario. Outcomes from patients whose pain was due to AWP were determined. AWP was defined as fixed or localized pain and superficial or point tenderness (less than 2.5 cm diameter) or a positive Carnett sign (increased pain with tensing abdomen). The primary outcome was long-term efficacy of TPI. The number of diagnostic tests ordered to exclude AWP and the cost of investigating it were determined. Secondary analyses were done to determine if there were significant predictors of response to TPI. Eighty-nine of 110 patients who received TPI met the criteria for AWP. In those who met the criteria for AWP, the average age was 42 years, 84% were female, and the average length of follow-up was 25 months. The primary outcome shows that, at follow-up, 77% had some or complete relief and 23% had no relief. An average of 4.3 diagnostic tests per patient were ordered to exclude other causes of abdominal pain. Secondary analyses show that meeting the criteria for AWP (P<0.0005), the absence of gastrointestinal symptoms (P<0.025), and an upper abdominal location of pain (P<0.025) were statistically significant predictors of a positive response to TPI. This study demonstrates that TPI, in patients who meet criteria for AWP, are effective over the long term.

Latent myofascial trigger points in paraspinal muscles of patients with chronic pain

We have found a unique type of latent myofascial trigger point in the paraspinal muscles of patients with various chronic pain conditions, which has not been described previously. The myofascial trigger points are located in paraspinal muscles that shared the same or adjacent spinal nerves with the primary lesion causing the chronic pain condition. We also investigated the efficacy of trigger point injections to those points to alleviate the original pain. We reviewed 11 patients with such latent myofascial trigger points. Diagnosed chronic pain conditions included postthoracotomy pain syndrome, postherpetic neuralgia, cancer pain, radiculopathy, chronic abdominal wound pain, and chronic pancreatitis. Injections of local anesthetics to latent myofascial trigger points in the paraspinal muscles immediately reduced the intensity of the original pain in all patients. After the series of treatments, a visual analog scale showed a significant decrease of pain.