From the Guidelines
Trigger point injections are strongly recommended for managing chronic back pain, irrespective of the type of medication used, as stated in the 2022 American Society of Pain and Neuroscience (ASPN) Evidence-Based Clinical Guideline of Interventional Treatments for Low Back Pain 1. The effectiveness of trigger point injections for back pain can be attributed to their ability to disrupt the pain cycle, reduce muscle tension, and decrease local inflammation.
- The procedure typically involves inserting a small needle directly into the trigger point and injecting a local anesthetic, sometimes combined with a corticosteroid.
- Patients may receive 1-3 injections per session, with sessions repeated every 2-4 weeks as needed.
- Relief from trigger point injections can be immediate but varies in duration, lasting from days to months depending on the individual.
- It is essential to note that trigger point injections are most effective when used as part of a comprehensive treatment plan that includes physical therapy, stretching exercises, and addressing underlying causes of muscle tension.
- Potential side effects of trigger point injections are generally minimal but may include temporary soreness at the injection site, bruising, or rarely, infection, as noted in various guidelines 1.
- The 2021 American College of Occupational and Environmental Medicine Low Back Disorders Guideline also recommends trigger point injections of local anesthetic for chronic low back pain that is not resolving with exercise or NSAIDs, although it advises against the use of glucocorticosteroids in trigger point injections 1.
- Overall, the current evidence supports the use of trigger point injections as a valuable treatment option for managing chronic back pain, particularly when used in conjunction with other therapies.
From the Research
Effectiveness of Trigger Point Injections for Back Pain
- Trigger point injections (TPIs) have been shown to be effective in managing myofascial back pain, with studies indicating a significant reduction in pain compared to conventional methods 2, 3.
- A study published in 2020 found that TPIs with 1% lidocaine improved myofascial back and neck pain compared to standard conventional approaches, with a median difference in Numeric Rating Scores (NRS) for pain of -3.01 2.
- Another study published in 2024 found that lidocaine intramuscular and intraosseous trigger point injections were effective in treating residual chronic pain after degenerative lumbar spinal stenosis decompression surgery, with a significant reduction in pain and improvement in quality of life 3.
Comparison of Different Injectates
- A systematic review published in 2022 found that the comparative effectiveness and harms of trigger point injections for myofascial neck and back pain were mixed, with some studies showing greater pain improvement with certain injectates such as Botulinum toxin A, while others showed no difference 4.
- The review found that Onabotulinum toxin A was associated with improved anxiety and depression in two studies, but also had a higher rate of adverse effects 4.
- Another study published in 2024 reviewed the current advances in the treatment of myofascial pain syndrome with trigger point injections, and found that the injectable drugs used in TPI therapy included glucose, saline, local anesthetics, botulinum toxin type A, and steroid preparations 5.
Safety and Efficacy
- Trigger point injections are generally considered to be a low-cost and minimally invasive procedure, with a good safety profile 5, 6.
- However, as with any medical procedure, there are potential risks and side effects associated with TPIs, such as pain, bruising, and infection 6.
- The use of imaging guidance such as fluoroscopy and ultrasound is recommended to improve patient outcome and safety 6.