From the Guidelines
Trigger point injections are strongly recommended for chronic lower 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 treatment protocol for trigger point injections in patients with lower back pain typically involves injecting a local anesthetic directly into the identified trigger points.
- The procedure begins with identifying the trigger point through palpation, where the clinician feels for a taut band of muscle that reproduces the patient's pain when pressed.
- Common medications used include lidocaine 1-2% or procaine 0.5%, typically 0.5-2 mL per injection site.
- After cleaning the skin with alcohol or antiseptic solution, a 22-27 gauge needle is inserted into the trigger point until a local twitch response is elicited, indicating proper placement.
- The medication is then injected slowly, and the needle may be redirected to treat adjacent trigger points using a fan-like technique.
- Post-procedure, patients should perform gentle stretching exercises of the treated muscles and apply heat or ice as needed for comfort. It's worth noting that the use of glucocorticosteroids in trigger point injections is not recommended by the 2021 American College of Occupational and Environmental Medicine Low Back Disorders Guideline 1. Trigger point injections work by disrupting the pain cycle through mechanical disruption of the trigger point, reducing local inflammation, and interrupting pain signals, allowing the muscle to relax and heal, as supported by the strong recommendation in favour of trigger point injections for chronic back pain in the 2022 ASPN guideline 1.
From the Research
Trigger Point Injection for Lower Back Pain
- Trigger point injections are a treatment modality used to inactivate trigger points and provide prompt relief of symptoms in patients with lower back pain 2.
- The treatment protocol for trigger point injections typically involves the identification of trigger points through palpation and physical examination, followed by the injection of a local anesthetic or other substance into the affected area 3, 4.
Efficacy of Trigger Point Injections
- Studies have shown that trigger point injections can be an effective treatment for lower back pain, with significant reductions in pain scores and improvements in functional outcomes 3, 5.
- One study found that trigger point injections with 1% lidocaine were superior to conventional approaches for myofascial pain in the emergency department, with improved pain scores and reduced length of stay 5.
- Another study found that compression at myofascial trigger points was effective in reducing pain and improving functional outcomes in patients with acute low back pain 6.
Comparison to Other Treatments
- Trigger point injections have been compared to other treatments, such as intravenous NSAIDs, and have been found to be superior in some cases 3.
- One study found that trigger point injection therapy was at least as effective as therapy with drug injection, and that the injected substance was not the critical factor in providing symptomatic relief 4.
Key Findings
- Trigger point injections can provide significant relief of symptoms in patients with lower back pain 2, 3, 5.
- The identification of trigger points through palpation and physical examination is crucial for effective treatment 3, 4.
- Trigger point injections can be used in conjunction with other treatments, such as physical therapy and medication, to provide comprehensive care for patients with lower back pain 5.