Downtown Pain Physicians of NYC

Trigger Point Injections

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Introduction

Everyone has experienced muscle pain at one time or another. But what happens when you have pain that is especially painful and it won’t go away? A trigger point injection is one way to achieve pain relief for muscles and TPI medical injections have helped in treating conditions like tension headaches, fibromyalgia ,and trigger point injections lower back pain.

We are an NYC pain management clinic approach procedures like trigger injections the same way. When patients come to us with muscle pain, knots in their neck, back, arms, or legs, or have a condition that leaves them with chronic pain, our goal to find the root cause of their pain and find a treatment that provides them with lasting pain relief.

Trusting Downtown Pain Physicians to Give Trigger Point Injections

 Downtown Pain Physicians are pain management specialists who focus on providing expert pain care that puts patients first. As pain management specialists in NYC, we know how important management for pain is to everyday functioning and to quality-of-life. This is why we focus on creating a treatment plan that addresses the root cause of each patient’s pain. We use state-of-the-art technology to help guide our treatments with the goal of helping to eliminate pain permanently.

TPI pain management is one of the most common requests for treatment that the physicians at Downtown Pain Physicians perform. They help treat pain caused by tension headaches, fibromyalgia, and injury. Trigger points can cause referred pain or pain that appears to be unrelated in another part of the body. By treating the trigger point, pain in multiple parts of the body may be relieved.

What is a Trigger Point?

Trigger points are knots of muscle fiber that develop due to strain, injury, or another condition. The muscle tightens and shortens forming a lump. The lumps can be small, similar to the size of a pea, or larger, closer to the size of a walnut. They are tender to the touch and pain may be in more than one part of the body. Trigger points cannot be relieved easily through things like massage, or a chiropractic adjustment, or over-the-counter medication.

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Trigger points are categorized as either active or latent. Active ones can cause referred pain in other parts of the body, as well as fatigue along with the pain at the site itself. These can be caused by the trigger point pressing against surrounding nerves. Active trigger points are responsible for conditions like tension headaches, which stem from knots in the neck and the shoulders pressing on nerves. Referred pain from active trigger points can cause tinnitus and TMJ.

By contrast, latent trigger points don’t cause any symptoms or referred pain at all. They don’t need treatment until they activate and start causing pain.

What is a Trigger Point Injection?

A trigger point injection is used for the management of pain. The injection contains can either be just a corticosteroid to serve as an anti-inflammatory, an anesthetic to relieve pain, or a mixture of both. The dry needle is used in some cases where a syringe of saline is injected into the trigger point instead of medicine.

Trigger point injections are helpful to patients who have trouble moving their head, experience referred pain, have a twitch, or are increasingly sensitive to the pain caused by the trigger point.

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What is the Purpose of a Trigger Point Injection?

Trigger point injections are meant to deactivate the trigger point because it is usually the source of causing pain. Patients who are in pain due to a trigger point may try to initially care for the injury or condition themselves. Common self-treatments include things like:

  • Ice
  • Heat
  • Massage
  • Over-the-counter pain medication

These types of treatment may work for other minor accidents or injuries. But trigger point pain is often very persistent and is not always easily be resolved by common self-care treatments like these. In fact, conditions like trigger point back pain can interfere with daily function and be aggravated by stress or anxiety.

What is a Trigger Point Injection Used For?

Trigger point injections are used to treat conditions like muscle knots that won’t relax or cannot be resolved with a manual adjustment from a chiropractor or by getting a massage. They are also used to treat conditions such as:

Myofascial Pain Syndrome: A chronic pain disorder where sensitive points in your muscles cause muscle pain and can cause pain in other parts of the body even though they don’t seem to be related. It can occur from repetitive motions in a job or hobby. Or from muscle tension related to stress. It causes tenderness in the muscle and makes sleeping difficult due to the pain it causes.

Fibromyalgia: A condition that causes widespread musculoskeletal pain. This is defined as a dull ache on both sides of the body. It also causes fatigue and patients with this condition have trouble sleeping, in part due to pain, as well as anxiety.

Tension Headaches and Migraines: Tension headaches and migraines cause sufferers significant ongoing pain that causes a vice-like feeling around the head.

People who are very active often experience trigger point neck pain due to factors like repetitive motions, injury, and stress.

Why Patients Choose This Injection

Trigger point pain makes it difficult for people to go about their daily lives. Patients commonly choose trigger shot for pain relief because their injury or pain won’t resolve using traditional self-care treatments. Some may opt to try prescription pain medication first and haven’t achieved sufficient pain relief with them.

The muscles at a trigger point aren’t able to relax, which is why they are particularly sensitive and won’t respond to other types of treatment. Trigger point injections help the point to relax, which helps with trigger point relief and lessens pain. People who receive an injection due to injury can return to therapy and move toward healing or to a desired amount of function.

People who have myofascial pain syndrome use myofascial trigger point injections as a form of trigger point management. The injection introduces anesthetic medication into the trigger point, which deactivates it and provides relief from pain. The effect of it is almost immediate and can last for more than a month.

Trigger point injections are also less invasive than other types of treatment options such as surgery. Multiple injections can be administered if the patient has multiple pain sites and the procedure itself doesn’t take very long. The recovery time for this type of injection is also minimal compared to surgical intervention.

Getting a trigger point injection due to long-term pain or discomfort, may help to target the root cause of the pain. In fact, TPI injections are a good option for treating conditions that have no cure and require ongoing pain management. They are an alternative to pain pills and opioids.

What to Do Before You Get an Epidural Spinal Injection

Pain management trigger point injections require some minor preparation before the procedure occurs. Since there are different types of trigger point injections, ask the doctor where each injection site will be and what is contained each shot.

Write down a list of all the medications you take including prescriptions, over-the-counter medications, vitamins, supplements, and natural remedies. Bring a copy with you to share with the doctor. You might need to stop taking some of these medications temporarily if they interact with the contents of the injection. Make sure you tell the doctor about any medical conditions you have such as:

  • Allergies
  • Heart conditions
  • Pregnancy or potential pregnancy
  • Bleeding disorders

Tell the doctor if you are on any major blood thinners during your consultation appointment. Medications in this category include:

  • Pradaxa
  • Coumadin
  • Plavix
  • Xarelto
  • Eliquis

Talk with the doctor who prescribed your blood thinner and ask them if it is possible to temporarily stop this medication for the procedure before scheduling your injection. Once you receive permission from your doctor, call us to schedule your appointment. We will tell you when to stop taking the blood thinner and when you can restart it.

Make an arrangement with a friend or family member to drive or take you home after the procedure is over. The injection may contain anesthesia and it is not safe for you to drive or go home alone depending on the location of the trigger point.

Don’t forget to bring any x-rays or other images that you have of your injury or condition.

On the day of the procedure, don’t eat anything starting 4 hours before the time of your appointment. You can drink light and clear liquids up to two hours before your appointment time if light sedation is going to be used during the procedure. These include water, tea, and soda. Take a bath or a shower before the appointment and have some over-the-counter pain medication to take in case of any discomfort after the procedure. Wear comfortable and loose-fitting clothing to the appointment.

If you have been sick or have taken antibiotics in the last 10 days, let us know. Illnesses to notify us about include:

  • Colds
  • Dental Sores
  • Gastrointestinal illness
  • Infections of any kind including skin infections

What Happens During the Procedure?

The trigger point injection procedure will occur in the doctor’s office and take approximately 30 to 60 minutes. Actual procedure time may be more or less depending on how many injections are being given in total. Unless sedation is being used, you will be awake and able to talk throughout the duration of the procedure.

You’ll be asked to sit or to lie down depending on where the injection site is. The doctor will press down on the area where the muscle is to locate the pain and pin point injections and clean the space with betadine or alcohol. A local anesthetic may be applied if the site requires one. Numbing spray like ethyl chloride will be used on the skin to decrease the pain of the injection. During the actual injection, a small needle will be injected into the trigger point using fluoroscopy or x-ray guidance. The contents of the injection may vary depending on the location and the reason why it is needed.

People who are allergic to the medication or want to avoid steroids may opt to receive an injection full of saline, known as a dry needle technique. Dry needling is intended to stimulate the muscle and make it communicate with the brain to cause a release and restore regular movement.

The injection of the needle may be painful. But the pain shouldn’t last any more than a few minutes. In some cases, the pain is only a few seconds. A bandage may be applied over the site if it’s needed. Each injection takes a few minutes to complete.

How Does a Patient Feel During the Procedure?

The most common sensation patients feel is the burning or stinging sensation caused by the anesthetic being applied to the skin. Expect to feel some sort of brief pain when the needle goes in. It should disappear within seconds or minutes and is a sign that the injection is in the right position. A twitching sensation or feeling of pressure is also possible.

Immediately after the injection is finished, the doctor will stretch the muscles manually. He may use a vapocoolant spray on the area to help relax them before stretching. After that, a hot pack will be applied to the area for a few minutes.

After this, you’ll stay in the office for another 20 minutes to be monitored for any reactions to the medication.

Post-Procedure Care and Expectations

Once the procedure is finished, it’s not uncommon for the injection site to be sore. Treat any feeling of soreness with a cold or ice pack 4 times per day for 15-20 minutes each for several days following the appointment. Keep the ice or cool pack from touching your skin by wrapping it in a towel first. Alternating moist heat and ice is another way to reduce pain.

You can take over-the-counter medications for pain like Tylenol, ibuprofen, or muscle relaxants as recommended by your doctor.

Dry needling tends to be more painful in the hours and days after the injection because it depends on how deep the needle goes into the muscle and how long it stays in during the procedure.

The effect of the trigger point injection on your pain levels may last for weeks or several months. How long it lasts in total depends on the individual person. It will start to take effect a few hours after the procedure usually. But it may take up to two weeks to kick in.

Some people may not feel any relief at all. Patients who don’t feel relief from pain after their first injection may require multiple injections before they feel relief. The doctor will also discuss other available treatment options if the trigger point injection is not effective.

If more injections are necessary, they can be given at one-month intervals.

Recovery Time After the Injection

The recovery time for this procedure is fairly minimal. The injection site will stay numb for up to an hour after the procedure is over and a bruise might form where the needle went in. Avoid strenuous activities, especially ones that may cause pain or stress the muscles too much.

Doing stretching and strengthening exercises with the affected muscles is recommended after the soreness goes away. Strengthening exercises include jumping rope, swimming, and jogging. Start gradually after doing this after the first day after the procedure. Ask the doctor for exercise suggestions that will benefit your case.

Complications and Side Effects Associated with a Trigger Point Injection

Trigger point injections are very safe, but they come with complications and side effects just like any other procedure. They are rare but still possible. Side effects may include:

  • Dizziness
  • Allergic reaction to trigger point injections lidocaine or Xylocaine, Bupivaccine or Marcaine, or anesthetic medication
  • Muscle stiffness related to muscle spasm
  • Tenderness, bleeding, or bruising at the injection site
  • Using other treatments if trigger point injections not working

When corticosteroids are used in the injection, there is a minor risk of an indent developing under the skin. The steroid causes fat cells in the area to shrink in the surrounding area. This is an uncommon side effect that may only occur with corticosteroids and not with a pure anesthetic medication.

Bleeding is a potential complication that can occur with any kind of injection. Monitor the bandaids over the injection sites for bleeding after the procedure. If blood comes through the bandages or the site continues to bleed for longer than 30 minutes, contact the doctor right away.

Infection is another risk of injection. After the procedure, make sure the injection sites are not oozing, red, or sore or that you don’t have a fever. If you do, contact the doctor immediately.

Other risks include a hematoma where blood pools in or near the injection site. There’s also a risk of fainting due to an overreaction to a trigger like the injection.

If you have any other conditions, make sure to tell the doctor about them before the procedure. They may increase the likelihood of side effects or complications if not disclosed beforehand.

Rare Risks Associated with the Injections

If the injection site is located in the chest wall or the lower part of the neck, there is a rare risk that the needle could puncture a lung. The puncture would cause chest pain and make it difficult to breathe.

The needle could also hit a nerve and cause pain.

The doctor will go over all of these potential risks, complications, and side effects before the procedure. Make sure to voice any specific concerns or to ask any questions about the risks and complications associated with trigger point injections.

Statistics and Other Data About Trigger Point Injections

Trigger point injections have been shown in studies to decrease symptoms of pain and hypersensitivity for fibromyalgia patients in the affected trigger point area. Another prospective study showed patients with this condition experienced a decrease in pain intensity, improved range of motion, and higher pain tolerance 14 days after their intensity.

A study of 91 patients with myofascial pain in different locations showed that the trigger point dry needling technique helped relieve pain for 93% of patients in the study.

Cancer patients who had myofascial pain syndrome were treated with trigger point injections using the medication neovitacain. Their pain levels went from a 7.3 and 9.0 on a scale of 10 and had their pain reduced to 1.93 and 3.2 out of 10 respectively.

Frequently Asked Questions About Trigger Point Injections

How long does the procedure take?

Each injection takes just a few minutes to complete. We’ll keep you in the office for 20 minutes after it is done to monitor for any reactions. The procedure may take longer if there are multiple trigger point injection sites.

Will the injection hurt?

Patients commonly feel sore at the point of injection after the procedure is over. You may feel a twitching sensation when the needle enters the muscle.

Are trigger point injections safe?

Yes, they are safe. Like any procedure, trigger point injections have side effects and risks. There are also serious complications that may happen to some people. To minimize risks and complications, tell the doctor about any conditions you have and any medications including prescriptions, over-the-counter medications, vitamins, supplements, and natural remedies you take.

Are there common conditions or trigger point injection sites?

Yes. Patients commonly come to us for trigger point injection locations and conditions like:

  • Trigger point injections back
  • Trigger point injections for neck pain
  • Spine trigger points
  • Trigger injections neck
  • Lumbar trigger point injection
  • Trigger point cervical.
  • Lidocaine injections for neck pain
  • Trigger point muscle spasm
  • Trigger point injection for back pain
  • Myofascial injections
  • Nerve trigger points
  • Muscle trigger points
  • Trapezius trigger point injection
  • Injection for muscle spasm in back
  • Trigger point injections for muscle knots
  • Injection for muscle spasm
  • Trigger pain injections
  • Trigger point injections for TMJ
  • Muscle trigger point injections
  • Trigger point injections for nerve pain
How long does it take to recover from a trigger point injection?

Recovery time for this type of injection is fairly minimal. Most patients can return to the work the same day. Taking it easy and not engaging in any activities that are strenuous or would cause pain is recommended. Using ice and moist heat along with over-the-counter medications will help alleviate injection-related discomfort.

What if I need another trigger point injection?

Your doctor may recommend a series of injections depending on the reason for treatment. Or you can discuss having another one. The injections may be given 3 to 4 weeks apart. If the injections series does not help relieve pain, another treatment option may be in order.

Are there other treatments I can try together with trigger point injection therapy?

Yes, moving your muscles is important after an injection. The exercises the doctor gives you should be performed after the procedure to help the healing process along.

What if I have other questions before or after my injection?

We are happy to answer any questions or concerns you might have. Trigger point injections are effective for many types of conditions. But we understand they are not for every patient. Our goal is to find a treatment that will address your pain and relieve it. Having discussions about your treatment is part of that.

Downtown Pain Physicians offers pain management downtown and are pain doctors in NYC. If you’re looking for pain management doctors and want to talk about your options or you want to schedule an appointment, call our pain management providers today at 212–404-8070 today!

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  • Dr. Raj Raval, M.D.

    1. Board Certified
    2. Interventional Pain & Musculoskeletal Medicine Specialist
  • Education & training

    1. SUNY Downstate PMR Residency
    2. Rutgers University Fellowship
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