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Myofascial Pain: How Trigger Point Injection Can Help

By Dr. Mehrtash Amini

An estimated 20% of the Canadian population deal with long-lasting or chronic pain. Of these people, two in three say that their condition afflicts them with moderate pain. At least half of all chronic pain sufferers also have had their condition for more than a decade.

The majority of these pain conditions trace back to myofascial pain syndrome (MPS). Studies even suggest that MPS has a prevalence rate of between 9% and 85%! That makes it one of, if not the most common type of pain condition in the Great White North.

If you suffer from MPS, know that you have several myofascial pain treatment options. One of these is the trigger point injection (TPI).

Ready to learn all about MPS and how TPIs can help you cope with your pain condition? Then let’s dive right into it!

A 101 on Myofascial Pain Syndrome

The term “myo” in “myofascial” is the fancy, scientific word for “muscles.” The term “fascia” refers to the connective tissues that surround the muscles.

You can think of the fascia as a thin encasement made of connective tissues. Not only does it cover all the organs, bones, blood vessels, muscles, and nerves in the body — it also holds them all in place.

As such, myofascial pain syndrome is a condition that affects the muscles and fascia. It occurs when the soft tissues in the body become painful and inflamed. Unlike muscle tension pain or delayed onset muscle soreness (DOMS), MPS symptoms persist.

As a “syndrome,” MPS comes with various signs and symptoms that a health-related issue can cause. It’s also because of this that MPS signs can arise from every which way of your body.

The pain you feel may not even be the actual location of the myofascial pain generator. In this case, those unpleasant sensations are a form of “referred pain.”

Experts say that MPS can be due to a significant amount of pressure placed on trigger points. Trigger points are sensitive, irritable spots found in the fascia. When trigger points develop, they may cause referred pain.

Symptoms of Myofascial Pain

Severe pain in local muscle groups is one of the most common signs of myofascial pain syndrome. The pain also worsens when you stretch or strain the affected muscles. Worse, the pain caused by MPS doesn’t improve or go away on its own.

It’s also common for people with MPS to feel actual “knots” in their muscles. When pressed, these knots produce even more intense pain.

The affected muscles can also become stiff or inflexible. Over time, they can get quite weak and have a reduced range of motion.

All these can then lead to mood alterations and sleep disturbances. Researchers have even found a strong association between MPS and poor sleep quality.

Risk Factors & When to See a Doctor

Many cases of trigger points develop due to traumatic injuries to and overuse of the muscles. High levels of psychological stress, which can affect up to 11 million Canadians, can also be to blame.

Traumatic muscle injuries are often a result of falls and blows. These usually include contusions, sprains, and strains.

Muscle overuse, on the other hand, can result from prolonged repetitive activities. People who are at risk of trigger points due to overuse are those who work and work out. For instance, if your work entails lifting and carrying heavy objects, then you may be at a higher risk of MPS.

Also, note that according to studies, most cases of MPS occur in people aged 27 to 50 years old. This also goes for those who have poor posture, are sedentary, and always skimp on sleep. Smoking, obesity, and nutritional deficiencies can also make you more susceptible to MPS.

If you experience any of these symptoms for a prolonged period of time, it’s time to visit your doctor. This is especially true if your muscle aches don’t improve even after a good amount of rest.

How Myofascial Pain Affects Your Quality of Life

Studies show that many people with myofascial pain syndrome also experience mood disorders. So, aside from physical pain, people with MPS may also suffer from depression and anxiety. The pain caused by MPS, after all, can be unbearable that it can impair one’s mental health.

The long-term pain or loss of mobility from MPS can also interfere with school or work tasks. For instance, employees who deal with chronic pain may incur up to an estimated 28.5 lost workdays each year. What’s more, some estimates say that up to 60% of people who suffer from chronic pain end up losing their jobs.

All in all, MPS can cause a severe reduction in the quality of your life. That’s why you shouldn’t underestimate the frequent symptoms you experience. Nor should you choose to just “live with it.”

The good news is, chronic pain treatments can help reduce the life-altering effects of MPS.

Treatments

A comprehensive treatment plan is the best way to ease the signs of myofascial pain syndrome. In many patients, these include a mix of medications and non-medicated methods. It depends on the severity of your symptoms, but you may be able to stick to non-opioid treatment methods.

Treatments

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are over-the-counter pain relievers. These include medications like Tylenol and Advil. They may help reduce pain, but only for a short period of time.

Muscle relaxants, such as benzodiazepines, may help control muscle spasms caused by MPS. Anticonvulsants, on the other hand, may help ease both spasms and pain.

Some patients with MPS may also achieve relief from symptoms with tricyclic antidepressants. These are drugs indicated to treat chronic pain, fibromyalgia, and nerve pain.

Botox injections also seem to have promising pain-relieving effects in patients with MPS. This neurotoxin, after all, prevents contraction (especially the involuntary kind) of the muscles.

Physical Muscle Treatment

Physical therapy has also shown to help manage the signs of myofascial pain syndrome. In one study, the researchers evaluated physical modalities, massages, and exercise. They found that the combination of all three led to a more significant reduction in MPS symptoms.

Physical therapy for MPS often includes stretching, massages, and posture training. Ultrasound therapy can also help by boosting blood circulation.

Trigger Point Injection

Trigger point injections (TPIs) are injections directed to one or more trigger points. They are not like “dry-needling,” as TPIs don’t involve poking your skin with a needle over and over again. Instead, the doctor will only inject a tiny needle with a solution into your trigger point.

The solution itself contains long-lasting anesthetics that inactivate the trigger point. Once “deactivated,” the trigger point will then stop causing severe pain.

How Trigger Point Injections Can Make a Difference

Trigger point injections can relieve muscle pain affecting various areas of your body. You can get them for painful knots in your neck, arms, lower back, and legs. It can even help relieve severe headaches!

There are several other reasons to consider TPIs, though. Let’s take a look at some of their other benefits.

Don't Have the Same Risk for Misuse as Pain Medications

In 2018, almost 13% of the Canadian population used opioid pain relievers. These medications, after all, do have a significant pain-reducing effect. Unfortunately, it’s the same potency — plus their psychoactivity — that makes them such a huge risk.

Even if used as instructed and prescribed, opioids still carry a massive risk for misuse. Especially with their long-term use, as they can alter the way that brain works.

Trigger point injections don’t use substances that can cause dependence like opioids. It is, in fact, because of this that more healthcare professionals are taking an interest in them. They can treat MSP inflammation at the root without the need for risky opioids.

Low-Risk Profile

Speaking of risks, trigger point injections are low-risk treatments for chronic pain. Infection and bleeding rarely occur.

However, it’s still possible to feel some soreness or numbness in the treated area. These unpleasant sensations don’t last long, though.

Multiple Injections in One Appointment

As trigger point injections carry minimal risk, you can get several of them in one doctor’s visit. Your pain specialist can administer injections in multiple painful areas of your body. For instance, if you suffer from painful muscle knots and sports injuries, then you can get TPIs for both.

Best of all, the injection process itself takes only a matter of minutes. You’re likely to spend less than an hour in the clinic even if you need several injections.

No Post-Procedure Downtime

Trigger point injections cause less soreness than dry-needling techniques. Moreover, the inactivation of the trigger point restores mobility in the treated area. So, you can use your once-painful muscles soon after you receive the injections.

That means you’ll have little to no downtime at all. You can go back to work or school right after the procedure. Since the injections take only a few minutes, you can even have them during your lunch break.

It’s best, however, to steer clear of strenuous activities right after your treatment. Doing so gives your muscles more time to recover and heal.

Can Deliver Targeted and Immediate Relief

Painful spasms of the muscles abruptly come and go. They can last anywhere from a few seconds to 15 minutes, sometimes even longer.

In people who have MPS, however, muscle spasms are a common occurrence. Sometimes, the pain can be so severe that they can make your knees buckle. In most cases, though, the pain is so intense that you can’t move the affected part at all.

The good news is, TPIs can provide targeted and quick relief for muscles often affected by spasms.

There Are Steroid-Free TPIs

Corticosteroids can help with certain types of pain, such as those caused by an injured nerve. However, when it comes to myofascial pain syndrome, steroids appear to have little to no impact at all. There’s not enough evidence that these lab-made hormones can help with MSP.

This is why, up to now, the use of steroids in TPIs is still debatable and controversial.

Fortunately, not all trigger point injections come with steroids. These steroid-free TPIs are your best bet if you don’t want more artificial chemicals in your body.

Determining Pain Areas With a Trigger Point Chart

Since myofascial pain is a syndrome, there are no actual tests used for its diagnosis. However, a pain specialist uses a trigger point chart to locate your “pain areas.” There are at least 20 trigger points in the front and back sections of the body.

Healthline has an excellent trigger point chart that depicts all these pain locations.

In any case, common trigger points that TPIs can help with are those found in your neck. These include the low cervical (found in the front part of your neck) and the occiput (back of the neck).

You may also have trigger points within your rib and upper back (supraspinatus). The same goes for your arms, thighs, gluteus, thighs, knees, and ankles.

What’s important is to be as honest as possible when describing how painful each trigger point is. Your pain specialist will use this as a determining factor during your diagnosis. This will also help your doctor ascertain how many injections you need as well as how often you need them

myofascial trigger point chart
*source - https://www.healthline.com/health/myofascial-pain#chart

Find Relief From Myofascial Pain Syndrome Now

There you have it, your ultimate guide on what myofascial pain syndrome is and how to treat it. Again, the most effective approach seems to be a mix of medicated and non-drug methods.

In this sense, medicated doesn’t automatically mean opioids. You may already find immediate relief with the less risky trigger point injections. You can then combine TPIs with physical modalities, such as stretching and exercise.

Ready to explore your injectable treatment options for MPS? Then please know that BeWell Medical Clinic is here to help. Please feel free to get in touch with us to know more about our trigger point injections!

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We are providing Telehealth appointments (e.g. telephone consults or virtual video consults) for all patients. Please call us to book or visit our website to book with your MyHealthAccess account. Telehealth visits can be particularly useful if you have travelled recently, you are self-isolating, you are a high risk patient (i.e. over 70, chronic health issues), have no need for physical examination, or if repeat prescriptions are needed. 

As a precautionary measure, we are ONLY booking appointments in the clinic for essential preventative services. You must call the office to schedule an in-office appointment, however, Trigger Point Injection (TPI) Therapy can now be booked via MyHealthAccess (online booking portal). If you have a scheduled in-office appointment that has been pre-approved by our team, please plan on keeping this appointment unless you are experiencing any COVID-19-related symptoms or have been in contact with a probable or positive case of COVID-19.

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