Myofascial Pain Syndrome Support Group
Myofascial Pain Syndrome (or MPS) is a term used to describe one of the conditions characterized by chronic pain. It is associated with and caused by "trigger points" (TrPs), sensitive and painful areas between the muscle and fascia. The symptoms can range from referred pain through myofascial trigger points to specific pains in other areas of the body. It may be related...
Hi all. I pop in on this board once in a while. I have had MPS for 3 years and developed fibro at about the same time (was officially diagnosed recently). Anyway, I want to share something I have learned about trigger point injections that may help some of you.
I always wondered why some of us have had great results with the injections and some have had bad results. I've found out at least one reason why. The level of skill of the practitioner has everything to do with it (including the formula of fluid he chooses to inject). I have had great results time after time with one practitioner I've been getting them from for the last 3 years. The procedure gives me relief (only in the areas he injects) usually for at least a month or two. However, since I moved across the country two years ago, I hadn't been able to see him as much as I'd liked and so I finally let a practitioner near where I live now (Chicago) give me the injections. Even though he's an MD with 30 years as a pain management specialist, he did not know what the heck he was doing. If I hadn't been so well versed in this procedure however I wouldn't have known any better and thought that this is just what trigger point injections are. He said he usually uses cortisone in his formulation which is a big no no (pros including Devin Starnalyl (sp?) know this. When I objected he was okay with not including it. He then said he would use marcane in the formula (another no no). He said it was because the relief given would last a little longer than lidocaine (who cares; we don't get these injections because of the anesthetic, we get them for the needle breaking the knot). He was okay with using lidocaine when I told him this. Once he put the needle in, he started moving it at different angles in my tissue, which was excruciating. I've seen this done in dry needling when an acupuncture needle is used, but with TPI I have never seen this. After about ten seconds I told him to take the frickin needle out of me. There's more to the story (like him prodding so hard that I started flaring up right then and there), but you get the point. 12 hours later, I'm in the worst pain I've been in since I got MPS. When I got the trigger point injections from my usual practitioner (a physician's assistant to an osteopath), I usually had immediate relief and would only sometimes have a little soreness for a day.
I also had gone to another practitioner for the TPI before I found the good
one, and his injections were merely two light pokes with an acupuncture needle that didnt do much of anything.
What I am trying to say is dont count trigger point injections out until you have tried them with a few different practitioners. Don't go to one who usually uses cortisone/steroids in the formula. And try to do some research on who is good (if someone else recommends a practitioner who they got good results from; or maybe have a consultation first to get a sense of how confident and good they are at the procedure).
If this had been my first experience with trigger point injections, I probably would never have tried them again. I have found far more poor medical professionals than good or even decent ones. Don't give up on tracking down a good one, even if it takes years.
I always wondered why some of us have had great results with the injections and some have had bad results. I've found out at least one reason why. The level of skill of the practitioner has everything to do with it (including the formula of fluid he chooses to inject). I have had great results time after time with one practitioner I've been getting them from for the last 3 years. The procedure gives me relief (only in the areas he injects) usually for at least a month or two. However, since I moved across the country two years ago, I hadn't been able to see him as much as I'd liked and so I finally let a practitioner near where I live now (Chicago) give me the injections. Even though he's an MD with 30 years as a pain management specialist, he did not know what the heck he was doing. If I hadn't been so well versed in this procedure however I wouldn't have known any better and thought that this is just what trigger point injections are. He said he usually uses cortisone in his formulation which is a big no no (pros including Devin Starnalyl (sp?) know this. When I objected he was okay with not including it. He then said he would use marcane in the formula (another no no). He said it was because the relief given would last a little longer than lidocaine (who cares; we don't get these injections because of the anesthetic, we get them for the needle breaking the knot). He was okay with using lidocaine when I told him this. Once he put the needle in, he started moving it at different angles in my tissue, which was excruciating. I've seen this done in dry needling when an acupuncture needle is used, but with TPI I have never seen this. After about ten seconds I told him to take the frickin needle out of me. There's more to the story (like him prodding so hard that I started flaring up right then and there), but you get the point. 12 hours later, I'm in the worst pain I've been in since I got MPS. When I got the trigger point injections from my usual practitioner (a physician's assistant to an osteopath), I usually had immediate relief and would only sometimes have a little soreness for a day.
I also had gone to another practitioner for the TPI before I found the good
one, and his injections were merely two light pokes with an acupuncture needle that didnt do much of anything.
What I am trying to say is dont count trigger point injections out until you have tried them with a few different practitioners. Don't go to one who usually uses cortisone/steroids in the formula. And try to do some research on who is good (if someone else recommends a practitioner who they got good results from; or maybe have a consultation first to get a sense of how confident and good they are at the procedure).
If this had been my first experience with trigger point injections, I probably would never have tried them again. I have found far more poor medical professionals than good or even decent ones. Don't give up on tracking down a good one, even if it takes years.
I think sometimes TPIs are forgotten, but they can be hugely helpful where trigger points are clustered in one area and / or in the earlier stage(s) in helping prevent the devestating increase in symptoms when they are overused and overloaded.
Thanks for the info. I hope to try them next week.
However my trigger points are extremely chronci. I had to finally give up work last year and while I have improved and identified many perpetuating factors, all of them may be unrealistic.
I thought trigger point injections were better for those with chronic TPs, and for whom all other therapies have failed. Is that not correct?
In response to your question, I have read and heard that TrP injections are used in the most stubborn cases. In Lisaloo's informative post, she explains that it's important to know what's in the solution that is being injected. Of major concern is the use of steroids. Steroids can leave scar tissue which can result in permanent damage . The American Arthritis Foundation recommends only 3-4 trigger point injections in one area per year (search their website for more information if you're curious).
I get more frequent trigger point injections with a lidocaine and saline solution. I've also had good luck with dry needling but had to forfeit that procedure because it's not covered by insurance. In both cases, the relief is only temporary for me. I also concur with Lisaloo that some practitioners are more skillful at injections than others.
Wishing you good luck with your injections! Report back if you're so inclined. I'd like to hear how you made out.