Trigger Point Injections for Muscle Pain

[Shanti1]

About a month ago I started noticing tightness in my neck, shoulders, and upper back. I didn't think much of it and adjusted the ergonomics of my office desk. Over the next few weeks, it developed into a burning, tight, soreness that began to impact my quality of life and sleep and didn't respond to NSAIDs. I was dismayed because muscle pain hasn't been a part of my symptom picture and I was (and am) concerned that this is another "gift" from ME/CFS that I'm going to have to figure out how to manage.

Anyhow, today I had 2% lidocaine trigger point injections into the belly of the upper trapezius and the trapezius where it connects to the base of the skull. Within 20 min the pain was reduced and, now, 6 hours later, it is completely gone (except for in the muscle in the front of my neck where it wasn't injected). For chronic pain syndromes, apparently, relief can last from a few days to a few weeks. I do not know if my pain would have gone away on its own as I only had it a couple of weeks, but I was thankful for the relief and will report back on if it returns.

I am posting in case it helps anyone else. I would also be curious if anyone else has had this done and if it helped.

Studies/info:
Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia

Effect of treatment of myofascial trigger points on the pain of fibromyalgia

Trigger Point Injection - MedicineNet

 

[lenora]

About a month ago I started noticing tightness in my neck, shoulders, and upper back. I didn't think much of it and adjusted the ergonomics of my office desk. Over the next few weeks, it developed into a burning, tight, soreness that began to impact my quality of life and sleep and didn't respond to NSAIDs. I was dismayed because muscle pain hasn't been a part of my symptom picture and I was (and am) concerned that this is another "gift" from ME/CFS that I'm going to have to figure out how to manage.

Anyhow, today I had 2% lidocaine trigger point injections into the belly of the upper trapezius and the trapezius where it connects to the base of the skull. Within 20 min the pain was reduced and, now, 6 hours later, it is completely gone (except for in the muscle in the front of my neck where it wasn't injected). For chronic pain syndromes, apparently, relief can last from a few days to a few weeks. I do not know if my pain would have gone away on its own as I only had it a couple of weeks, but I was thankful for the relief and will report back on if it returns.

I am posting in case it helps anyone else. I would also be curious if anyone else has had this done and if it helped.

Studies/info:
Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia

Effect of treatment of myofascial trigger points on the pain of fibromyalgia

Trigger Point Injection - MedicineNet

Hello @Shanti.....I'm so glad the trigger point injections worked for you. I had them a long time ago and they did absolutely nothing and, as you said, the pain was most unpleasant.

In my case, after a lot of investigation, acupressure turned out to help the most...that, and ice packs which totally numbed everything. I'm grateful that I found them, so I can only imagine how my must feel. Yours, Lenora.

 

[Shanti1]

Hi @lenora, Yes, I am hoping the trigger point injections hold, or the result is at least repeatable if the pain comes back. It is definitely a huge win when we find something that helps. I'm glad you found the acupressure and ice

 

[Woof!]

For me, fascial dry needling done by my beloved and very in-tune physical therapist was the way to go. The results were immediate and ever-lasting. No meds needed.

 

[Shanti1]

@Dr.Lynne what a great response! Was the fascial dry needling also done in a trigger point in the muscle belly?

 

[Woof!]

@Dr.Lynne what a great response! Was the fascial dry needling also done in a trigger point in the muscle belly?

The needles were used wherever fascia was spasming around muscles in my neck, shoulders, back, butt and legs. Each needle went through a proximal layer of fascia and then a muscle belly, and when it touched the distal layer of fascia the muscle would bitch like crazy (sometimes for 2 seconds, and sometimes for 5 minutes) before giving up the fight (and all spasming - yay!).

I really learned a lot about my body during the process, with the take-home message being: all of our muscles (from the top of our head to the tip of our toes) are interconnected by fascia, and when fascia in one area is unhappy, it pisses off the fascia (and muscles) in lots of other places, often creating trigger points. This is why so much more than trigger points need attention.

BTW, do you know where the term "dry needling" comes from? (It's an interesting story, if you haven't heard it).

 

[Shanti1]

@Dr.Lynne I don't know where the term 'dry needling' came from, I just figured it was descriptive of using a needle without injecting something 'wet'. Do share....

Thanks for your great description of the dry needle technique, it is what I was picturing. I have seen practitioners who do a combo of dry needling and trigger point injection. The advantage for me for trigger point injection is that it is simple enough that we can do it at home, but if I find I need more, I will consider looking for someone who can do the dry needling as treating the fascia as you describe makes a lot of sense.

 

[Woof!]

This is what I've been told:

There was a study done to see if tiny injections of medication into bitchy muscles would be helpful. (I think the medication was an anti-inflammatory, but it may have been similar to lidocaine.) The study involved people with long histories of muscle pain and trigger points divided into three groups: (1) a group that got medication injected into individual muscles; (2) a group that got similar "injections" that contained no medication - the "dry needle" group; and (3) a group that got neither.

It was expected that the first group would benefit, but not the other groups. To everyone's surprise, the dry needling group did the best, far surpassing the first group. When the technique was done so the bitchy muscles could spasm themselves out in response to the needling, the muscles stayed un-bitchy!!!!! I'm living proof of that. While I have had lots of dry needling done, it's been for different muscle groups. It's rare to need repeated treatment of the same muscles (same areas, yes, but not the same muscles).

My PT trusts me enough that she sent me home with needles so I might use them on my own, but despite lots of needle experience (haha), when I need the needling to be done, I am so sick that I'm pretty dysfunctional when it comes to using my hands and arms predictably.

She also sent me home with a do-it-yourself cupping kit. That I can do quite well on my own, and it's been helpful more times than not.

 

[Shanti1]

@Dr.Lynne I would be interested if you could find the study, on a quick search, the studies I found showed equal efficacy:
https://journals.lww.com/ebp/Abstra...jection_is_most_effective_for_trigger.14.aspx
https://asja.springeropen.com/articles/10.1186/s42077-019-0026-x
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797918/
https://pubmed.ncbi.nlm.nih.gov/8043247/

But I do find the elicitation of a twitch response interesting, also, I would bet that the skill of the practitioner with dry needling makes a difference. Here is to non-bitchy muscles!!!!

 

[Haley]

I also get a lot of pain in my neck and upper back, mostly trapezius and rhomboids but around the shoulder blade as well. I've never had injections but have dry needling via my physio when its gets really bad (about once a year or evrn less frequently), but I find daily use of a trigger point ball keeps the pain and tightness at bay. Might be an option to consider...

 

[Woof!]

@Dr.Lynne I would be interested if you could find the study.

It was simply the story as told to me by my PT...

But I do find the elicitation of a twitch response interesting, also, I would bet that the skill of the practitioner with dry needling makes a difference. Here is to non-bitchy muscles!!!!

The skill and intuition of the practitioner makes a HUGE difference (I've been to three of them, only because my #1 PT travels a lot and isn't always available. Sadly, only one of the three is able to get the twitch response needed.). And yes, here's to non-bitchy, non-twitchy muscles!

 

[Shanti1]

It was simply the story as told to me by my PT..

Gocha, 10-4

 

[lenora]

Good day, ladies......I've had FM for at least 35 yrs. now, probably longer. Yes, I believe that lidocaine is used in trigger point injections (which wears off whether or not it works at the time) but dry needling does get to the heart of the problem.

Unfortunately, dry needling did nothing for me AT THE TIME, but I would be willing to try it more than once. FM is very painful, people don't understand how it can feel, especially after surgery and being in bed for any length of time.

Some good news: As I've aged, I've also aged out of the worst of my FM, save and except for the occasional flare-up (usually caused by my husband...not to man bash here. I'm sure I give him something in return.)
I also have abdominal and rib pain....the rib problem in just that, a problem especially if I cough a lot. Very painful. On the other hand, for the most part the rest has moved around and doesn't cause the tight knots that it once did. So I'm wishing anyone with FM well.

For those not familiar with fascia, I'll tell you that it's a fibrous layer (like collagen) underneath the skin. If it's disturbed some people really live with the consequences. Ice pads do help deaden it (no more than 15 min. on). Yours, Lenora.

 

[Woof!]

@Shanti1, @Haley & @lenora:
This inexpensive cupping set (below) has also been helpful when my neck and shoulders start spasming. The trick is to apply fractionated coconut oil (also below) to your skin, then attach the cup, then move the cup slowly to pry any tacked-down, spasming fascia away from its adhesions. The slow movement of the cup is vital. Just attaching the cup doesn't do as much.

It's gotten so I reach for my cupping kit before I reach for anti-inflammatories at the first twinge of neck or shoulder pain. Roughly half the time I don't wind up taking any meds because the cups have done the job. Having taken so many anti-inflammatories that my stomach was objecting, I like having non-medical approaches to recurrent issues like this.

One caveat: Don't use cups near your jugular vein, carotid artery or other large blood vessels.

https://www.amazon.com/Premium-Qual...hvlocphy=&hvtargid=pla-4583451672037081&psc=1

https://www.amazon.com/Viva-Naturals-Organic-Fractionated-Coconut/dp/B0792JFQN8/ref=sr_1_5?crid=10YD03CYA4IR8&dchild=1&keywords=fractionated+coconut+oil&qid=1633629830&s=hpc&sprefix=fractionated+,hpc,215&sr=1-5

 

[Shanti1]

This inexpensive cupping set (below) has also been helpful when my neck and shoulders start spasming. The trick is to apply fractionated coconut oil (also below) to your skin, then attach the cup, then move the cup slowly to pry any tacked-down, spasming fascia away from its adhesions. The slow movement of the cup is vital. Just attaching the cup doesn't do as much.

Fantastic, I just put it in my cart. I am all for things I can do at home and minimizing meds.

 

[Woof!]

Fantastic, I just put it in my cart. I am all for things I can do at home and minimizing meds.

Let me know how it works for you! Also, if you haven't used cups before, know that the tendency is to overdo it which leaves you with a whole bunch of hickey-like bruising that goes away pretty quick .

 

[Shanti1]

Let me know how it works for you! Also, if you haven't used cups before, know that the tendency is to overdo it which leaves you with a whole bunch of hickey-like bruising that goes away pretty quick

My x-husband is an acupuncturist, so I won't be alarmed Good thinking to give a warning though

 

[Shanti1]

then move the cup slowly to pry any tacked-down, spasming fascia away from its adhesions.

Also thinking the cupping may pull blood into our muscles that are suffering from lack of oxygen, blood flow, and waste (lactic acid) removal.