I have questions about trigger point injections.

[remar]

Hello everyone.
I went to see the pain Dr last week. I didn't get to see my Dr because I had to have my regular appointment rescheduled because we had some flooding here. Anyway, I saw the other Dr and she recommended I get trigger shot injections at my next visit. It's in my records that I have a lot of muscle pain along with spine pain. I've never had these injections before so I don't know what to expect. I did research so I know a needle will be involved. Ha ha! The Dr didn't say if it would be a dry needle or medication that would be used.
I would really like to know if anyone else has had luck with these shots. I have no insurance so I can't afford to waste money on something that's not going to help my pain.
What is the best medication to use? I read that it's common to use Lidocaine. I was also wondering how long the shots last and how much pain relief can be expected. I really trust my new Dr. My sister also sees him and got an injection in her hip the last time she saw him. She was having an RA flare up and asked for the shot. He used an x ray to get the shot in to the perfect spot and my sister said it gave her so much relief. Mine would be different because it's going in to the muscles.
Any help would be greatly appreciated.

[nonnie68pain]

Received my first trigger point May 25 2-21.  I was in tears from my sciatica.  I have had pills hip shot, 8 procedures on hip (osteo arthitis.  I nearly cried from the relief.  Go, Get it.  They had 10 points to inject.  Some steroid. Shot is like an allergy shot.  Not uncomfortable at all.  My hopes for you.

[Tuckamore]

Hello and Welcome,

I'll first begin by telling you what I do to everyone that doesn't begin their own thread - please do so. "Post a Question" and you'll obtain better visibility and more responses - if not soon than by search.

If I understand what you are saying you haven't had trigger point injections - as they are more for soft tissue. You first had Steroidal Injections into your Cervical Spine. Ouch!  I've had them in my SI Joint with the same result you have experienced.

Now your PMP has preformed a Cervical RFAs (Radiofrequency Ablation).  It can  also be called Cervical Facet Thermal Coagulation or Rhizotomy. Is that correct? He's recommending the other side be done too.

The Cervical Spine is unlike other areas of the spine in the sense that it is much smaller and more delicate. Procedures (including surgery) is more complex. It tells a lot of skill and experience to treat the Cervical Spine. Make certain your PMP has a lot of both.

I too have a nasty Cervical Spine and experience daily pain and frequent headaches. I chose to stop with a Neurologist and not go further down the road to treatments until I find a Neurosurgeon that I completely trust and has a record to back up that confidence. Yes, I'm a bit of a coward. The Cervical Spine is a tricky area. I applaud you for being courageous - and I am very sorry to hear about your continued severe pain.

RFAs can be a God sent for some patients. When everything goes well under a skilled practitioner than pain can be greatly reduced - and function restored. Even successful RFAs have to be repeated every 6 - 18 months, as a general rule. This is a treatment and not a cure. Nerves will regenerate. We have and have had many Chronic Pain members that sing the praises of RFAs. Many claim it's the only thing that has helped in pain reduction.

Is it always effective? No? Can there be lasting side effects? Yes. Where you will be in that scale I cannot say. You're through the worst of it, one more session to go through. It's not overly alarming that you pain is not reduced to any degree - the procedure isn't completed. The next session may bring you better results. It may not.

If the pain is caused by constant muscle contractions are you taking muscle relaxers? I find an occasional Diazepam reduces my muscle tightness and spasms better than any thing else. It also last longer, seems to break that cycle. I've tried all the meds that are considered actual muscle relaxers - none were effective. My previous physician finally had to insist I try Diazepam (Valium) - and it's been the only med that stops those spasms and reduces the tight pain. I don't take it near as often as I should - but I know the dangers of  mixing opiates and benzodiazepines. I'm overly cautious. You may want to discuss this with your PMP. Be prepared for some push back from him - he may not agree.

What I encourage you to do - and everyone to do - is know your DX (diagnosis). Know it, as well as your treating physicians. Know the terms, procedures and treatments, the pros and cons. It's the only way you can make informed decisions and offer suggestions. Be a partner in you care and not just the patient.

Any fusion of the spine brings concern and often problems in other areas of the spine. That is a fact. The mobility and normal stress that your C6 and C7 once handled is now forced on the other vertebrae, discs and structures above and below that fusion. Once you change the structure of one area of the spine, it effects other areas. You may have this challenge for the remainder of your years. It's important that you find a treatment and/or procedure that will help reduce your pain.

That said, I believe it's important that you continue with the RFA.  If you find that it is not effective than search for another practitioner. It is not just PMPs that perform RFAs, Neurosurgeons and some Neurologists do them also. Research any and every practitioner that you consult. You can find reviews on line, including any malpractice or sanctions that may have had imposed. Make sure the practitioner is skilled and experienced. Be sure he/she is trusted by patients and the medical board. I can't repeat or stress that enough! It's your body and no one cares about it as much as you do. You are your own best Health Care Advocate. Be assertive.

I think you've gone through the usual and customary treatments. If this fails and a SCS (Spinal Cord Simulator) is suggested make certain you understand completely the pros and cons. They may also suggest an implantation of a Pain Pump. Again, be certain to do your research. Never agree to anything until you fully understand the pros and cons.

I hope something I offered has been of help. If you have a specific question - or require clarification please feel free to ask. We're here to support you and share information. Again I encourage you to begin your own thread by clicking on "Post a Question."

I'll look forward t hearing more from you. Take good care of your self.

Regards,
~Tuck

[kobera123]

Tuck, I've had injections for chronic pain in my neck. I had c6-7 fused about 1 1/2 years ago. Started therapy after surgery and main complaint was muscle tightness and pain above surgery area. Therapy did not give any relief. Last june, I finally told surgeon that I couldn't take pain anymore. He sent me to local pain management dr. He did injections of steroid in 3 joints above fusion on each side. I've had some painful things happen in my 46 years, but I have never experienced anything like this. He had to wait 5 min after first side before I would let him start second. It took over two days to recover from proceedure pain before I felt relief due to injection. The relief only lasted 2 days and then came back same as before. When I went back two weeks later for second set of shots, he told me second set wouldn't help but should still try. If still didn't help, then he would do test to see if I was candidate for burning nerves. Needless to say it didn't work, but testing showed that I could try burning nerves. He never explained what this involved, so I was in no rush to try it. I tried accupuncture for five weeks with not help. Tried rumatologist, but couldn't help me. So I went back and agreed to do burning. I had right side done a week ago and having left side done in two weeks since insurance won't pay for having both at same time. I had relief for two days and went back to prior pain level. Any suggestions? The pain seems to be caused by constant muscle contraction at base of skull to above c6 and works down into shoulders and back. Thanks

[Tuckamore]

Of course you have some apprehension. It's normal, You do not sound like a baby. When I am facing something new I feel the same - mostly because I am afraid of treatments that have the potential to make my pain worse. A TPI does not have that potential.

It was just several years ago when I had the injections. Remember I am not the average patient. My condition went years without a DX and totally untreated. Due to that fact and continued deterioration I do not usually respond as well as the average chronic pain person. I experienced just several days of approximately a 30% reduction in my pain levels. They were given during flares so that 30% was welcomed. It had no long lasting effect on my pain. Remember a steroid was not injected.

These injections are placed into the muscles. Treatment is based on relieving muscle spasms with stretching and the injection of numbing agent or normal saline into trigger points. There are other agents that can be utilized. It depends on each Practitioner. It's thought to reduce inflammation and irritation - as well as the obvious, reduce or stop the spasm and tightness within the muscle.

You may be having muscle spasms and mot even be aware of it. My long time PCP and PMP told me my muscle were tight and a few of them in near constant spasm. I wasn't sure that was true until she began to treat those spasms and my pain reduced.

I'm not certain where your PMP will inject. I've never had one in my side. I've had them in my gluteal area, flank and vastus lateralis. I get golf ball sized knots in my vastus lateralis and TPIs reduced their size and pain.

I agree with your husband and mom - it's worth a try. It's a safe procedure and hopefully will bring you some relief.

My Best to You.
~Tuck

[remar]

Thank you so much Tuck. I was hoping you had knowledge about these injections. You do, and you also have experience with them.
I kind of figured they wouldn't hurt too much but there could be some soreness after.
Do you remember how much pain relief you got and how long it lasted?
I deal with a lot of muscle pain that's all over my back but is mainly in the lower middle and radiates over to my right side. Do you know if my Dr might be doing the injections in my side too? It's really deep muscle pain.
If I could get any relief from doing this I would be so happy! My husband agrees that I should give it a try and so does my Mom. Having your support and theirs means a lot to me. Sorry that I sound like a baby about this it's just that I've never had it done before so I'm a little scared. I think mainly scared that I'm getting my hopes up for some relief and then it may not help. I'll do my best to stay positive.
My next appointment is on the 29th of this month. I might be able to get in sooner to have this done but I'm just going to wait.
Thank you so much for all of your help. As always, it's greatly appreciated and I feel so much better now that you've told me what to expect.
I hope to hear from you soon.

[Tuckamore]

Hi Remar,

Thanks for posting an excellent question. We can learn from one another - and thank you for promoting that learning. :o)  

I've have had multiple Trigger Point Injections (TPI). If I know you - you've done your research. You know there are several medications that are utilized in TPIs. Yes, some - though few practitioners will use the dry needle method. Most practitioners use a numbing agent - some also include an injectable steroid. It depends on your HX (history) and where the injection is being placed.

First let me tell you that TPIs were not painful - at least in my case. I've talked to others that have had these injections - in several areas and not one reported pain. Yes it's a needle prick - but no bore hole needle. In most cases it feels like a needle prick - though the numbing agent helps.  

When I had the TPIs they injected a  numbing medication, Lidocaine.  - Prior to the injections my muscles were tight, painful and often in spasms. The TPIs were somewhat effective in reducing my SX. Finally they gave me a burst of (oral) steroids with the TPIs. The two together provided me the most relief.

Some ppl have complained of a soreness at the injection site. I didn't experience that - but than I had a great practitioner. I hope you'll have good results. I'll be thinking of you my friend. Please let me know how effective the TPIs are for you. Best of Luck!

Warm Regards,
~Tuck