Chapter 63 Trigger Point Injection
OVERVIEW.
Trigger point therapy involves needling or repeated insertion and withdrawal of a needle1 into muscle tissue2 with the goal of mechanically breaking up pockets of fibrotic tissue that entrap nerve endings and a sensitizing substance in order to interrupt a pain cycle.1 Trigger point therapy includes both injection therapy and noninjection modalities such as spray and stretch (i.e., vapocoolants; see Cryotherapy).1 This section will cover injection therapy for trigger points.
SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.
In general, except for pregnancy and some psychiatric concerns, issues listed here are also mentioned under concerns for injection therapy (see Injection therapy). Because trigger points are regarded as a problem of reflex irritability rather than inflammation, corticosteroids are not typically recommended during trigger point therapy.1
CONTRAINDICATIONS AND PRECAUTIONS
A00-B99 CERTAIN INFECTIONS AND PARASITIC DISEASES
D50-D89 DISEASES OF BLOOD AND BLOOD-FORMING ORGANS AND CERTAIN DISORDERS
F00-F99 MENTAL/BEHAVIORAL DISORDERS
L00-L99 DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE
1 Tan JC. Practical manual of physical medicine and rehabilitation: diagnostics, therapeutics, and basic problems. St Louis: Mosby, 1998.
2 Walsh NE, Rogers JN. Injection procedures. Delisa JA, editor. Physical medicine and rehabilitation: principles and practices, ed 4, vol 1. Philadelphia: Lippincott Williams & Wilkins, 2005.
3 Rachlin ES. Trigger point management. In: Rachlin ES, editor. Myofascial pain and fibromyalgia. St Louis: Mosby, 1994.