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Pain injections

Trigger points

What are trigger points?

A trigger point injection is a simple procedure for chronic muscle spasms causing pain. Trigger points are localized muscle spasms., Muscle spasms occur when muscles become tight (contracted) for too long. This causes a decrease in oxygen to the muscle. This prevents the muscle from healing. Trigger points are a type of myofascial pain. Myofascial pain is caused by the muscle itself and/or the fascia (a type of connective tissue) that attaches to the muscle. Sometimes myofascial pain feels like muscle tension. Other times it can be severe pain. The pain can be in a small area. This is called local pain. The pain can also be in a large area. This is called referred pain. Myofascial pain can occur in all body regions.

The following pictures show areas where trigger points can occur and where these trigger points can refer pain.

How do I know if I have trigger points causing pain? If you have pain in one or more of these areas that has not improved in four weeks, you may have pain from a trigger point.

Common tests such as x-rays or MRIs do not show if a trigger point is causing pain.

How is a trigger point injection done? In a trigger point injection, an anesthetic (numbing medicine) and sometimes corticosteroid (anti-inflamatory medicine) are injected into one or several of trigger points. The steroid is used to treat local inflammation of the muscle.

Sacroiliac Joint injections

The sacroiliac joint is the longest joint in the body and connects the spine to the pelvis. It bears a very large weight load, and is held together only by ligaments that can be damaged in automobile accidents, birthing, or lifting injuries. Damage to the ligaments can cause the joint to become hypermobile and painfully unstable, requiring realignment by chiropractors or physical therapists, or by the patient.

The joint surfaces can become arthritic and painful due to osteoarthritis, rheumatoid arthritis, and several other types of arthritis. Usually the pain from a dysfunction of this joint is one sided in the low back and buttocks, and may refer to the back of the thigh, groin and occasionally into the calf.

Lumbar spine joint injections or "facet" joint injections

The “z-joints” also called the facet joints are located in the back of the spine and prevent

excessive twisting of the spine in the low back, and excessive extension in the neck. Damage to the joints can occur due to trauma (automobile accidents, falls), arthritis, infection, reduced disc height, or in the low back: repetitive lifting of heavy objects for many years and arthritis. Usually the facet joints in the low back carry about 15% of the weight on the spine, but in cases where the disc is very narrow, the weight load may increase to 65%. The facets can have damage to the cartilage lining, overgrowth of bone (bone spurs), fractures through the joint, tears in the thick fibrous capsule over the joints, or can have bruising or bleeding into the joints. Pain from the facets usually can’t be diagnosed solely by x-ray, CT scan, MRI, or Bone scan. The diagnosis is made by precision injection of a local anesthetic or other substance onto the medial branch nerve (nerve to the facet joints). If your pain is relieved 50 to 80% or more by this injection you may benefit from Radiofrequency Neurotomy or ablation, for longer term pain relief. If the relief is less than this amount, you may have other significant spine disease that should be addressed with other therapies.

WHAT IS A Medial Branch Block?

A medial branch block involves the x-ray guided injection of a medication onto the nerve to the z-joint. You will be placed face down on a procedure table for the low back medial branch block and face down or on your side for the neck (cervical) medial branch blocks. After skin preparation, local anesthesia or numbing medication is injected into the skin. IV sedation is usually not given as this is a diagnostic test whose outcome depends on your ability to perceive pain relief. A thin needle is guided onto the medial branch nerve, then a medication will be injected and the needle is removed. Usually 3-4 injections on each side of your low back or neck are required at the time of the procedure. After the injection, you will have your pain and function briefly assessed, then you will go home where you will continue to assess the outcome of the block over the next several hours. The time period for which relief is perceived and the degree of relief (pain scale or other) is important information that is used to direct further therapy.

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