Trigger Point
injection
Trigger points are discrete and specific points in the muscle and ligaments
which produce pain on compression.
What is a Trigger Point injection?
An injection of steroid combined with a local anaesthetic is injected into
the trigger point.
The local anaesthetic numbs the area, providing short-term pain relief. The
steroid reduces inflammation in the area providing longer-term pain relief.
Why do I need this injection?
Trigger point injections can relieve pain that originates from muscles and
ligaments. Commonly affected areas include the neck, shoulders, back,
abdomen, arms and legs.
Please inform us if you:
• You are on medicines that thin the blood or prevent clotting, you
will be informed as to how this should be managed. These include:
Acenocoumarol, Aspirin, Apixaban, Clopidogrel, Dabigatran,
Dipyridamole, Prasugrel, Phenindione, Rivaroxaban and Warfarin. You
will be told how to manage these medications.
• Suffer from a blood disorder that interferes with clotting eg
haemophilia.
• Are allergic to any medicine, food, sticky tapes, metal or latex.
• Are scheduled for any kind of surgery.
• Are undergoing steroid injections by any other doctor and, if so, when
was the last injection and what was the dose of steroid used.
• Are due a flu vaccine.
• Are pregnant, if there is a possibility of pregnancy or if you are planning
to conceive.
Essential information that you need to tell us on the
day of the procedure.
• If there is a possibility of pregnancy.
WPR42004 July 2020 Review date: July 2022
• Are you on antibiotics for the treatment of an infection in any part of
the body?
• Have you had a flu or any other kind of vaccination within the last
week?
The injection may not be done if:
• You have received a flu or any other kind of vaccination within the last
week.
• You are scheduled to have spinal surgery.
• If you feel unwell on the day of the procedure.
• There is a possibility you may be pregnant.
• You have a known or suspected allergy to local anaesthetic and/or steroid.
• You have an infection at the proposed site of insertion of the needle.
• You are on Acenocoumarol, Phenindione or Warfarin. These need to be
stopped for a period of time, before the procedure. You will need to be
given daily injections of a drug called Heparin, as a substitute for these
drugs. This needs to be planned beforehand, with the knowledge and
involvement of your GP.
• You are on Apixaban, Dabigatran and Rivaroxaban. These medications
are prescribed for a definite and possibly long period. These
medications need to be stopped prior to the procedure but depending
on the reason for prescribing of the drug, it may not be possible to
stop the drug. You may therefore have to wait for the completion of
treatment with Apixaban or Rivaroxaban, before you can have the
injection done.
• If you are on a medication (other than Warfarin and Rivaroxaban) that
thins the blood and you have not stopped taking the drug.
How is the injection performed?
You will be admitted to the Pain Management Unit. The procedure is
performed under sterile conditions, in the treatment area. The number of
injections depends upon the number of trigger points. The consultant will
examine you and identify the trigger points.
This procedure cannot be done under general anaesthesia or with
sedatives as we need you to be awake to help us to identify the points to
be injected.
Pain Management Unit
What happens after the injection?
You can go home once you are able to get out of bed, walk and feel
reasonably comfortable.
Will I get pain relief straight away?
Some feel immediate pain relief after the injection while others do so after
a period of time. Some patients feel sore for a short period before the
pain relief develops. If you experience an initial sore feeling, you should
take your usual painkillers and rest until it settles.
How long will the pain relief last?
The amount and duration of pain relief following steroid injections is
different between individuals. In the majority of patients the relief is
significant and lasts for 1 to 2 months, before the pain returns gradually.
What are the complications of trigger point injection?
• Soreness and bruising at the injection site.
• Temporary exacerbation of pain.
• Infection.
• Problems caused by steroid eg increased chance of infection, increase in
blood sugar in diabetics.
• Possibility of damage to the lungs in those undergoing injections on the
chest; this is called pneumothorax.
• Nerve damage due to infection, direct damage by the needle or
compression by a blood clot or collection of pus.
• Failure of procedure to relieve pain.
What happens next?
A follow-up appointment will be made in clinic 6 to 8 weeks after the
procedure and you will be asked about your response to the injection. If
you report pain relief of a significant amount and lasting for a significant
duration of time, you will be offered repeat injections. You will be placed
in an open list and asked to contact the Pain Management Unit when you
would like a repeat injection. We do not advise more than three injections
in a year to limit the adverse effects of the steroid.
If and when you contact us for a repeat, please inform us of any change in
your health or medications. In particular, please tell us of the following:
• If you have started any medication that thins the blood or prevents
clotting.
Pain Management Unit
• If you have developed a new allergy.
• If you have been hospitalised for any kind of medical problem.
• If you are being investigated for a medical problem.
• If you are due a flu vaccination.
What are the signs and symptoms of nerve damage?
• Persistent numbness at the site of the injection or in a surrounding area.
What are the signs and symptoms of lung damage?
• Difficulty in breathing
• Feeling of tightness in the chest
• Chest pain.
What should I do if I develop symptoms of lung damage?
You should report to the nearest A&E for urgent medical attention. You
will require a chest x-ray and further treatment, which may include
inserting a tube in to your chest, under local anaesthetic.
What should I do if I develop any of the other complications?
Please contact the Pain Management Unit and ask to speak to your
consultant who will be able to advise you.
Special instruction for diabetics:
The injection may increase your blood sugar temporarily. Please check
your blood sugar regularly and frequently for a few days following your
injection. Please contact your GP if your blood sugar stays high as you may
need the dose of your tablets or insulin modified.
For further information, contact the Pain Management Unit at Montagu
Hospital, Tel: 01709 649040.
Email: [Link]@[Link]
Patient Advice and Liaison Service (PALS)
The team are available to help with any concerns/complaints you may
have about your experience at the Trust. Their office is in the Main Foyer
(Gate 4) of Doncaster Royal Infirmary. Contact can be made either in
person, by telephone or email.
The contact details are:
Telephone: 01302 642764 or 0800 028 8059
Email: [Link]@[Link]
Pain Management Unit