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Section Icon Trigger Point Injection
Overview
TPI may also be used to treat pain due to acute or chronic strain or trauma or for simple muscle pain.1
Indications
Focal reproducible pain with movement or palpation in a defined (typically 1-2 cm or fingertip size) externally accessible location within a muscle group
  • Pain refractory to OTC and prescription analgesics, relaxation techniques, or localized massage
  • Pain in a patient who wants to avoid medications or has previously experienced positive results with TPI
Contraindications
Allergy to local anesthetic
Fear or syncope related to needles
Injection site near a critical anatomic structure
Overlying cellulitis
Previous adverse experience with TPI
Severe coagulopathy or bleeding disorder
Equipment & Dosing
22- to 25-gauge needle
Lidocaine 1% or bupivacaine 0.5% without epinephrine 1 to 2 mL
Procedure & Administration
Palpate the area of the suspected trigger point.
  • Isolate a point of maximal tenderness approximately the size of a fingertip.
  • Mark or note its location.2
Disinfect the injection site.
Insert the needle through the skin superficially and into the identified trigger point/muscle.
Move the needle in and (almost all the way) out, engaging all four quadrants of the trigger point, and before removing the needle, inject 1-2 mL of local anesthetic in the center.
Charting & Documentation
TPI requires a procedure note in the medical record.
Document:
  • The precise location of the injection
  • Cleaning of the site
  • Size of needle used
  • Type and dose of anesthetic injected
  • Type and quantity of medication injected
Special Considerations
Do not reinject the site if pain relief is not adequate.
Dry needling without injection of local anesthetic is not considered TPI and is not a billable procedure in the ED.
Discharge Procedure
Tell the patient to avoid strenuous activity for 72 hours.
Tell the patient to use warm compress and stretch the affected muscle.
References
  1. Roldan CJ, Hu N. Myofascial pain syndromes in the emergency department: what are we missing? J Emerg Med. 2015;49(6):1004-1010.
  2. What are trigger point injections? Wake Spine & Pain Specialists website. Accessed June 22, 2018.

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