Muscles are thought to be the cause of low back and other common pain problems by some clinicians. Myofascial pain (syndrome), which actually means pain that originates in the muscles and connective tissue (i.e. tendons, ligaments and fascia) is the diagnosis that is frequently used and it is often considered to be the same as trigger point pain. Trigger points are small nodules or knots in the muscle that when pressed produce pain locally and often at a distant area, i.e. a trigger point in the trapezius muscle may radiate pain to the upper arm. Doctors who diagnose and treat muscle pain in their practice may inject trigger points with varying results.

Why are the results so inconsistent when doctors provide trigger point injections?
When injections are given the doctor may use lidocaine, steroids, botox, saline or sometimes nothing (known as dry needling) with generally some suggestion for exercises after the injections. The needles used may also vary from very short (5/8") to long (3 1/2") and the injection site may be just the painful nodule in the muscle or as much as the entire muscle including the areas where the muscle attaches to bone or fascia. This wide variety of approaches all using the same name, trigger point injections, makes it difficult to assess this frequently used type of treament for muscle pain and is one of the reasons that organizations such as Cochrane
(www.cochrane.org), that attempt to determine if a treatment is valid based on the analysis of the accumulated research publications, have been unable to determine if muscle injections are a valid approach in the treatment of chronic low back or neck pain.

Next time I will tell you how our approach is different and why it consistently works.

May 29, 2009 - 1:39pm — Posted by Dr. Norman Marcus