Trigger Point Injections

 

The aim of this leaflet is to give you information about trigger point injections and to answer some questions that you may have. Please note that places may do things differently. Your doctor will be able to explain fully what to expect.

What is a trigger point injection?

A trigger point is a tender area of your body, often a muscle, which when pressed causes pain.
Normal muscle contracts and relaxes. At trigger points, the muscle may not relax and a knot or
tight band of muscle is formed. Several injections are usually made on a single occasion and
can contain local anaesthetic, often with a small amount of steroid. The injection is often given
in the shoulders, neck or back. The injection is usually given alongside other treatments such as
physiotherapy.

Is this the right treatment for me?

Other treatment options will be discussed with you before deciding to have the injections and
your consent is needed. The decision on whether or not to have with the injection(s) is made
together by you and your doctor. Your doctor will be able to provide you with up-to-date
information about the chance of the treatment working for you and how it fits in with other care. If you are undecided about whether or not to have the injection, more advice and information can be given. Please speak to your doctor for more details.

I have heard that steroids are being used unlicensed/off-label. What does this mean?

Steroids (corticosteroids) are commonly used in managing chronic pain but are only licensed to be given in specific ways. Some methods of giving steroids to treat pain are not licensed.
This is referred to as off-label use. The manufacturer of the medicine may not have applied for a specific licence for it to be used more widely. MANY medicines used in pain medicine are
used off-label. Your doctor will be able to discuss this with you further.

What will happen to me during the treatment?

Before the injection, your doctor will discuss the procedure with you. Your doctor will either ask for your consent before the injection or ask you to confirm that you have already given consent and are still happy to have the injection. The treatment will take place in a dedicated area with a trained person. Not all doctors give these injections in the same way, but this is what usually happens:

• A medical professional will get you ready for the procedure. Your blood pressure and The 
  rate may be checked.
• A small needle (cannula) may be placed in the back of your hand.
• You will be carefully positioned, and the skin around the injection site(s) will be cleaned with
  an antiseptic solution or spray; this can feel very cold.
• You will feel a pressure as the doctor identifies the tender areas by running his finger over the
  skin. Your doctor will warn you just before making the injections.
• When the injections are made, you may feel pressure, tightness, or a pushing sensation. If it is
  Uncomfortable, do let the doctor know.

What will happen to me after the injections?

After the injections, you will be taken to a recovery or ward area where nursing staff will check on you. Sometimes you will be asked to lie flat for about 30 minutes or longer. You may be helped to sit up, and your blood pressure and pulse may be checked. You will be told when to get dressed and be given help to make sure that you can stand safely after the procedure. You will be given further advice when you are ready to go home.

When will I be able to go home from the hospital after my injections?

You will usually be able to go home within 30 minutes to a few hours after the injection, depending on how many injections are needed and how long your doctor or nurse wants you to stay. Please make sure that you have someone to collect you after the procedure. It is unsafe for you to drive home immediately after the procedure. If you do so, your motor insurance will
be invalid

What can I do after my procedure?

Ideally, you should arrange for someone to stay with you for 24 hours but if you can’t, you should at least have access to a telephone. You should not drive, operate machinery, sign legal
documents, provide childcare without help or drink alcohol until fit to do so.
If you are not sure, please ask your doctor for more advice.

When can I return to work after the procedure?

This will be different for different people and may depend on the type of work you do. It is difficult to give general advice, and so you should discuss this with your doctor.

Will I experience any side-effects?

As with any procedure, there may be side effects. However, these are usually very minor and there is little risk of serious harm.

Side-effects may include:

• Mild local tenderness and/or bruising at the site of the injection, that usually gets better over the first few days.
• Intravascular injection. During the injection, you may experience signs of local anaesthetic toxicity if the injection is passing into a blood vessel. You should tell your doctor immediately if you develop tingling around your mouth or a metallic taste, ringing in your ears, feeling drunk, dizzy, blurred vision, muscle twitches, or difficulty in breathing.
• Infection. This is rare. You should seek medical help if there is local warmth or redness where you had the injection, with tenderness. Or if you feel hot and unwell. This may need antibiotic treatment.
• Fat necrosis of the skin (a potential risk of steroid injection close to the skin) may rarely result in skin dimpling.
• Skin discolouration (a potential risk of steroid injection close to the skin)
• The steroids can have other effects ranging from flushing, menstrual disturbances, weight
  gain, increase in blood sugar levels and worsening of mental health issues. These effects are
  temporary and are more likely with repeated steroid injections.
• Injection treatments do not always work and may not help your pain.
• In rare circumstances, steroid use can damage your eyesight. You should report any new vision problems (such as blurred or distorted vision) to your doctor.

What can I expect in the days afterwards?

You may feel some soreness or aching at the injection site. Please keep the area of the injections dry for 24 hours after the procedure. Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain killers and medications as normal and this should get better. Try to keep on the move about the house while avoiding anything too difficult.

What should I do in the weeks after the injections?

As your pain decreases, you should try to gently increase your exercise. It is best to increase your activities slowly. Try not to do too much as you may have more pain the next day. Your doctor can give more specific advice.

What follow-up will be arranged?

A letter will usually be sent to your GP and your doctor will advise on what to do after the procedure. You may be asked to make a call to the pain department, be given a form to fill in,
or given a telephone review or other appointment.

Is there anything else I need to think about before the procedure?

• Please bring your glasses if you need them for reading.
• Bring any other devices you may need, such as hearing aids, mobility aids etc.
• Always bring a list of all current medication.
• Continue to take your medication as usual on the treatment day.
• Avoid vaccinations including COVID-19 jabs for 2 weeks on either side of the procedure