MYOFASCIAL TRIGGER POINTS

Myofascial trigger points are small areas of muscle spasm in larger muscles. These small areas can be exquisitely painful. There is often an area of inflammation in the surrounding fascia. Trigger points can be palpated using the finger tips and this type of palpation not only induces pain, but also reveals the actual area of spasm of the muscle being evaluated. The fascia around the trigger point is pulled taught and can lead to inflammation of that area. The pain caused by chronic trigger points can be severe, breaking through high doses of opioid medications and combinations of medications. Pain can be referred and may imitate neuropathic pain. It can be aching, stinging, burning or throbbing in nature. Referred patterns of headache are quite common from the shoulder and intrascapular areas of the trapezius muscle.

Several approaches to treating these pinpoint areas of muscle spasm have been tried. Message therapy can be helpful, but should probably be combined with the use of Fluorimethane and trigger point injections. Using cold in the form of Fluorimethane spray and stretching after this treatment can be quite effective. Injecting the trigger points with a small gauge needle and local anesthetic can also be helpful. The injections should be aimed at multiple puncture of the part of the muscle in spasm, using 1 to 2% Lidocaine for local anesthesia and some local anti-inflammatory effects. The key here is not the pain relief from the infiltration with the Lidocaine, but is more for the needle penetration, breaking up the muscle spasm. Some people inject steroids with the anesthetic, but the IM nature of the steroid injections can lead to cumulative steroid toxicity, if the injections need repeating every three to four weeks.

In instances of chronic trigger point recurrence the use of botulinum toxin can give longer term relief. This treatment is somewhat controversial, but patient's can gain excellent long term results, when other methods have failed.

A less invasive approach can be to put a Lidoderm® patch over the area of trigger points or to use transdermal Ketamine in PLO. Muscle relaxers, such as cyclobenzaprine may also be helpful. Again this treatment tends to stretch the length of time between trigger point injections and can be very helpful with referred pain.