Trigger Point Needling to Alleviate Pain

http://pain6.blogspot.com/2009/10/chronic-pain-referral.html
Trigger Point Needling is a commonly used method to alleviate pain from trigger points, which are knots or hardening of muscle fiber. The procedure is generally performed by a medical doctor or osteopath and can be either in the form of dry needling or the doctor may inject a pain killer such as lidocaine or even botox into the trigger point to ease the patient's pain.

Injecting lidocaine into a trigger point is very similar to getting any type of injection, except that with a trigger point injection, the doctor wants the medicine to reach a specific area in a specific muscle as opposed to the medicine generally entering the patient's system.

Lidocaine "is widely used for infiltration, nerve-block, and spinal anesthesia in a 0.5 to 2 percent aqueous or saline solution and is also applied to mucous membranes (2 to 4 percent) for mucosal anesthesia." (1) Because lidocaine is a fast acting anesthetic, pain relief may be almost immediate depending upon the reason for the trigger point flareup.

According to Dr Janet Travell, "trigger point injection requires careful positioning of the patient and often needling at both the central and attachment trigger point regions to be successful." (2) After trigger point injection the physician will also usually prescribe several visits to a physical therapist for "bimanual release of tightness in the vertical and diagonal muscle fibers" (3) of the muscle immediately surrounding the trigger point.

In addition the physical therapist will also prepare the trigger point for manipulation by either icing down the trigger point and surrounding muscle or applying a vapocoolant spray over the muscle and painful areas prior to manual manipulation.(4) The goal of both the injection and the physical therapy is to coax the trigger point to relax its tight grip on the muscle.

Figure 1 shows a perpendicular injection into a trigger point, which is the injection into the central area of the trigger point that was previously mentioned. Figure 1 also shows a similar injection into the trigger point at an angle in the inset picture. Many physicians will inject straight in and at angles to the right and to the left to insure reaching all areas of the trigger point needed to ease the patient's pain.

Botox, or Botulinum Toxin Type A, is injected in a similar manner that lidocaine is injected. Botox is a drug developed from a toxin produced by the bacterium Clostridium botulinum, which is the same toxin that causes food poisoning or botulism. (5)

This is the same botox that dermatologists and plastic surgeons use to treat facial wrinkles to make their patients look younger. Doctors also use botox in small doses to treat "Cervical dystonia - a neurological disorder that causes severe neck and shoulder muscle contractions." (6)

Cervical dystonia and the neck and shoulder muscle contractions are a fancy way of saying that the trigger points in those muscles are working overtime and causing the muscles to contract to the point of causing severe pain. If you can get the trigger points to relax their grip on the muscle, the pain will subside.

"Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves." (7) A muscle that is weakened or cannot contract will also not be able to cause pain by overcontracting.

The negatives of botox are that its effect ony lasts from three to six months after which the needling procedure must be performed again to continue to ease the pain. Botox can also cause pain in the injection area and even worsen the symptoms that you are trying to eliminate.

When botox is used to treat cervical dystonia, the pain in the general area of the injection will increase somewhat for a week or ten days, after which the pain caused by the trigger points will ease or dissipate completely. However, the treatment can occasionally backfire by increasing pain in the injection area and never easing, leaving the patient in an even worse state of pain and never easing the pain.

Botox can also cause flu-like symptoms, headache and upset stomach. According to the Allegan, Inc. web site, which is the company manufacturing botox, other side effects may include: "dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes," problems swallowing, speaking, or breathing, or a spread of toxin effects to other areas of the body. (8)

Dry needling is performed in the same manner as injecting lidocaine or botox, however, no medicine is injected into the site. The needling itself is sometimes enough to induce the trigger point to relax. Dry needling can be performed by an acupuncturist or a medical doctor.

The following video is an example of how a doctor performs dry needling on the infraspinatus muscle:

The efficacy of any of the forms of needling will naturally depend upon the reason for the flare up of the trigger point. In the case of a trigger point flareup caused by trauma, such as an auto accident,the flareup may subside completely after treatment or may return because of permanent injury such as spinal cord injuries.

• Managing Chronic Pain

• Referred Pain? What's That?

• What Are Trigger Points?
  

(1) Dictionary.com. http://dictionary.reference.com/browse/lidocaine, retrieved 10/25/2009.

(2, 3, 4) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 491.

(5, 6, 7) Medline Plus - Botox. http://www.nlm.nih.gov/medlineplus/botox.html. Retrieved 10/26/2009.

(8) Botox Cosmetic. http://www.botoxcosmetic.com/. Retrieved 10/26/2009.

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What Are Trigger Points?

The term "trigger point" was coined by Dr Janet Travell and Dr David Simon in the 1950s. A trigger point is a local hardening of an area in a muscle that often hardens to such a degree that, when touched with your finger, or palpated, it feels almost solid, like something entirely separate from the muscle itself. (1)

But the trigger point is a real part of the muscle, not at all a separate entity. When the muscle is pressed upon the trigger point will slide slightly away from the point of touch, or palpation. In figure A we see the trigger point slide to the right.

Likewise, when you press the trigger point from the opposite side, it will slide away from the point of pressure, or in this case to the left as seen in Figure B.

Trigger points are also sometimes referred to as Trigger Zones, Trigger Spots and Trigger Areas. You will also see Myofascial Trigger Points frequently mentioned when discussing these devilish areas of your muscles. (2)

All of these terms refer to the same area, Trigger Points, which "are localized and sometimes extremely painful contractures ('knots') found in any skeletal muscle of the body." (3)

"Trigger points...are described as hyper irritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain." (4)

That last sentence is probably one of the most telling of all. "Trigger point(s)...are...a common cause of pain." All skeletal muscles of the body have trigger points, and each and every one of them is capable of causing pain.

The pain caused by trigger points may range from a minor annoyance to a pain that is so crippling and severe that it induces people to commit suicide to rid themselves of the agony caused by the trigger point.

One of the most recognizable trigger points lies in the upper trapezius muscle, which lies atop of the torso resting between one's shoulder and neck.


The area in yellow in the diagram above shows a trigger point that lies in the upper trapezius muscle that most people will recognize. This area is one that frequently tightens up because of stress and is part of an area that people automatically massage to loosen the muscle up, especially when one is fatigued.

In addition to causing pain to the area immediately surrounding the trigger point, the trigger point will often cause referred pain to a completely different muscle. Trapezius trigger points will often refer pain to the sides (scalenes) of the neck, to the jaw and to the temple of the head, causing headaches. (5)

Despite the many areas of the body to which trigger points can refer pain, successful treatments are available assuming that one finds the proper medical professional.

• Trigger Point Needling to Alleviate Pain

• Referred Pain? What's That?

• Managing Chronic Pain
  

(1) Color Atlas of Acupuncture, Body Points, Ear Points, Trigger Points, 2nd Edition; Authors: Hans-Ulrich Hecker, MD, Angelika Steveling, MD; Elmar T Peuker, MD; Joerg Kastner, MD; Kay Liebchen, MD. P 168.

(2) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 8.

(3) Wikipedia, Myofascial pain syndrome, http://en.wikipedia.org/wiki/Myofascial_pain_syndrome, retrieved 10-18-2009.

(4) (3) Wikipedia, Trigger point, http://en.wikipedia.org/wiki/Trigger_points, retrieved 10-18-2009.

(5) Myofascial Pain and Dysfunction: The Trigger Point Manual; Authors: Janet Travell, MD and David Simons, MD. p 279.

Ready to Try Trigger Point Therapy? Click Here!

Managing Chronic Pain

The purpose of this site is to introduce chronic pain sufferers to a method of treatment and management of chronic pain through a combination of trigger point therapy and acupuncture point therapy.

This is a system of pain management with which even many medical doctors have little familiarization. Most folks are somewhat familiar with or have at least heard of acupuncture, but relatively few lay people are aware of the benefits of trigger point therapy.

Trigger Point Therapy was discovered and developed in the United States by Dr Janet Travell, a brilliant physician who "developed and popularized the diagnosis and treatment of myofascial pain syndrome secondary to trigger points." (1)

In order to avoid tedious technical jargon which is difficult for most lay people to understand, care will be taken to avoid such lengthy medical terms whenever possible. However, in order to understand how Trigger Point Therapy works, you should have a basic understanding of what it is.

"Myofascial Pain Syndrome (or MPS) is a term used to describe one of the conditions characterized by chronic, and in some cases, severe, pain. It is associated with and caused by "trigger points" (TrPs), which are localized and sometimes extremely painful contractures ('knots') found in any skeletal muscle of the body." (2)

"Trigger points or trigger sites are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point researchers believe that palpable nodules are small contraction knots and a common cause of pain." (3)

The basic tenet of Dr Travell's is to locate the trigger point or points responsible for the patient's pain, treat the irritability of the trigger point through various means, and the pain will often dissipate and even disappear completely.

Dr Travell, in association with Dr David Simons, wrote Myofascial Pain and Dysfunction: The Trigger Point Manual, which is the master reference book that medical providers worldwide use to treat pain related to irritated trigger points.

The following are some of the conditions that may be successfully treated with Trigger Point therapy: Abdmominal pain, achilles tendonitis, ankle sprain and pain, ankylosing spondylitis, lower and upper back pain, bell's palsy, busitis, calf pain, carpal tunnel syndrome, cervical spondylosis, chronic fatigue syndrome, muscular chest pain, coccyx injury, costocondritis, dupuytren's contracture, earache, elbow pain, facial neuralgia or tic, facial pain, fibromyalgia, finger pain, foot pain, ganglion, gout, groin injury, hamstring injury, hand pain and stiffness, head pain including headaches, heel pain, hernia, hip pain, intercostal Neuralgia, knee pain, runner's knee, lower and upper leg pain, mandibular pain, menstrual cramps, metatarsalgia, migraine, muscle cramps, muscle sprains, strained muscle, pulled muscle, neck pain, pelvic pain, osteoarthritis, peripheral neuropathy in hands and feet, post operative pain, prolapsed disc in lower back, rheumatoid arthritis, sciatica, scoliosis, shin splints, shingles, frozen shoulder, shoulder pain, spondylosis, temporo-mandibular pain, tendonitis, thigh pain, thumb pain, trigger thumb, and wrist pain. (4)

• Trigger Point Needling to Alleviate Pain

• What Are Trigger Points?

• Referred Pain? What's That?
  

(1) Wikipedia. Janet G Travell, http://en.wikipedia.org/wiki/Janet_G._Travell, retrieved 10-18-2009.

(2) Wikipedia, Myofascial pain syndrome, http://en.wikipedia.org/wiki/Myofascial_pain_syndrome, retrieved 10-18-2009.

(3) Wikipedia, Trigger point, http://en.wikipedia.org/wiki/Trigger_points, retrieved 10-18-2009.

(4) Natural Health, Pain Management in the 21st Century, pp 55-210, Bruce R Hocking.

Ready to Try Trigger Point Therapy? Click Here!