Definition:
We take a
multi-disciplinary approach to treating trigger points of myofascial
origin. Trigger points are defined as areas of muscle sensitive to
palpation. These areas can occur in any muscle of the body but are
generally localized in the upper and lower back muscles. Myoneural
injections are frequently done to these palpable areas and then physical
therapy is instituted to get the best range of motion while the area is
anesthetized. The tender areas are located and marked with a skin marker
and then injected with long-acting numbing agents along with a corticosteroid
preparation, through a thin needle. These medicines will help reduce
inflammation and pain. Initially, the pain may feel worse but this
quickly subsides and prompt relief is obtained.
Depending on
each patient's condition, the best time to have your physical therapy done may
be after a myoneural injection. Other modalities used by the Physical Therapy
Department include moist heat, massage, cold pack application, TENS unit, spray
and stretch, electrical stimulation and ultrasound.
Along with
the myoneural injection, a non-steroidal anti-inflammatory drug may be
prescribed. In addition, an appointment for biofeedback and relaxation
techniques may be considered beneficial in your care.
Factors that
have been identified as precipitating the formation of trigger points include
excessive strain of any given muscle, poor nutrition, poor posture, endocrine
or metabolic imbalances, mechanical discrepancies (i.e., one leg shorter than
the other) and excessive stress or anxiety. Other phenomenon that have
been identified as increasing the intensity of myofascial pain include smoking,
cold or humid weather, fatigue, a sedentary state and overactivity.
Complications:
The local
infiltration block or myoneural block can be safely performed as an outpatient procedure.
However, as with any block, certain complications may occur. These
include, allergic reactions to the medicines, local anesthetic toxicity, and in
extremely rare occasions, pneumothorax (punctured lung), seizures and even
death. Even though these complications are seldom seen, resuscitative equipment
with experienced doctors and nurses are always close by to handle these
emergency situations.
Things that
you can do to help in your care with the treatment of trigger points or
myofascial pain are as follows:
1. Stop smoking.
2. Practice home exercises taught to you
by your physical therapist.
3. Practice relaxation techniques given
to you by your psychologist or biofeedback technique.
4. Avoid stressful situations whether
physical or emotional that have been known to intensify your pain.
5. Take medications prescribed
regularly.
6. Eat a well-balanced meal and
supplement with vitamins if you feel your diet is not providing all that you
need.
7. Get at least 7 to 8 hours of sleep
per night.
8. Shower everyday, early in the morning
with warm-hot water. This helps relax the muscles and promotes blood flow,
which in turn, helps eliminate the by-products of the increased metabolism.
9. Add to your diet a supplement of
"anti-oxidants" (Vitamin C, A, E, etc.). They can be purchased in any
pharmacy, over-the-counter. The can be found in the Vitamin section. If you
have a problem finding them, ask your pharmacist.
10. Take a "sports drink" daily
(Gatorade, etc.). They will help correct any electrolyte imbalances that you
may have.
What to expect after the block:
You can
imagine that if the area is tender to palpation, sticking a needle into it will
be "no fun". In fact, a hallmark of the procedure is that it will be
painful on injection. This pain will last a couple of seconds, after that it
will go numb, due to the local anesthetics. This numbness may last 4-6 hours,
after which, the pay will come back, probably worse for about 5 to 6 days until
you get the benefit of the steroids. You may also experience some muscle spasms
for a couple of day. All of this is normal. The steroids will begin to work
immediately after the injection, but it will take 5-6 days for the swelling to
come down to the point where you will be able to tell a difference. Apply Ice
to the injection area, immediately after the procedure, and heat the day after.
This will help minimize the discomfort.
The Pain
Program recommends that you have a driver to drive you home after your block.