Abstract: Tender Point Injections Are Beneficial in Fibromyalgia Syndrome: A Descriptive Open Study

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Editor’s Note: This abstract appears in the Journal of Musculosckeletal Pain, Vol. 8 (4) 2000, and is used with permission of the Haworth Press.

A new study investigated the possibility of using tender point injections as a form of treatment for Fibromyalgia Syndrome. Below are some of the highlights from the authors’ discussion of the study, followed by the actual study abstract.

Reasons for Investigation

FMS is a form of nonarticular rheumatism characterized by chronic pain at widespread locations accompanied by tender points (TePs) at multiple sites, fatigue, and poor sleep. Management of FMS involves a multidisciplinary approach. Management includes nonpharmacologic therapy, e.g., education, psychological support, and physical therapy, as well as various medications, including simple analgesics, e.g., acetaminophen and nonsteroidal anti-inflammatory drugs. However, treatment is generally unsatisfactory, and it has been suggested that TeP injections are useful in FMS.

First Study of Its Kind

Although several papers have described the efficacy of trigger point (TrP) injections in myofascial pain syndrome, data in FMS are limited. Ours is the first detailed study on TeP injections in FMS. The single previous publication of such a study had important limitations, e.g., a small number of only nine patients. Our study was open and uncontrolled, but has several strengths. We collected data by a protocol and asked patients to record the duration of pain relief in a diary. Also, importantly, the study was carried out in the usual clinical setting, allowing us to follow the patients over a relatively long period.

Positive Results

Our study demonstrated that the mean duration of benefit per injection site was quite long, i.e., 13.1 weeks. We consider this duration of pain relief to be very satisfactory. In fact, in our practice, TeP injections are the only modality that significantly helps some patients. Many of these patients were kept functional in their jobs and daily activities primarily through TeP injections.

Safety

Tender point injections are remarkably safe in experienced hands. Although one of our patients had a brief postinjection flare, such an adverse effect is extremely rare in our practice. Without adequate training, however, a nerve, an underlying intrathoracic or intraabdominal organ may be injured; such a complication never occurred in our hands.

Relationship to Myofascial Pain Syndrome

The benefit of TeP injections in FMS and TrP in MPS involving a probable central mechanism may suggest a common pathophysiologic mechanism of an aberrant central pain mechanism for both conditions. In fact, it has been suggested that MPS and FMS are overlapping and similar conditions.

Significant Relief for Majority Patients

In conclusion, our prospective but open study of TeP injections in FMS provided significant relief for a mean period of nearly 13.1 weeks per injection site; only one of 41 patients failed to respond. Thus, TeP injections are a very useful adjunct to other standard therapy in FMS with minimal adverse reactions. However, further studies with appropriate design are warranted.

Abstract

Objective:

Efficacy of tender point (TeP) injections in fibromylagia syndrome (FMS) has not been well described in the literature. The goal of our study was to determine the extent of benefit from such injections in this syndrome in the usual clinical practice setting.

Methods:

Tender points at most symptomatic sites of forty—one patients with FMS, 40 females and one male, were injected with a mixture of ½ ml 1% lidocaine and ¼ ml intralesional triamcinolone diacetate suspension, and prospectively followed for a mean period of 66 [range 14-240] weeks. All patients were asked to maintain a diary to record the duration of pain relief from injections. They continued their usual therapies.

Results:

On an average, 3.97 injections per visit were performed. Mean duration of pain relief per injection site was 13.1 +- 9.4 weeks excluding a single outlier patient. Only one patient failed to obtain any relief at the injected site. There were no side effects with the exception of a brief postinjection flare in one patient. No demographic or clinical variables at initial consultation were associated with duration of pain relief, with an exception of anxiety and depression scores, which were negatively correlated.

Conclusion:

Our prospective but open study demonstrated that TeP injections are a useful and safe adjunct to other forms of therapy in FMS. However, further studies in the future are indicated.