Ask the Doctor: Are trigger point injections cumulative over time?

Q: I have been getting weekly trigger point injections for a month. I don't see any improvement. Are the injections cumulative over time or can you suggest anything else for pain?

One should know immediately whether a myofascial trigger point injection is effective. Firstly, if the trigger point is accurately located there should be a sharp pain when it is pierced; sometimes this is associated with a muscle twitch and pain referred to a nearby location. So it is important to provide this feedback to your doctor. Assuming the injection fluid contained a local anesthetic, there should be an almost immediate reduction in pain that lasts for several hours. A more long-lasting effect often takes a day or two to become apparent. The effectiveness of trigger point injections seldom lasts more than a couple of months at the most. Most myofascial trigger points have associated satellite trigger points; unless these also injected, pain relief will not be optimal.


Robert M. Bennett, MD, FRCP, FACP, MACR is Professor of Medicine and Nursing at Oregon Health and Science University (OHSU) in Portland, Oregon. He is a past President of the International Myopain Society and the American College of Rheumatology Western Region, and has been on the Editorial Boards of Pain, Arthritis and Rheumatism and the Journal of Musculoskeletal Pain. In 2007 he was elected a Master of the American College of Rheumatology (MACR), in recognition of his contributions to rheumatology research and teaching.

Dr. Bennett and his colleagues at OHSU have been actively involved in fibromyalgia research since 1980. He founded the Fibromyalgia Information Foundation in 1995 and continues as their executive director and webmaster. Starting in 1971 Dr. Bennett has been a regular contributor to the rheumatology literature with over 500 articles, abstracts and book chapters. He holds three US patents (5,378,686, 5,965,520, and 7,132,399) for discoveries regarding growth hormone and the molecular characterization of cell surface DNA receptors.

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