Trigger Point Injections

Trigger Point Injections

Trigger point injection therapy is used to relieve painful trigger points—painful areas of overactive muscle that have become too tight and feel like “knots” or hard lumps when pressed. If pressure is applied to a trigger point, this may “trigger” extreme pain at the point of touch and often in other parts of the body as well. For instance, pressing a trigger point at the base of your neck could cause eye pain or send pain into your shoulders or hands.

Muscles can form trigger points when they are injured (e.g., after a car accident or an athletics injury) or strained. Everyday, repetitive motions (such as typing, grasping a computer mouse, spending long hours at a computer, clenching tools, and sitting at a desk chair that doesn’t support your back) and holding your muscle in an awkward position for long periods of time (e.g., holding a phone between your ear and shoulder) can tightene or over-exert your muscles, causing trigger points to form. Being under emotional or mental stress can further aggravate trigger points if it causes you to tense certain muscles.

Any part of the body can develop trigger points, but most often they occur in the neck, shoulders, buttocks, and upper and lower back. When trigger points form, it can lead to headaches, stiff necks, shoulder pain, backaches, nerve irritation in the legs, and even tinnitus and temporomandibular joint pain. In extreme cases, it can limit your ability to move comfortably, disrupt your sleep patterns, and make you hurt all over and feel worn out. You may wake up feeling stiff and tired even when you think you had enough sleep.

What is a trigger point injection?

Taking measures such as reducing stress levels, improving your posture, and participating in an exercise program can often relieve trigger point pain. But not always. When these measures don’t correct a painful trigger point, your doctor may want to treat the problem with trigger point injection therapy. This is a therapy Dr. Sonia Pasi offers to select patients at Advanced Pain Consultants.

A trigger point injection (TPI) is an outpatient procedure used to treat painful areas of muscle that contain trigger points, or “knots” of muscle that form when muscles do not relax. TPI also can be used to treat fibromyalgia and tension headaches.

TPI therapy involves the injection of either a local anesthetic alone or a mixture of an anesthetic with a long-acting pain reliever (usually a corticosteroid), into the trigger point in the muscle. The injection basically “breaks up” the tight muscle, relieving muscle spasms and providing long-term pain relief. Sometimes several trigger points are treated in a single visit, if more than one is suspected to be causing pain.

Good candidates

Candidates for trigger point injections are people who have ongoing muscle pain—particularly “knots” or extremely tight muscles, chronic tension headaches, or fibromyalgia pain that has not improved with other treatment, including pain medication and physical therapy.

Trigger point injections are not recommended for people who have an active infection, bleeding disorder or allergies to the local anesthetic or medicines being used, or are pregnant or taking blood thinner medication.


Trigger point injections are administered in-office and normally take around 30 minutes (or sometimes longer if multiple trigger points are being treated). It’s a relatively simple and straightforward procedure. First, Dr. Pasi examines the patient to identify the trigger points. After cleansing the skin, she inserts the local anesthetic (and perhaps a pain reliever) into the trigger point area (or multiple areas if more than one trigger point is being treated) using a small needle. Once that’s been done, the needle is removed. Dr. Pasi will then massage the treatment area(s) to help the medicine spread throughout the muscles around the trigger point.

Following the injection, the skin will be cleansed and a bandage applied. The patient is then sent to the recovery room for observation for about 15 minutes, and then discharged to go home. Normal daily activities can be resumed immediately. There may be some soreness at the injection site, but this can be treated with ice packs or over-the-counter pain relievers (such as ibuprofen).


Immediately after the injection, it is normal to feel some pain relief, however, this is due to the local anesthetic that was injected. The steroid, when used, takes two or three days to take effect. When it does, some patients will experience significant pain relief that lasts for several weeks. Others may not benefit at all from the injections.

If the procedure was effective, injections may need to be repeated for multiple sessions, one or two weeks apart, until the trigger points are deactivated and the pain is gone or no longer severe. In some cases, patients may get the relief they need with just one injection. Most patients, though, need multiple injections. Sometimes Dr. Pasi may recommend additional types of pain treatments to help manage the pain, particularly if the pain is due to injury in more than one muscle area. There is no one-size-fits-all solution.

For more information

If you suffer from trigger points or painful muscle knots that are not responding to home treatments, please call Advanced Pain Consultants at (919) 510-7901 to schedule a consultation with Dr. Pasi. After a thorough evaluation, she will determine whether a trigger point injection, another treatment method, or a combination of therapies will best treat your condition.

A Holistic Approach to Pain Management