Trigger point injections

Your doctor has referred you to the Pain Clinic for specialist advice on your pain.

The Consultant in Pain Management has recommended that you consider local anaesthetic and steroid injections to painful points in a muscle which may be involved with your pain. (Myofascial trigger point injections.)

This leaflet aims to explain this procedure to you and to answer some of the questions you may have.

Please read it carefully. Ask if there is anything you do not understand.

Before going ahead with the procedure the Consultant will discuss the expected benefits and risks with you.

Trigger points are described as very irritable spots in a muscle that may, when pressed, trigger off pain.

This pain may be where they are pressed, or in another area of the body. Why these points develop is not well understood.

This type of treatment can be considered for a number of reasons. The injections will involve injecting a mixture of local anaesthetic and steroid. The local anaesthetic can quickly cause the trigger point to relax.

The steroid may help to dampen down pain signals from this painful area.

In some cases the procedure may have to be repeated as many as four times. However, you may feel a
benefit after one or two injections.

Injecting steriods into trigger points is not a licensed use of the drug. However there is some evidence that these injections can be helpful.

Will it help?

Unfortunately there are no guarantees as to how much pain relief you will get or how long it will last for.

Everyone's pain is unique and responds differently.

The procedure - what to expect?

This procedure is usually carried out in the Day Procedure Unit at the Borders General Hospital.

Below is a summary of what to expect.

• The Consultant will review with you any changes in your general health
• You are asked to bring an up to date list of any medicines you are taking
• You will be asked a number of questions, often more than once. This is designed for safe care
• After discussion with the Consultant and your consent to the procedure, you will asked to make yourself comfortable on the bed
• You should not need to undress fully or take off under garments
• Wear loose fitting clothes that can be easily pulled down or lifted up
• The area to be injected is cleaned with antiseptic and examined by the doctor to try to find the irritable spot(s).
• The mixture of local anaesthetic and steroid is then injected. This can sting a little at first. You may get more than one injection depending on how many trigger points there are.

Will it be painful?

Local anaesthetics will sting for a few seconds. As the injection is given you may feel an increase in your pain.

This does not last long and can help the doctor find the right place to do the injection.

What happens after the injection?

You will normally be able to get up off the bed by yourself and walk normally.

Pain relief may happen in the following ways:

1. Immediate relief lasting for several weeks.
2. Worse for a while and then relief for several weeks.
3. No change at first and then gradual relief over several weeks.

But sometimes no pain relief happens at all.

Going home

You may go home as soon as you feel ready.

• Temporary numbness where you have the injection which usually wears off after a few hours. This is often considered a desirable effect.
• Irregular menstrual periods due to hormonal imbalance. This is caused by the Depomedrone and usually does not last long.
• Post menopausal bleeding (a "period" which happens after your normal periods have stopped) due to hormonal imbalance. This is caused by the Depomedrone and usually does not last long.
• Depomendrone may cause a temporary rise in blood sugar levels in diabetics. Non-insulin- dependent diabetics do not normally need to take any further action. Those taking insulin may need a slight increase in their dose. Please ask your family doctor for further advice about this.

What are the possible complications of this treatment?

Soreness or bruising around where you have the injection. This usually settles within a few days.

No pain relief is probably the most common side effect for the reasons already given.

The pain may be worse afterwards rather than better. This is unusual and does not usually last long

It is important to feed back your response from the procedure. Usually arrangements will be made for the Clinical Nurse Specialist to phone you about 4 weeks after the last injection. This is to see if any benefit gained has been maintained. Alternatively you may be placed on an open review and asked to contact us when any benefit has worn off so we can see how long the benefit has lasted.

Useful contact details

If you still have any questions after reading this leaflet, please contact the Pain Clinic or leave a message with the Pain Clinic Nurse Specialist tel:01896 826335 or Pain Clinic Secretary/answer phone tel:01896 826323 and we will return your call.

Pain Clinic
Borders General Hospital
Melrose TD6 9BS