"Medical practice must be inspired with soul and be filled with understanding and equipped with the gift of keen observation; these together with accurate scientific knowledge are the indispensable requisites for proficient medical practice."

~ Maimonides,
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Articles: Trigger Points

Trigger Points and Chronic Pain

Nearly everyone experiences muscle pain from time to time but it is often temporary and resolves on its own. However, when a muscle is injured or over stressed small contractions known as trigger points may form causing a wide variety of chronic pain conditions.

Trigger points are highly irritated, painful spots found in muscles that are the result of injury, overuse, or chronic stress. Trigger points can be found by careful diagnosis. They are usually painful to the touch and contain nodules (or knots) and tight bands that can often be felt under the skin. When these trigger points irritate the nerves around them they cause “referred pain”, in other words they send their pain to some other site in the body, often far away from the actual trigger point itself. This can be very misleading to health care providers and is often the reason why so many conventional treatments for chronic pain fail. Conditions frequently associated with trigger points include neck or back pain, joint pain, pain in the limbs, sciatica, headaches, migraines, sinus irritation, heartburn, dizziness, nausea, irritable bowel, and many others). Some experts even believe that trigger points are the beginning stage of fibromyalgia.

Myofascial pain syndrome is a chronic condition that results in pain and inflammation in muscles, fascia and other soft tissues of the body. Myofascial pain syndrome is the result of un-treated trigger points that have, over time, persisted or worsened. With myofascial pain or other chronic pain conditions it is important to note again, that the area where the person experiences pain or other symptoms may not be where the actual underlying “trigger” of the pain is located.

Chronic pain is almost always associated with trigger points. There are many treatment modalities that address them but trigger point injections have been shown to be one of the most effective treatments available to bring about prompt relief, especially in complicated or chronic cases. Trigger point injections are used to alleviate the symptoms of trigger points, myofascial pain syndrome and many other chronic pain issues (such as back or neck pain) that haven’t responded to other therapies. It is a very simple office procedure that involves the injection of small amounts of procaine (or other local anesthetics of the “caine” family) into the trigger point. The goal of these injections is to relax the area of muscle contraction. This often results in immediate pain relief and increases blood flow to the area so that tissue may begin to repair itself. We typically also see immediate improvement of the referred pain that was caused by the trigger point. The procedure is relatively pain free and often results in a rapid, long term relief of pain.

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