Overview

A trigger point is a tender area of your body, often a muscle, which when pressed causes pain. Usually, muscles contract and relax. At trigger points, the muscle might fail to relax, and a knot or tight band of muscle is formed.

Several injections are usually made in 1 session. They contain local anaesthetic, often with a small amount of steroid.

The injections are usually given into the muscles at the shoulders, neck or back, and are often given alongside other treatments, such as physiotherapy.

Other treatment options

The decision about treatment is shared between you and your doctor. If there are any other treatment options available, your doctor will discuss these with you. Your doctor can give you up-to-date information about the chances of this being a successful treatment for you, and how it fits into the best pathway of care.

If you are undecided about treatment, more advice and information can be provided. Please speak to your doctor about this.

Side effects

As with any procedure, you can have side effects. However, these are usually very minor and there is little risk of serious harm.

Not everyone will get them, but possible side effects include the following.

Common side effects

• Mild tenderness or bruising at the injection sites, that usually settles over the first few days.

Rare side effects

• Infection, that might need treatment with antibiotics. Contact your GP or NHS 111 if there is warmth, redness or soreness at the injection site, or you feel hot and unwell.

• Skin discolouration (a risk when injections are close to the skin, but very rare, and most commonly seen in brown or black skin)

Asking for your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what treatment involves and agree to have it.

If you would like more information about our consent process, please speak to a member of staff caring for you.

Before treatment

If your health has changed, it is important to let your doctor know if you:

• have an infection in your body or on your skin (your doctor will delay the treatment until the infection is cleared)
• have any allergies

You must also tell the doctor if there is any chance that you could be pregnant.

If you are planning to fly or travel abroad within 2 weeks after the injections, please let your doctor know, as it might be best to change the date of the injections.

Make sure that you have made arrangements for someone to collect you after the procedure. If you do not, your procedure will probably be cancelled. It is unsafe for you to drive immediately after the procedure. If you do so, your car insurance will not be valid.

Bring a list of all of your current medicines, including any you buy from a pharmacy or shop, and any herbal or homeopathic remedies.

Continue to take your medicines as usual on the treatment day.

During treatment

Not all doctors give these injections in exactly the same way, but this is generally what will happen.

• Observations, such as blood pressure and pulse rate, might be taken.
• You will be carefully positioned, and the skin around the injection sites will be cleaned with an antiseptic solution or spray. This can feel very cold.
• You will feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. Your doctor will warn you of this.
• The doctor will direct the needles to the area suspected to be a source of pain.
• When the injections are given, you might feel pressure, tightness or a pushing sensation. If there is any discomfort, let the doctor know.

After the treatment

After the injections, you will be taken to a recovery ward where nursing staff will observe and monitor you. You will be told when you can get dressed, and be given help to make sure that you can stand safely after the procedure. You will be given more advice when you are ready to leave hospital.

Leaving hospital

You can usually leave hospital within a few hours after the injections, and sometimes much sooner. This will depend on how long your doctor or nurse want you to stay for in recovery.

You should arrange for someone to stay with you for 24 hours after your treatment. If this is not possible, you should at least have access to a phone. During this time you should not:

• drive
• operate machinery
• sign legal documents
• provide childcare unsupervised
• drink alcohol

If you are unsure, please discuss these issues with your doctor.

Before you go home you will be given information about who to contact outside office hours. If it is an emergency, go to your nearest emergency department (A&E) or call 999.

You might have some soreness or aching at the injection site in the days after treatment.

Keep the injection sites dry for 24 hours after the procedure.

Do not worry if your pain feels worse for a few days, as this sometimes happens. Take regular painkillers and medicines as normal, and this should settle down. Move about if you can, but avoid anything too strenuous.

As your pain decreases, you should try to gently increase your exercise. Simple activities, like a daily walk, using an exercise bike or swimming, will help to improve your muscle tone.

It is best to increase your activities gradually. If you are unsure, or finding exercises increasingly difficult, please contact your GP or the pain team and discuss a referral to physiotherapy.

Returning to work

This will be different for everyone, and might depend on the nature of your work. It is difficult to give general advice, so you should discuss this with your doctor.

Follow-up appointments

You will receive a letter with details of a follow-up appointment. It will be a phone call with a nurse specialist, or in clinic with a consultant. If you haven’t heard from us within 10 weeks after the procedure, please contact us, phone 020 7188 4714, Monday to Friday, 9am to 5pm.

Acknowledgements

Adapted from information from the Faculty of Pain Medicine of the Royal College of Anaesthetists, and includes contributions from Addenbrooke's Pain Management Unit, the Chronic Pain Service at St Georges Hospital London, Newcastle Pain Management Unit, and the Interventional Specialist Interest of the British Pain Society.