Trigger Point Injection
What is a Trigger point injection (TPI) Trigger point injection (TPI) may be an option for treating pain
Trigger point injection (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body. WebMD
During the Trigger Point Injection procedure, the pain doctor inserts a small needle into the center of your trigger points. Typical the injection contains a local anesthetic or saline, and sometimes includes a corticosteroid. The purpose of the injection is to render the trigger point inactive and therefore the pain is alleviated. Hopefully the result is sustained relief. Injections are given in our office and usually take just a few minutes. Several sites may be injected in one visit.
Trigger Point Injections are used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. Many times Trigger Point Injections can be used to treat fibromyalgia and tension headaches. The technique is also used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatments. We have found that Trigger point injections can be very useful in tandem with Chiropractic adjustments for car accident victims.
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Typically when you ask a pain management doctor about joint injections he or she would say in what part of the body? So for this discussion we are going keep our discussion to the joints of the arms and legs (Upper & Lower extremities).
Joints form the connections between bones. They provide support and help you move. Any damage to the joints from disease or injury can interfere with your movement and cause a lot of pain. Many different conditions can lead to painful joints, including osteoarthritis, rheumatoid arthritis, bursitis, gout, strains, sprains, and other injuries. Joint pain is extremely common. In one national survey, about one-third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint, followed by shoulder and hip pain, but joint pain can affect any part of your body, from your ankles and feet to your shoulders and hands. As you get older, painful joints become increasingly more common. Joint pain can range from mildly irritating to debilitating. It may go away after a few weeks (acute), or last for several weeks or months (chronic). Even short-term pain and swelling in the joints can affect your quality of life. Whatever the cause of joint pain, you can usually manage it with medication, physical therapy, or alternative treatments.
Typically the joint injections of specific joints in the arms and legs are utilized to decrease pain and inflammation involving the ligaments, tendons and cartilage. Because each specific joint is capable of a myriad of different movement (bending, flexing and twisting), they are susceptible to to traumatic injury.
Obviously, the larger joints of the hip and leg also function to bear your body’s weight and facilitate walking, running and jumping. The Joints of the upper extremities are susceptible to repetitive movement or a traumatic injury that causes quick and extensive movement that stretches causing excessive sprain and strain in the soft tissues of the joints such as muscle, ligament and tendon tissues. Although all the joints of the upper and lower extremities are susceptible to these quick and repetitive movements. The shoulder is especially susceptible because of its ability to perform large ranges of movement. The shoulder is the most predisposed to become frozen and this is called “Frozen Shoulder” or Adhesive Capsulitis.
Injury to the joints of the arms and legs are normally very troublesome to say the least and most of the time decreases one’s ability to perform activities of daily living.
Obviously if you are suffering with injury to the muscles, tendons, ligaments tissue of your affected joints and have not responded to initial treatments such as chiropractic or physical therapy, over-the-counter pain relievers such as ANSADS, massage therapy, hot and/or cold application as well as rest are candidates for joint injections. The goal is to may relief of pain through joint injections.
These joint injections are minimally invasive and performed in our office as an outpatient setting, hopefully providing an alternative to surgical consideration.
Joint injections are intended to decrease pain, promote healing and improve quality of your life, allowing you to be more mobile and enjoy an energetic healthy lifestyle.
Your doctor at Avondale Pain management and treatment will diagnose and treat the condition that is causing your joint pain with the number one goal to reduce pain and inflammation and improve your overall joint function.
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Spinal epidural steroid injections are a frequently used treatment for chronic pain syndromes, especially if a person suffers with radicular pain which means arm pain if the neck is the source of pain and leg pain if the source of pain is emanating from the lower back or Lumbar region
What is radiculopathy?
Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy). Medicine.net
OK …so radicular means root or nerve root and typically refers to an irritated nerve root “radiculitis” anything to do with nerves you just add “Itis” or weakness associated with an affected nerve root “Radiculopathy.”
Radicular pain is pain that radiates from the spine down an irritated spinal nerve root. Irritation of a spinal nerve in the low back, called lumbar radiculopathy, causes pain that typically travels down a leg. Cervical radiculopathy describes pain that travels down an arm. Epidural injections are also used to treat nerve compression in the neck (cervical spine), and well as the low back (lumbar spine).
Typically the Epidural Steroid injection procedure involves injecting a “cocktail” of two or more medication into the epidural space, where irritated nerve roots are located. This injection includes both a long-lasting steroid and a local anesthetic. The steroid reduces the inflammation and irritation and the anesthetic works to interrupt the pain-spasm cycle and pain signal transmission function of the nervous tissue know as nerve roots or the part of the nerve when it first originates from the spinal cord. The “cocktail” of medicine then able to spread to other levels of the spinal nerves because of the anatomy of the nerves and spine, reducing inflammation and irritation. Amazingly the entire procedure usually takes less than fifteen minutes.
Do Epidural Steroid Injections hurt to receive?
Steroid Injections are considered to be routine and relatively painless. Approximately 72% of patients experienced immediate pain relief in a 2007 research trial to evaluate the usefulness of a cervical interlaminar epidural steroid injection in patients with neck pain and cervical radiculopathy (Kwon 2007). If pain relief is only moderately achieved with the first injection then another injection can be given in 2 weeks and may provide additional relief.
The use of multiple injections was studied by the Department of Anesthesiology and Intensive Care at the University of Pavia, Italy and they concluded that therapy with multiple Epidural Steroid Injections did in fact provide better control of chronic neck pain compared to that with a single injection.
The Good News
If your first worked well to help relieve your pain, and chances are it will help, you are a candidate for up to two more injections!!
What are my risks when undergoing Epidural Steroid Injection
Epidural Steroid Injections are considered an appropriate non-surgical treatment for many patients who suffer from back and neck pain. Although ESIs are considered safe and are one of the most commonly performed procedures in the world, there are risks associated with the procedure. The major risks associated with this procedure involve bleeding, infection, post-dural puncture headache, and nerve damage.
If you have neck, arm, low back, or leg pain (sciatica) stemming from inflammation of the facet joints you may benefit from a facet injection. Typically, it is recommended for those who fail to respond to other conservative treatments, such as oral anti-inflammatory medication, rest, back braces or physical therapy. The doctor may wish to perform the injection as a diagnostic test to determine if the facet joint is causing your pain. Facet injections may be helpful in treating inflamed facet joints caused by:Spinal stenosis: A narrowing of the spinal canal and nerve root canal can cause back and leg pain, especially when walking. Spondylolysis: A weakness or fracture between the upper and lower facets of a vertebra. If the vertebra slips forward (spondylolisthesis), it can compress the nerve roots causing pain. Sciatica: Pain that courses along the sciatic nerve in the buttocks and down the legs. It is usually caused by compression of the 5th lumbar or 1st sacral spinal nerves. Herniated disc: The gel-like material within the disc can bulge or rupture through a weak area in the surrounding wall (annulus). Irritation, pain, and swelling occur when this material squeezes out and comes in contact with a spinal nerve. Arthritis: Joint inflammation caused by degeneration of the cartilage; causes pain, swelling, redness, and restricted movement. Postoperative pain: Acute pain following discectomy or spinal decompression caused by disruption of the facet joint or spine muscles.
Radiofrequency ablation is the utmost progressive treatment available for treating pain created at the spinal joints known as facet joint related pain. Facet Joint pain can be in the neck upper back, mid to low back and sacroiliac regions.
Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up and ablate a small area of nerve tissue, thereby decreasing pain signals from that specific area. Web MD
Radiofrequency Ablation or RFA procedure has several medical interchangeable names such as Medial Branch Block, radiofrequency rhizotomy and/or even RF procedure. By whatever name RFA procedure utilizes electromagnetic technology at the speed of light combined with extremely high frequencies, giving the procedure its effectiveness.
RFA procedure lasts much longer than corticosteroid injections so the typical RFA candidate has usually had some good success with steroid injections into the joints of the spine called facet joints. Facet Joints are finger nail sized joints on both sides of your spine. These joints are lined with cartilaginous tissue are very rich with sensory pain fibers and therefore are susceptible to arthritis and can produce quite exquisite pain. Therefore your interventional pain management physician will only suggest a radiofrequency procedure if you have experienced pain relief from facet joint injections that wear off.
During the Radiofrequency Ablation procedure the nerve tributaries known as the medial branches are heated with radiofrequency current until they no longer transmit pain sensation. Typically there are 2-3 levels treated because of the way your spinal joints are supplied with nerve endings. So it is like throwing a circuit breaker that affects several appliances or outlets in a house.
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RFA can be performed in a pain management office which have a Fluoroscope which is an x-ray device that allows the doctor to know exactly where he is placing the RFA probes or is done at an ambulatory surgical center.
Since you have had significant relief that wears off following facet joint injection your pain doctor will already know what facet joints are involved and therefore will include one spinal level above and below the levels you have already had relief with injections.
Many candidates have the RFA without twilight sedation it is available for those who choose to have it. Most of the time patients just take a few Tylenol about a half hour prior to the procedure. Typically you will lie face down on a specialized x-ray procedure table and the doctor will use fluoroscopic guidance to place the RF needles(s). Once placed and the placement is verified as spot on radiofrequency current is passed through and the procedure is completed and after a brief recovery but mostly observatory period you will be released to go home. You will be expected to just take it easy for the day and can go to limited work the next day. If you elected for twilight sedation you will need a driver and you cannot eat after mid night the night before your procedure.
Your doctor will want to perform this procedure up to three times approximately 2 weeks apart depending on how chronic and the level of pain you have.
There is extensive proof in the research literature 50 to 90% of the time relief has lasted between 6 to 24 months and one study showed an average relief period of time as being 16 months.
Unfortunately the nerve endings that make up the medial branch may grow back and therefore produce pain again. The good news is you can have the procedure done again and can expect good results.
If you are suffering from neck pain, mid back or low back pain, the pain doctors at Avondale Pain Management and Treatment are experts in radiofrequency ablation procedures.
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