A question that has been asked on several occasions is which medications to use while performing a triggerpoint injection? The combination of medications clinicians use for triggerpoint and joint injections can be quite a complex mixture at times but it boils down to the individual clinicians judgement based on previous experiences from which combinations of short/long acting corticosteroid along with whichever "flavor" of short and/or long acting anesthetic works for them.
As far as my previous experience, I see no difference in sustained analgesic effect using corticosteroids in triggerpoint injections vs. using anesthetic alone. Now, I'm not saying NEVER use corticosteroids along with an anesthetic but one needs to remember why triggerpoints are being performed: 1. to provide relief of pain in the specific muscle and 2. to promote circulation of the triggerpoint area by active needling during the procedure. I know some clinicians that perform triggerpoint with a dry needle (no medications at all) with good results- however, I'm concerned about patients pain level while performing the procedure- especially in those with chronic myofascial pain (Fibro) that would require additional injections in the future.
Including corticosteroids in triggerpoint injections does pose a chance of hypopigmentation of the skin as well as atrophy of surrounding tissues that could cause scarring in that area. If you choose to perform triggerpoint injections with corticosteroids- Please discuss with the patient in rare occasions patients do experience these complications and have this on your consent form.
I'd love to hear from others who perform these procedures and what medication combinations work best for your patients?
All the best,
Andy Austin FNP-C, FAAPM
www.injectioncourses.com
Medical Procedures for Nurse Practitioners, Physicians and Physician Assistants
