Efficacy of trigger point injection for non-malignant persistent musculoskeletal pain: a narrative review
Published: January 28, 2025
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Myofascial pain is a commonly occurring reason for pain complaints and can affect patients' daily activities, work commitments and well-being. Several non-invasive approaches practised for myofascial trigger point relief are stretching, massage therapy, ischemic compression, and heat- therapy. Invasive treatment for trigger points commonly refers to the injection of fluid directly into the trigger points using a variety of substances, such as sterile water, saline, local anaesthetics, long-acting corticosteroids, or botulinum toxin. This review evaluates the efficacy of trigger point injections (TrPI) for patients with myofascial pain syndrome compared with non-invasive management options through published studies. In accordance with SANRA guidelines, 35 studies that focused on comparing TrPI and other therapeutic interventions managing myofascial pain syndrome, were included. Results indicate that a combination of TrPI, ultrasound therapy and myofascial stretches was found to be more effective than a stand-alone trigger point intervention. Tropisetron showed a 50% decrease in pain, botulinum toxin type A (BTX-A), and lidocaine injection also demonstrated improvement, although short-term, of up to 4 weeks. Physiotherapy in conjunction with BTX-A increased the efficacy of TrPI. Ultimately, both TrPI and ESWT demonstrated comparable results in managing myofascial pain syndrome. A clear limitation was a lack of objective clinical imaging testing while identifying trigger points or tender points. Current practice in treating myofascial pain syndrome remains empirical without established clinical standards. Although, TrPI have demonstrated its value in treating myofascial pain syndrome, future research is warranted addressing its effectiveness within a multidisciplinary approach instead of a stand-alone treatment. Pain perception, culture and genetics should also be taken into consideration in future studies as other risk factors.
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Giannaki A, Rekatsina M, Hassouna M, Cregg R. Efficacy of trigger point injection for non-malignant persistent musculoskeletal pain: a narrative review. Adv Health Res [Internet]. 2025 Jan. 28 [cited 2025 Jan. 30];2. Available from: https://www.ahr-journal.org/site/article/view/30
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