by Nicole Evans M.D.

Created on: March 28, 2010

Many individuals with fibromyalgia are excellent candidates for trigger point injections. While fibromyalgia is known to cause a chronic, diffuse musculoskeletal pain, many people also often have discrete tight muscle knots that may be released through trigger point injections.

An accurate diagnosis of fibromyalgia is essential prior to performing trigger point injections.  An individual may experience widespread muscle aches and pains due to a rheumatological condition such as systemic lupus erythematosus, an adverse reaction to medications, hyper- or hypothyroidism, and more. 

Once other causes of myofascial pain have been excluded, the diagnosis of fibromyalgia is a clinical diagnosis.  An individual with true fibromyalgia will have had chronic diffuse pain for atleast three months.  Additionally, people with fibromyalgia will have significant tenderness to palpation of at least 11 of 18 known fibromyalgia-specific tender spots.  For comparison, the physician will also press on non-fibromyalgia spots.  These areas should be significantly less tender.

Individuals with an accurate diagnosis of fibromyalgia will benefit from specific physical activities and improvement in their ability to manage stress. Some people with fibromyalgia  benefit from supplements and/or prescription medications.  In addition, many people with fibromyalgia experience significant pain relief with trigger point injections.

Trigger point injections are done by first identifying the areas that will be injected.  Often these areas are firm knots or lumps within muscle.  These specific trigger points may or may not be tender, but are located in an area of general pain.

Prior to the patient encounter the physician will have prepared the injection.  A syringe is filled with saline or dilute lidocaine.  The needle used to give trigger point injections does not need to have a large diameter, but may be quite long if a large muscle group or area with a thick layer of fat is to be injected.

Once a trigger point is identified, the health care provider will prep the area by cleaning it with alcohol, chlorhexidine or betadine.  The trigger point is then directly pierced by the needle.  Often, the physician will redirect the needle using different trajectories in an attempt to locate an area of resistance.  This specifically locates the trigger point within the muscle. 

A small amount of saline or lidocaine is injected directly into the trigger point.  This may feel uncomfortable but is usually painless.  Once the liquid is injected into the trigger point the practitioner will remove the needle.  Ideally, they will then massage the trigger point firmly for at least one to two minutes. 

Trigger point injections should result in an almost immediate decrease in pain.  The pain relief may continue to increase over time or may lessen.  Additionally, some individuals with fibromyalgia may actually experience worse pain for one to two days which then improves.  Frequently, trigger point injections provide effective temporary relief from the pain of fibromyalgia.

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