Trigger Point Injections for Chronic Non-Malignant Musculoskeletal Pain: A Systematic Review

OBJECTIVE: This systematic review assessed the available published evidence on the efficacy and safety of using trigger point injection (TPI) to treat patients with chronic non-malignant musculoskeletal pain that had persisted for at least 3 months.

METHODS: All published systematic reviews or randomized controlled trials detailing the use of TPI in patients with chronic, non-malignant musculoskeletal pain (persisting for >3 months) were identified by systematically searching literature databases and the Websites of various health technology assessment agencies, research registers, and guidelines sites up to July 2006.

RESULTS: Although no systematic reviews were identified, 15 peer-reviewed randomized controlled trials met the inclusion criteria. However, deficiencies in reporting, small sample sizes, and marked inter-study heterogeneity precluded a definitive synthesis of the data. TPI is a safe procedure when used by clinicians with appropriate expertise and training. It relieved symptoms when used as a sole treatment for patients with chronic head, neck, shoulder, and back pain or whiplash syndrome, regardless of the injectant used, and may be a useful adjunct to intra-articular injection in the treatment of osteoarthritis pain. Although the addition of TPI to stretching exercises augments treatment outcomes, this was also true of other therapies such as ultrasound and laser.

CONCLUSION: The efficacy of TPI is no more certain than it was a decade ago as, overall, there is no clear evidence of either benefit or ineffectiveness. The only advantage of injecting anesthetic into trigger points may be to reduce the pain of the needling process, which may not be an insignificant benefit.

N. Ann Scott , PhD ,* Bing Guo , MD ,* Pamela M. Barton , MD , †‡ and Robert D. Gerwin , MD §¶

* Institute of Health Economics, Edmonton;

† Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary

‡ Calgary Health Region Chronic Pain Centre, Calgary, AB, Canada;

§Department of Neurology, Johns Hopkins University School of Medicine, Baltimore;

¶ Pain and Rehabilitation Medicine, Myopain Seminars, Bethesda, Maryland, USA