What are trigger point injections?

Trigger points are focal areas generally situated around the neck/shoulders/lumbar. Often described as a “knot” within the muscle. These trigger areas often cause pain in the neck or shoulder or lower back.
The areas are palpated by the clinician to assess a focal point to see if this triggers a painful stimulus and whether this radiates/refers around the site. Quite often you will have several trigger points.

Why am I having the injection?

Your pain specialist consultant has determined that your pain may be coming from these areas. These injections can reduce pain for some patients.  

What is injected?

Local anaesthetic alone or local anaesthetic and steroid.

Does it work?

The injection is used primarily to diagnose and treat the source of your pain. You should experience pain relief within 15 minutes of the injection, which may last for a few hours to a few months.

Risks and side effects

• No reduction in your pain levels
• Infection – (affects around one out of every 100 patients treated)
• Bleeding (affects less than one out of every 100 patients treated)
• More discomfort for the first few days after your injection. This is usually temporary and should settle. Continue with your normal pain relief. Sometimes it can take a couple of weeks, but generally only lasts a couple of days. (Affects around one out of every 100 patients treated)  
• Bruising to the injection area.
• Numbness around the site. This is usually temporary and should return to normal
• Allergy to injected medication (affects around one out of every 100 patients treated
• Dizziness
• Unlicensed steroids - side effects include hot flushes, feeling sick, mild abdominal pain, fluid retention, a temporary rise in blood sugar, menstrual irregularities (in women), subcutaneous fat atrophy and hypopigmentation. These should settle within a few days.  
• Other side effects - soft tissue injury, toxicity, weakness/heaviness, vasovagal attacks, blindness

What happens on the day?

• Please arrive at the Injection Suite in the Outpatient Department (OPD) no more than 10 minutes before your appointment time.
• Take all your tablets as normal.
• Bring a list of your tablets with you.
• A nurse will take some details from you to check that you are fit for your procedure.
• A doctor, not necessarily your consultant will come and see you. You may be asked to sign a consent form. The doctor will be able to answer any questions you may have at this time.
• You may be asked to put on a hospital gown

You will be at Injection Suite in the Outpatient Department (OPD) for about 30 minutes. This time may vary depending on unforeseen circumstances.

What does the procedure involve?

• You will be asked to sit or lie on your stomach.  
• The area will be palpated and possibly marked, then injected with local anaesthetic +/- steroid.
• You may feel some discomfort during the procedure.
• After you have had your procedure, you will need to stay with us for about 30 minutes before you can go home.
• Due to theatre lists, you may have to wait a period of time before your slot, please be prepared for this.  

Before the procedure

You must inform the Injection Suite in the Outpatients Department (OPD) if:

• you are diabetic, have a cough or cold or have any kind of infection.
• you are taking any of the following tablets Antibiotics, Anti-retroviral medicines (steroids interact therefore preferably avoided) Apixaban, Aspirin, Dabigatran, Rivaroxaban, Warfarin or Clopidogrel or any other tablet to thin the blood before attending as some of these may need to be stopped some days before.

You must also inform the doctor if:

• you are having surgery within 2 months of steroid injection
• you intend to travel abroad within 2 weeks after injection (we may need to change your appointment date

Information for females:

We will need to know the start date of your last menstrual period. If you think you might be pregnant, contact Injection Suite in the Outpatient Department (OPD).

Your procedure may be cancelled if you do not inform us of the above. 

After your procedure

You will be monitored by nursing staff until you are ready to go home. You must not drive home or go home on public transport. Please arrange for someone to collect you. You are allowed to go home by taxi.

Back at home

• Take things easy for the rest of the day.
• Do not do any excessive exercise or heavy work for the first few days, it is best to increase your activities gradually.
• Remove the dressing the next morning.
• Continue to take your pain tablets till you notice any improvement in your symptoms.

Who do I contact if I have problems following procedure?

From 9am-4pm you can either speak to a nurse in the Outpatients Injection Suite on 0121 685 4000 extension 55814 or contact the clinicians secretary. Outside of these hours, contact the on-call via switchboard: 0121 685 4000.

Follow up appointment

You will be given contact details and a date when you will be contacted. You’ll speak to a pain nurse specialist and report on the progress of your injection. If you have any urgent problems, contact your GP.

If you cannot make your appointment date, you must let the Scheduled Care Coordinators know as soon as possible on 0121 827 3835. 

Useful contact numbers
PALS - 0121 685 4128
Scheduled Care Coordinator - 0121 827 3835  
Injection Suite in the Outpatient Department (OPD) - 0121 685 4000 extension 55814