Trigger Point Therapy: Is It Safe? Does It Work?

If you've ever suffered from chronic (day in and day out) neck, back, shoulder, or other muscle pain, you may have tried trigger point therapy. Needles are placed in painful areas of the muscles. Then a numbing agent and/or inflammatory drug such as steroids is injected at that spot. This treatment technique is the form of treatment we call trigger point therapy. Some people swear by it. Others receive little or no apparent benefit.

Does this treatment work? Is it safe? Who can benefit? When and how? After 50 years of use, study, and experimentation, these questions remain unanswered. So says, N. Ann Scott, PhD of the Institute for Health Economics in Alberta (Canada). Dr. Scott and associates performed a systematic review of studies on the use of trigger point injections for chronic musculoskeletal pain.

Only studies with patients who had muscle pain caused by a nonmalignant (noncancerous) source were included. There were a total of 15 randomized controlled trials (RCTs) found in the published literature. Randomized means the patients were assigned to a group without any criteria. They were just as likely to be in one group as in another.

Controlled means there were other people in the study matched to the patients by age, weight, gender, or other distinguishing features. The control group does not receive the treatment given to the experimental group. Results between the two groups are compared after a period of time. This gives a better (unbiased) view of the true effects of the treatment.

Back, neck, or shoulder pain was the topic of the majority of studies. The remainder included patients with whiplash syndrome, osteoarthritis, and headache affecting the head and neck. All received some type of trigger point injection therapy.

But there were too many factors that varied from one study to another. The authors said the heterogenous nature prevented any large-scale synthesis of the results. If the studies aren't conducted in similar ways, then it's like comparing apples to oranges. The results aren't helpful in answering the questions posed.

Overall, the safety of trigger point injections was never a problem. This was true when the treatment was applied by trained health care professionals. The actual benefit of the treatment is what remains unknown. No further conclusions can be made until enough quality evidence can be produced to support or refute trigger point injection therapy.

Future studies of good design must be conducted in similar enough ways to be included in the analysis of a systematic review. Injections into trigger points may be both safe AND effective. But until the research can prove it, the subject remains controversial and inconclusive.

Trigger Point Injections Still Trigger Controversy. In The BACKLetter. December 2008. Vol. 23. No. 12. Pp. 137.



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