• Trigger points are lumpy spots in your muscle that are tender and irritable
• Pressing on a trigger point can cause pain over an area or somewhere else
• Symptoms tend to be consistent i.e. pressing on the same trigger point should lead to the same site and type of pain

What is myofascial pain syndrome?

• This happens when someone has 2 or more trigger points in the muscle and the covering over the muscle, known as the ‘fascia’

What is the cause of trigger points?

• Nerve impingement
  • A herniated disc or bony spur presses on the nerve, leading to trigger points in the area controlled by that nerve
• Prolonged pain
  • Pain in a certain area that is not treated causes changes in the nerves that carry the signal to the brain, leading to extreme sensitivity over the area
• Muscle overuse
  • The frequency of the muscle usage and small tears results in insufficient time for the muscle to heal up
  • There is inflammation and less oxygen and nutrients; the muscle fibres shorten and need even more nutrients, leading to a vicious cycle
  • There are ‘polymodal’ nerve receptors inside the muscle that can turn them into trigger points
• Poor physical fitness
• Ageing
  • Middle aged people between 30-60 are more likely to get it
• Poor posture
• Stress and mental illness like anxiety, depression, PTSD
• Lack of vitamins and iron
• Poor sleep
• Trauma and accidents

How do we treat trigger points?

• Medications
  • Paracetmaol and NSAIDs and COX 2 inhibitors
  • Muscle relaxants
  • Weak opioids like tramadol for a short time
  • Strong opioids are not recommended
• Physiotherapy
  • Cold packs to reduce inflammation
  • Hot packs to increase blood flow and circulation
  • Stretching and strengthening
  • Posture training and changes in office ergonomics
  • Massage
• Laser light therapy
• TENS machine
• Acupuncture
• Pain procedures

What pain procedures are available for treatment of trigger points?

• Trigger point injections with:
  • Dry needling
  • Steroid
  • Concentrated Glucose
  • Local anaesthetic
  • Biologics like PRP (under research)
• Ultrasound guided nerve blocks to target the underlying nerve responsible
• Radiofrequency procedure to target the joint that is in pain that is causing the trigger point
• Nucleoplasty to treat the disc herniation and relieve pressure on the irritated nerve

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