Back pain-related complaints account for millions of visits in emergency departments every year, and all of us have had patients that despite our best efforts aren’t satisfied with their pain control. Trigger point injections of local anesthetics well as anti-inflammatory medications have been common treatments in chronic pain and headache clinics for years, and are an underutilized resource for patients in the emergency department.
Studies done in multiple different specialties have yielded different and sometimes contradicting results as to which injected medications are more effective, but several have shown no difference between just infecting normal saline, or even dry needling vs anesthetics, NSAIDS, and botox. While there is conjecture that this could be due to causes ranging from nerve feedback loops to simple placebo effect, the evidence simply shows that it works in improving myofascial pain both acutely in the emergency department as well as in repeat assessments.
So next time you have that patient that just won’t respond to your back pain cocktail of choice, try a little pinch of some local!
Kamanli, A., et al. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005 Oct;25(8):604-11. Epub 2004 Sep 15.
Bakunas, C., et al. Using Saline Injections to Treat Myofascial Pain Syndromes/ University of Texas Health Science Center at Houston, Houston, TX
Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. Am J Phys Med Rehabil. 1994 Jul-Aug;73(4):256-63.
Strayer, Reuben. Stayerisms: Trigger Point Injections. EMRAP. 2016 Nov. https://www.emrap.org/episode/penetratingthe/strayerisms