HelpDesk

Do trigger point injections effectively treat fibromyalgia?

Author and Disclosure Information

 

References

EVIDENCE-BASED ANSWER:

Possibly. Trigger point injections appear effective in reducing pain and increasing pressure thresholds in patients with fibromyalgia and myofascial trigger points (strength of recommendation [SOR]: B, small randomized controlled trials [RCTs]).

Consensus guidelines suggest that trigger point injections may have a role in the treatment of fibromyalgia (SOR: C, expert opinion).

Active injections produce sustained improvement

A 2011 double-blind RCT randomized 68 female patients with both fibromyalgia and myofascial trigger points to either active trigger point injections with 1 mL 0.5% bupivacaine or placebo-like needle penetration with no medication to an area near the trigger point.1 Patients were evaluated for both local and generalized fibromyalgia symptoms at 4 and 8 days (trial period) and after 30 days (follow-up). Injections occurred on Days 1 and 4, with an option of additional injections on Days 8 and 11.

Compared to baseline (7 days before the injection), patients receiving active trigger point injections had decreased myofascial pain episodes 7 days after the injection (5.6 vs 0.97 episodes; P<.001), decreased pain intensity (62 vs 19/100 mm Visual Analog Scale score; P<.001), and increased pressure threshold at the trigger point (1.5 vs 2.9 kg/cm2; P<.0001), whereas the control group showed no differences.

During Days 1 to 8, patients receiving active trigger point injections required less acetaminophen (0.2 vs 2.7 tablets/d; P<.0001). At Day 8, no patients in the active trigger point injection group requested additional injections, whereas all the patients in the control group requested an injection (P<.0001).

At Day 8, patients also had significantly decreased intensity of fibromyalgia pain, fewer tender points, and higher tender point pressure thresholds; none of these differences were statistically significant in the placebo injection group (data presented graphically). The improvements persisted at 30 days of follow-up (data presented graphically).

Pages

Evidence-based answers from the Family Physicians Inquiries Network

Recommended Reading

VIDEO: JIA response predicted after start of therapy
MDedge Family Medicine
Surgery for persistent knee pain? Not so fast
MDedge Family Medicine
Suspect myopathy? Take this approach to the work-up
MDedge Family Medicine
Radiating low back pain • history of urinary symptoms • past surgery for scoliosis • Dx?
MDedge Family Medicine
Expert dispels common strength-training myths
MDedge Family Medicine
Helmets for positional skull deformities: A good idea, or not?
MDedge Family Medicine
Is nonoperative therapy as effective as surgery for meniscal injuries?
MDedge Family Medicine
PAS: Mind-body practices benefit teens with chronic illnesses
MDedge Family Medicine
EULAR: Serious adverse events rise with number of biologics used in JIA
MDedge Family Medicine
VIDEO: JIA study details impact of biologics on adverse events
MDedge Family Medicine