Pull the Trigger

Trigger point injections (TPI) is an option many of us choose to treat pain.

trigger-point-injections-300x201TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.

TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat FM and tension headaches. The technique is also used to alleviate myofascial pain syndrome that does not respond to other treatments.

What Happens During a Trigger Point Injection?

trigger-point-injectionsIn the TPI procedure, a health care professional inserts a small needle into the patient’s trigger point. The injection contains a local anesthetic that sometimes includes a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief.

05001_05XInjections are given in a doctor’s office and usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain drug, a dry-needle technique (involving no medications) can be used.

The effectiveness of TPI for treating myofascial pain is still under study.


Further Reading:

What is the Difference between Trigger Points and Tender Points?

The terms tender point and trigger point are often used interchangeably; however, they are different from each other.

At first glance, the medical community appears divided over whether they in fact are the same thing. You can even find a lot of websites and books, written by healthcare professionals (but we know how much help they can be!), who talk about diagnosing FM with trigger points and treating it with trigger-point injections.

Nonetheless, the scientific literature makes it clear that, while tender points and trigger points both appear to play roles in FM, they are not the same thing. Some of the confusion may be because it’s extremely common for people with FM to also have myofascial pain syndrome (MPS), which is a diagnosis of chronic pain from multiple trigger points. (Some doctors also question whether FM and MPS are different illnesses.)

  • Tender Point: One of 18 specific places on the body that are used to diagnose widespread pain and tenderness in FM. The presence of widespread tender points helps your doctor diagnose FM.
  • Trigger Point: Also called myofascial trigger point (TrPs or MTrPs), a trigger point is a small, hard knot in the muscle (myo) or connective tissue (fascia) that won’t relax. TrPs are painful when pressure is applied. In the absence of pressure, they may cause pain in the immediate area and/or cause pain in a different area. This is called a referred pain pattern. Chronic pain from multiple TrPs is called myofascial pain syndrome.

A 2011 study describes several key differences between them:

Tender Points in FM

See Umm…What Exactly are Tender Points?

Trigger Points in FM

Multiple studies show that TrPs can in fact play significant roles in FM, as a cause of significant pain, and possibly even in a causal role.

In one study, researchers were able to fully reproduce FM pain by manipulating the TrPs. They also found that the participants with more active TrPs had more intense spontaneous pain. What they concluded was that pain from TrPs may help lead to something called central sensitization, which is believed to be an underlying mechanism of FM. Essentially, central sensitization means that the central nervous system (the brain and spinal cord) are hypersensitive to pain and other stimuli, such as light, noise and temperature (hypervigilence). Central sensitization is also believed to play a role in migraines, osteoarthritis and chronic fatigue syndrome.

A review of literature on tender points and trigger points states that confusion between the two and the interchangeable use of the terms can lead to misdiagnosis, which in turn leads to ineffective treatment.

BUT 90 per cent of the 18 predetermined tender points are actually TrPs. Pressing on a trigger point hurts in the area and also shoots pain to other regions, while pressing on a tender point is believed to only cause discomfort to the local area.

The finding that most of your tender points are actually trigger points is good news because it opens up your treatment options. There are specific therapies for relieving the painful knots in the muscles where the trigger points are located, and research shows that relieving the pain of just one trigger point can have a significant on reducing your body-wide pain. One of the more popular approaches is therapeutic massage, which involves working out the trigger points to try to get the muscles to relax. During my time at the rehabilitation pain clinic, my physio spent her time teaching me ways to de-sensitize my trigger points – which in time, would help to reduce pain. This mostly involved self-massage regularly. In fact, anything that eases muscle tension, such as a hot shower or soaking in a hot tub, will reduce the impact of the trigger points. Unlike tender points, trigger points cause a restricted range of motion (muscle tightness) and they radiate pain to other areas of the body.

Despite all of this, FM requires different treatment than MPS. For the many people who have both, it’s essential to treat both in order to alleviate symptoms and regain function.

You’re So Vain


So, when you read about me getting botox in Bali, was your first thought ‘how self-involved?’ Guess again, people…

Most common locations of trigger points in migraine sufferers.

Scientists at the University of Granada have confirmed that injecting botulinum toxin (botox) into certain points named “trigger points” of the pericraneal and neck muscles reduce migraine frequency among migraine sufferers. University of Granada researchers have identified the location of these trigger points – which activation results in migraine – and their relationship with the duration and severity of this condition.

Headache is a universal experience. At present, there are more than 100 different types of headache and one of the most recurring ones is migraine, which affects approximately 10-12% of the population. And once again, women suffer more than men (being three times more common in women than in men). When migraine becomes chronic (occurring more than 15 days a month), it can disrupt patients’ daily life in a great degree.

This research study is one of the three studies that have been conducted by Juan Miguel García Leiva -a researcher at the University of Granada Institute for Neuroscience “Federico Oloriz” — and coordinated by professor Elena Pita Calandre.

Trigger Points in Migraine Sufferers

In the first study, researchers examined a sample of healthy subjects and patients with a diagnosis of migraine (any frequency), and analysed the presence of trigger points and their location, many of the explorations resulting in a migraine crisis. The most interesting findings of this study were: 95% of migraine sufferers have trigger points, while only 25% of healthy subjects have them. The most common locations of trigger points are the anterior temporal and the suboccipital region, both bilateral, of the head. Furthermore, researchers found a positive correlation among the number of trigger points in a patient, the number of monthly crises and the duration in years of the condition.

Subsequently, researchers conducted another study with 52 migraine sufferers. Over three months, patients received a weekly subcutaneous injection of 1mL of a local anesthetic into their trigger points.

After the injection of the anesthetic, 18% of patients experienced a 50% or higher reduction in the frequency of migraine crises, as compared with the basal period. Additionally, an 11-49% reduction of frequency was observed in 38% of patients. Two thirds of the patients treated reported to feel “better or much better.”

Few Side Effects

In the third study, 25 patients with chronic migraine were injected with 12.5 doses of botox into each trigger point twice, during a period of 3 months. Frequency (main variable), intensity and scales of migraine crises were recorded one month before and one month after the treatment to compare the changes experienced. In addition, side effects were also recorded during the experiment, and they were found to be mild and temporary.

After the injections, the most significant decrease in crisis frequency was observed at week 20. Similar results were obtained in those crises labelled as “moderate” and in the frequency of analgesic use by patients.

García Leiva specified that this treatment “is not a first-choice treatment for migraine sufferers,” but it can only be applied in patients with chronic migraine who have tried several treatments with poor results, and who show peripheral sensitization of muscles. Recently, the Foods and Drugs Administration (USA) has approved botulinum toxin as a therapeutical drug for the treatment of chronic migraine.

So when I have established my Bali Fibro Haven Retreat, I’ll be organising trips to my now favourite doctor for all my guests, as well as yoga and meditation sessions. I’m willing to embrace all treatments that may help us.



The above story is reprinted from materials provided byUniversity of Granada, via AlphaGalileo.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Please, Help Yourself

I’ve been in pain all day – does that actually surprise anyone?

Back to the point, the pain in my cheek and the spots above my eyes have been intolerable despite numerous pain killers and soothing eye masks. Then, idiot that I can be when fibro fog enters my brain, I realised that the rehab physio told me about some self-treatment for the area. It’s still not my first thought when it comes to pain treatment but I’m working on it and I find that it can help – it doesn’t take it all away but it soothes it, like tucking it into bed with a blanket and letting it relax.

The muscle that affects this area is called the sternocleidomastoid (SCM). It is a muscle of the neck so-named because it originates on the sternum (sterno) and the clavicle (cleido) and inserts on the mastoid process (mastoid) which is an easily located bony prominence behind the ear. The muscles pass diagonally across the front and side of the neck beginning at the top of the sternum and ending behind the ear. This two-sided muscle is large and ropy, making it the most prominent muscle visible at the front of the neck.

There is rarely pain present in the SCMs themselves but they have the potential to refer a large amount of pain to areas of the head, face, throat, and sternum (see all those red dots and marks in the picture to the left).

Trigger points in the sternal branch of the SCM can cause deep pain around the eyes, headaches behind the ear, at the top of the head, and over the eye (sound familiar?). They may cause pain in the pharynx (throat) and the tongue when swallowing, giving you a “sore throat.” They may also contribute to temporomandibular joint (jaw) pain along with the muscles of mastication.

Dizziness or balance problems, nausea, fainting, lacrimation (excess tear production,) blurred vision, eyelid jerking or droopy eyelid and visual disturbances have all been claimed to be a possible result of trigger points along the SCM.  A host of other systemic symptoms such as cold sweat on the forehead, distorted weight perception, excess mucus in sinuses, nasal cavities and throat, and chronic cough have also been attributed to them.

So what is it that I’ve been told to do?


  • Lay back flat on a cushion.
  • Put some cream on your fingers (not too much as it’s just to make the massage movement easier). It doesn’t really matter what type of cream you use.
  • Find the spot (with the opposite hand) behind your ear where the muscle begins. For example: use your right hand to find the top of the muscle behind your left ear (this means that you’re not putting excess pressure on your left shoulder by scrunching it up).
  • Then follow the muscle down (it runs diagonally) until you get to the bottom of it, at those clavicle bones.
  • Basically, rub your fingers up and down (slowly, and DO NOT use a circular motion) that muscle (at the most 10 times).
  • Use only as much pressure as you can tolerate. If you feel any pain or dizziness, reduce the pressure.
  • Then do the other side.

Initially, it may be extremely painful and may even bring on the referred pain symptoms, such as a headache. But the pain should get better quickly upon subsequent sessions and referred pain symptoms should begin to subside almost immediately. I have been told to do this daily.


To stretch and strengthen this muscle, move your head sideways (your ear towards your shoulder) then look at your underarm. Hold that position for 5 seconds (working up to 10 seconds). Do 10 of these on each side (you can alternate or do one side at a time – it doesn’t matter).

I hope some of you find this helpful (and that you can understand my directions).

From the Bottom Up

Every morning, I wake up and the bones in my feet have moved. When I stand up, it feels like the bones are moving back into place. This phenomenon happens each time my feet have remained still for 15 minutes or more. What triggers our foot pain?  Who knows?  It’s not likely to be an over-reaction to injury, since it typically strikes both feet at the same time.  It doesn’t seem to result from tired feet, either. Theoretically, it could ensue from aggravated myofascial trigger points in the legs, sciatic nerve problems, or a tight iliotibial band (ITB), and then amplified by the hyper-excitable pain regions in our fibromyalgic-addled brains.

Fibromyalgia treatment should extend from the top of your head to the tips of your toes — literally. Although feet are not the location most likely to experience fibromyalgia pain, in a recent paper published in the journal Arthritis Research and Therapy, about half of the 202 patients with fibromyalgia studied reported foot problems.

What works for foot pain?  The first thing I do in the morning is grab my extra fluffy bed socks – it’s not a perfect solution (far from it!) but it helps. If foot pain is caused by trigger points, sciatica or the ITB, acupuncture or back-and-leg massage could help relieve it. Some people swear by a pair of memory foam slippers, covered in ultra-soft terry cloth, or a very gentle foot massage with soothing lotion.

You’ve probably been referred to rheumatologists, or chiropractors to treat fibromyalgia; an acupuncturist probably got a couple of visits, and you might have talked things out with a psychologist along the way, too. But what about a podiatrist? The last time you went to a podiatrist, it was almost assuredly because you wanted to treat your feet, not because you wanted to treat your fibromyalgia…right?

According to Dr. Howard G. Groshell, Jr., a podiatrist who has specialized in the foot and its related ailments, for nearly half a century, with a mysterious condition, like fibromyalgia, that encompasses numerous symptoms which illogically coincide, the medical approach in the West has hit a brick wall. Dr. Howard G. Groshell, Jr. has practiced podiatric medicine since 1960, taking the knowledge he learned in traditional medicine and combining it as he detoured toward the philosophy of Eastern medicine. One of the earliest doctors to combine the two approaches, Dr. Groshell is also the first published author to give a definitive explanation which identifies one of the main causes of fibromyalgia as well as a treatment protocol which examines and corrects energy imbalances in the foot. In the case of fibromyalgia, says Dr Groshell says, Western medicine will never be the answer for long-term relief and healing.

Fibromyalgia Pain Explained: Correcting the Two Levels of Fibromyalgia Pain – reblogged from http://fibromyalgiafreelife.com/fibromyalgia-treatment-information/fibromyalgia-pain/, posted by Dr. Groshell on September 18th, 2010.

The source of confusion over what causes fibromyalgia pain has become the byproduct of one of Western Medicine’s greatest flaws: the proclivity to target the symptoms of a condition or disease, using prescription medication, opposed to trying to correct the root problem of the condition itself.

Fibromyalgia is a condition that is categorized by a myriad of pain symptoms, but rarely do you see any rational explanation for what causes fibromyalgia pain, itself…

There are many causes for pain, and too voluminous to list, but if we did make a list, I am sure many causes would be omitted.  The core of my theories for the pain in Fibromyalgia relates to the causes of the first level of pain.  Our findings are that in Fibromyalgia, there are generally two levels of pain.  The first level of pain is caused by internal and external forces that affect our body’s overall energy fields.  Pain at the first level is called Latent Pain.

Latent pain can be caused by multiple environmental and physical factors that can lower the body’s energy fields.  There are many, many, many causes.  My consistent findings are that poor foot biomechanics cause a majority of latent pain in the body.

Latent pain is that pain that is present but not recognized until the physical area is palpated or pressed.  At that time, the pain will not be perceived until trigger points are pressed (light, moderate, severe on a scale of 1-10).  Latent pain found in multiple common trigger points in the body should always be a part of a general physical exam. Why is that?

Latent pain is a symptom only.  It lets you know that there is a general energy decrease or blockage to multiple body systems.  When there are energy field blockages in the body, all body systems can be affected.  Hence, energy field blockages to body systems can be the cause of multiple body symptoms.  If these energy field blockages are not recognized, we can only treat symptoms.  That is Western medicine’s approach, in general.  If this direction in medicine continues, we can only surmise that our best doctors will never, ever be more than half right.  If you can only treat symptoms and not recognize the cause, you can never use the term cure (which is almost impossible to use, as it is).

My findings are all new to medical literature.  They are consistent with the laws of nature. Poor or faulty foot biomechanics cause weakened neurotransmitter signals to be sent to the Central Nervous System.  This causes bodily energy field weaknesses or blockages to all systems in general down to the cellular levels.  Our fibromyalgia treatment protocol is directed to realign and strengthen foot biomechanical weaknesses.  Our treatment clears blocked energy fields and pain many times within minutes.

All future medical research in body kinetic chain balance and energy field balance needs to use our findings as its physical basis.  When you are consistent with the laws of nature, you cannot be disputed.

If the patient or doctor doesn’t recognize this new principle in medicine, nothing can change.  The patient will stay where they are.  The doctor will continue to be only half right.  Western medicine will prevail, which ultimately leaves pain as the final winner.

Finally, a connection between chronic foot pain and the myriad of symptoms relating to fibromyalgia.