Trigger Point Injections Versus Medical Management for
Acute Myofascial Pain: A Systematic Review and Meta-Analysis
Haroutiun Hamzoian, Vahe Zograbyan
Myofascial Pain
Myofascial pain is described as pain associated with inflammation or irritation of the muscle or fascia surrounding the muscle
Myofascial pain is pain due to muscle or fascia inflammation
Trigger points are hyperirritable nodules within muscle fibers causing pain
Myofascial pain results from various causes: overuse, trauma, poor posture, stress, or medical issues
Myofascial pain symptoms: stiffness, restricted motion, weakness
Untreated pain leads to chronicity, lower quality of life, increased healthcare utilization, and psychological distress
Multimodal approach: combines non-pharmacological and pharmacological interventions
Pharmacological Management ▪ Analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants, antidepressants and anticonvulsants)
Non-Pharmacological Management ▪ Physical therapy, stretching exercises, thermotherapy, ergonomic modifications
Trigger point Injections (TPI): minimally invasive therapy using local anesthetics or anesthetics with corticosteroid
Objective
The objective of our meta-analysis is to consolidate the available evidence and conduct a thorough assessment of the effectiveness and safety of trigger point injections compared to isolated medical management for treating acute myofascial pain.
Materials and Methods
Conducted search following Cochrane Handbook and PRISMA standards [PubMed, Scopus, Web of Science, and Cochrane Library]
Keywords included "trigger point injection," "nonsteroidal anti-inflammatory medications," "acute muscular pain," and "myofascial pain.”
Inclusion Criteria:
Randomized controlled trials (RCTs).
Comparing trigger point injections with medical management.
Involving adult participants aged 18 years or older.
Reporting outcomes related to pain intensity.
Exclusion Criteria:
Focused on chronic myofascial pain, not acute cases.
Utilized interventions other than trigger point injections or medical management.
Lacked sufficient data for outcome assessment.
Non-English publications.
Results
Data synthesis was performed utilizing RevMan 5.4
Measuring the change in pain scores participants experienced in randomized control trials (RCTs) when trigger point injections (TPI) were compared to isolated medical management
Effect calculated using the mean difference (MD) between the TPI group and the isolated medical management group, which was then extended to calculate the standardized mean difference (SMD)
Negative SMD indicated reduced pain in TPI group
Based on 4 RCTs, TPI significantly reduced pain scores compared to medical treatment (SMD = -2.09, 95% CI, (-3.34, -0.85), P = 0.001)
First systematic review and meta-analysis on TPI vs. medical treatment for acute myofascial pain
Conclusions
The analysis demonstrated that TPI significantly reduces pain scores compared to medical treatment
Findings support using TPI as an effective intervention to alleviate acute myofascial pain
Well-designed studies with standardized dosing protocols and administration timelines are warranted to validate these findings, explore the impact of TPI on other relevant outcomes, and identify factors contributing to the observed heterogeneity
