Do trigger point injections effectively treat fibromyalgia?

Author and Disclosure Information




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).

Evidence-based answers from the Family Physicians Inquiries Network

Next Article: