Trigger Point Therapy in the Emergency Department

Patients with myofascial pain conditions or trigger point pain commonly present to the emergency department seeking therapeutic relief. It is not rare to see patients with specific areas of unrelenting muscle spasm who have undergone multiple medical therapies and expensive imaging studies without diagnostic or therapeutic success. Unfortunately, the outcome of most emergency department visits for these patients is another failure to accomplish definitive therapy. We usually prescribe more ineffective therapies that simply perpetuate the therapeutic delay. This blog hopes to present hard-hitting therapeutic interventions that rapidly and effectively relieve trigger points and their associated symptoms. We are not talking about fibromyalgia pain. Fibromyalgia is a widespread pain problem and not really a regional condition caused by specific trigger points that would be amenable to the interventions discussed in this post. Travell defined a myofascial trigger point as “a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.”1 Although the body has approximately 400 muscles, the one in the neck and upper back seem more commonly to have myofascial trigger points. Associated referred pain or radicular symptoms, autonomic symptoms, and paresthesias are common and partially responsible for the not-so-helpful CT scans and MRI imaging studies that these patients often receive. (J Am Osteopath Assoc 2004;104[6]:244; Arch Ph...
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