A prospective, randomized, double-blind evaluation of trigger-point injection therapy for low-back pain

Author(s): Marks, M., Wiesel, S.

Journal/Book: Spine. 1989; 14(9): 962-964.

Abstract: The efficacy of trigger-point injection therapy in treatment of low-back strain was evaluated in a prospective, randomized, double-blind study. The patient population consisted of 63 individuals with low-back strain. Patients with this diagnosis had nonradiating low-back pain, normal neurologic examination, absence of tension signs, and lumbosacral roentgenograms interpreted as being within normal limits. They were treated conservatively for 4 weeks before entering the study. Injection therapy was of four different types: lidocaine, lidocaine combined with a steroid, acupuncture, and vapocoolant spray with acupressure. Results indicated that therapy without injected medication (63% improvement rate) was at least as effective as therapy with drug injection (42% improvement rate), at a P value of 0.09. Trigger-point therapy seems to be a useful adjunct in treatment of low-back strain. The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger-point seems to give symptomatic relief equal to that of treatment with various types of injected medication.Trigger-point injection therapy is a useful method of treating low-back strain when there is an area of maximum tenderness. lt is a relatively safe, quick office procedure which can alleviate symptoms so that patients can tolerate their pain while time and nature intervene in its resolution.This study indicates that the critical factor in giving relief of pain is not the injected substance but, rather, some type of mechanical stimulus to the trigger point. We recommend the use of topical vapocoolant, followed by acupressure or acupuncture, since this modality resulted in the greatest pain relief of the four methods used and had no obvious side effects.

Keyword(s): Adult

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