Document Type : Research articles


Department of Orthopaedics, Third Medical Center of PLA General Hospital, Beijing, 100039, China


Objectives: This study aimed to investigate the therapeutic effect of trigger point (TrP) injection of paravertebral muscle to control postoperative lumbar pain.Methods: The medical records of 46 patients who underwent lumbar surgery in our hospital between January 2013 and January 2020 were retrospectively analysed. The patients included in the study were divided into an observation group (n=26) and a control group (n=20) based on the certainty of their myofascial pain TrP diagnosis. The TrPs were found and injected with a 1:5 mixture of compound betamethasone/lidocaine (2 mL). The Visual Analogue Scale (VAS) scores and Patient Satisfaction Index (PSI) scores of the two groups were recorded before injection, on the day after injection, and one and two weeks after injection. The two groups postoperative bedridden time and analgesic medication treatment duration were calculated. All the scores were then compared.Results: The VAS scores of the observation group and the control group before injection were 7.00 ± 0.63 and 6.85 ± 0.59, respectively, and no significant difference was observed between the two groups (P>0.05). The VAS scores on the day and one and two weeks after injection were 2.65 ± 0.63, 3.46 ± 0.51, and 2.62 ± 0.50 in the observation group and 3.75 ± 0.44, 4.70 ± 0.47 and 4.95 ± 0.51 in the control group. Within the same group, the difference in patients at different time points was statistically significant (P<0.01), and the difference between the two groups at the same time point after injection was also statistically significant (P<0.01). The PSI score of the observation group was significantly lower than that of the control group (P<0.01). The bedridden time of the observation group was 2.71 ± 0.45 d, which was shorter than the bedridden time of the control group (4.42 ± 0.49 d; P<0.01). The duration of non-steroidal drug use was also shorter in the observation group than in the control group (P<0.01).Conclusion: Accurate injection of compound betamethasone/lidocaine mixture at the pain TrP can effectively control the early pain response after lumbar surgery. It is also beneficial to the early recovery of postoperative function and improves the patients satisfaction with the surgery.


  1. Parthasarathy S, Sundar S, Mishra G. Assessment of predisposing factors in myofascial pain syndrome and the analgesic effect of trigger point injections-A primary therapeutic interventional clinical trial. Indian J Anaesth. 2019;63(4): 300-03. doi: 10.4103/ija.IJA_6_19. [PubMed: 31000895].
  2. Garg B, Mehta N, Bansal T, Shekhar S, Khanna P, Baidya DK. Design and Implementation of an Enhanced Recovery After Surgery Protocol in Elective Lumbar Spine Fusion by Posterior Approach: A Retrospective, Comparative Study. Spine. 2021;46(12):679-87. doi: 10.1097/BRS.0000000000003869. [PubMed: 33315772].
  3. Urits I, Charipova K, Gress K, Schaaf AL, Gupta S, Kiernan HC, et al. Treatment and management of myofascial pain syndrome. Best Pract Res Clin Anaesthesiol. 2020;34(3): 427-48. doi: 10.1016/j.bpa.2020.08.003. [PubMed: 33004157].
  4. Hsu ES. Acute and chronic pain management in fibromyalgia: updates on pharmacotherapy. Am J Ther. 2011;18(6): 487-509. doi: 10.1097/MJT.0b013e3181d6b6d4. [PubMed: 20458213].
  5. Botelho L, Angoleri L, Zortea M, Deitos A, Brietzke A, Torres ILS, et al. Insights About the Neuroplasticity State on the Effect of Intramuscular Electrical Stimulation in Pain and Disability Associated With Chronic Myofascial Pain Syndrome (MPS): A Double-Blind, Randomized, Sham-Controlled Trial. Front Hum Neurosci. 2018;12:388. doi: 10.3389/fnhum.2018.00388. [PubMed: 30459575].
  6. Desai M J, Saini V, Saini S. Myofascial pain syndrome: a treatment review. Pain Ther. 2013;2(1):21-36. doi: 10.1007/s40122-013-0006-y. [PubMed: 25135034].
  7. Huang JT, Chen HY, Hong CZ, Lin MT, Chou LW, Chen HS, et al. Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies. Patient Prefer Adherence. 2014;8:1105-11. doi: 10.2147/PPA.S64736. [PubMed: 25170256].
  8. Leite FM, Atallah AN, El Dib R, Grossmann E, Januzzi E, Andriolo RB, et al. Cyclobenzaprine for the treatment of myofascial pain in adults. Cochrane Database Syst Rev, 2009, 2009(3): Cd006830. doi: 10.1002/14651858.CD006830.pub3. [PubMed: 19588406].
  9. Montes-Carmona J F, Gonzalez-Perez LM, Infante-Cossio P. Treatment of Localized and Referred Masticatory Myofascial Pain with Botulinum Toxin Injection. Toxins. 2020;13(1):6. doi: 10.3390/toxins13010006. [PubMed: 33374687].
  10. Wada JT, Akamatsu F, Hojaij F, Itezerote A, Scarpa JC, Andrade M et al. An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle. Biomed Res Int. 2020;2020:9240581. doi: 10.1155/2020/9240581. [PubMed: 32076620].
  11. Skorupska E, Rychlik M, Samborski W. Intensive vasodilatation in the sciatic pain area after dry needling. BMC Complement Altern Med. 2015;15:72. doi: 10.1186/s12906-015-0587-6. [PubMed: 25888420].
  12. Kang JJ, Kim J, Park S, Paek S, Kim TH, Kim DK. Feasibility of Ultrasound-Guided Trigger Point Injection in Patients with Myofascial Pain Syndrome. Healthcare.2019;7(4):118. doi: 10.3390/healthcare7040118. [PubMed: 31618922].
  13. Jaeger B. Myofascial trigger point pain. Alpha Omegan. 2013;106(1-2):14-22. [PubMed: 24864393].
  14. Hong JO, Park JS, Jeon DG, Yoon WH, Park JH. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum. Ann Rehabil Med. 2017;41(4):582-588. doi: 10.5535/arm.2017.41.4.582. [PubMed: 28971042].
  15. Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):Cd013814. doi: 10.1002/14651858. CD013814. [PubMed: 33306198].
  16. Salamone FJ, Kanamalla K, Songmen S, Sapire J. Bilateral supraclavicular abscesses following trigger point injections. Radiol Case Rep. 2021;16(9):2630-2633. doi: 10.1016/j. radcr.2021.06.032. [PubMed: 34295446].
  17. Yi KH, Lee KL, Lee JH, Hu HW, Kim HJ. Guidance to trigger point injection for treating myofascial pain syndrome: Intramuscular neural distribution of the quadratus lumborum. Clin Anat. 2022;35(8):1100-1106. doi: 10.1002/ca.23918. [PubMed: 35655442].
  18. Macki M, Alvi MA, Kerezoudis P, Xiao S, Schultz L, Bazydlo M, et al. Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. J Neurosurg Spine. 2019;22:1-10. doi: 10.3171/2019.8.SPINE19260. [PubMed: 31756702].
  19. Zeng Y, Qu X, Chen Z, Yang X, Guo Z, Qi Q, et al. Posterior corrective surgery for moderate to severe focal kyphosis in the thoracolumbar spine: 57 cases with minimum 3 years follow-up. Eur Spine J. 2017;26(7):1833-1841. doi: 10.1007/s00586-016-4875-8. [PubMed: 28032226].
  20. Kim JY, Ryu DS, Paik HK, Ahn SS, Kang MS, Kim KH, et al. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J. 2016;16(7):867-875. doi: 10.1016/j.spinee.2016.03.010. [PubMed: 26970600].
  21. McAfee PC, Garfin SR, Rodgers WB, Allen RT, Phillips F, Kim C. An attempt at clinically defining and assessing minimally invasive surgery compared with traditional "open" spinal surgery. Sas j. 2011;5(4):125-130. doi: 10.1016/j.esas.2011. 06.002. [PubMed: 25802679].
  22. Neychev D, Sbirkova T, Ivanovska M, Raycheva R, Murdjeva M, Atanasov D. Correlation between CGRP Levels and the Neuropathic and Inflammatory Component of Postoperative Pain. Folia Med. 2020;62(2):365-371. doi: 10.3897/folmed. 62.e46533. [PubMed: 32666766].
  23. Mobbs RJ, Mobbs RR, Choy WJ. Proposed objective scoring algorithm for assessment and intervention recovery following surgery for lumbar spinal stenosis based on relevant gait metrics from wearable devices: the Gait Posture index (GPi). J Spine Surg. 2019;5(3):300-309. doi: 10.21037/jss.2019.09.06. [PubMed: 31663040].
  24. Ge HY, Arendt-Nielsen L. Latent myofascial trigger points. Curr Pain Headache Rep. 2011;15(5):386-392. doi: 10.1007/s 11916-011-0210-6. [PubMed: 21559783].
  25. Jin F, Guo Y, Wang Z, Badughaish A, Pan X, Zhang L. The pathophysiological nature of sarcomeres in trigger points in patients with myofascial pain syndrome: A preliminary study. Eur J Pain. 2020;24(10):1968-1978. doi: 10.1002/ejp.1647. [PubMed: 32841448].
  26. Stecco A, Gesi M, Stecco C, Stern R. Fascial components of the myofascial pain syndrome. Curr Pain Headache Rep. 2013;17(8):352. doi: 10.1007/s11916-013-0352-9. [PubMed: 23801005].
  27. Wen GJ, Liu H, Chen J, Zhang SF, Li YK, Zhou SG. [Effect of warm acupuncture on pathological morphology and pain-induced inflammatory mediators in rats with myofascial pain trigger]. Zhongguo Gu Shang. 2019;32(3):260-264. doi: 10.3969/j.issn. 1003-0034.2019.03.013. [PubMed: 30922010].
  28. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol. 2004;14(1):95-107. doi: 10.1016/j. jelekin.2003.09.018. [PubMed: 14759755].
  29. Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil. 2008;89(1):16-23. doi: 10.1016/j.apmr.2007.10.018. [PubMed: 18164325].
  30. Mense S. Muscle pain: mechanisms and clinical significance. Dtsch Arztebl Int. 2008;105(12):214–219. doi: 10.3238/ artzebl.2008.0214. [PubMed: 19629211].
  31. Watkins LR, Hutchinson MR, Ledeboer A, Wieseler-Frank J, Milligan ED, Maier SF. Norman Cousins Lecture. Glia as the “bad guys”: implications for improving clinical pain control and the clinical utility of opioids. Brain Behav Immun. 2007;21(2):131–146. doi: 10.1016/j.bbi.2006.10.011. [PubMed: 17175134].
  32. Climent JM, Kuan TS, Fenollosa P, Martin-Del-Rosario F. Botulinum toxin for the treatment of myofascial pain syndromes involving the neck and back: a review from a clinical perspective. Evid Based Complement Alternat Med. 2013:381459. doi: 10.1155/ 2013/381459. [PubMed: 23533477].
  33. Rhim HC, Cha JH, Cha J, Kim DH. Sonography-guided trigger point injections in abdominal myofascial pain syndrome. Medicine. 2020;99(49):e23408. doi: 10.1097/MD.0000 000000023408. [PubMed: 33285730]
  34. Lee CY, Kim EJ, Hwang DG, Jung MY, Cho HG. The Effect of Trigger Point Injections on Pain in Patients with Advanced Cancer. Korean J Fam Med. 2019;40(5):344-347. doi: 10.4082/kjfm.18.0065. [PubMed: 31487973].
  35. Son BC, Kim DR, Lee SW. Intractable occipital neuralgia caused by an entrapment in the semispinalis capitis. J Korean Neurosurg Soc. 2013;54(3):268-271. doi: 10.3340/jkns.2013. 54.3.268. [PubMed: 24278663].
  36. Liu Y, Yang Y, Hu Q, et al. Latent Myofascial Trigger Points Injection Reduced the Severity of Persistent, Moderate to Severe Allergic Rhinitis: A Randomized Controlled Trial. Front Med (Lausanne). 2021;8:731254. doi: 10.3389/fmed.2021. 731254. [PubMed: 34660639].
  37. Dibai-Filho AV, Guirro EC, Ferreira VT, Brandino HE, Vaz MM, Guirro RR. Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle. Braz J Phys Ther. 2015;19(2): 122-128. doi: 10.1590/bjpt-rbf.2014.0076. [PubMed: 25993626].
  38. Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM&R. 2015;7(7):746-761. doi: 10. 1016/j.pmrj.2015.01.024. [PubMed: 25724849].