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概要

Tolerability and Efficacy of Long-Term Lidocaine Trigger Point Injections in Patients with Chronic Myofascial Pain

Neetu Dhadwal, Mihaela F Hangan, Frances M Dyro, Richard Zeman and Jin Li

Objective: To ascertain the tolerability and efficacy of long term lidocaine trigger point injections (LTPI) in alleviating myofascial pain. Method: A cohort of individuals (n=74; 23 men, 51 women) aged 18 to 85 years (mean: 44 years) who received ≥ 5 single or multiple LTPI between January 2001 and January 2010 from a private neurology practice were selected for the study. All study patients’ charts were reviewed for age, gender, etiology of myofascial pain, comorbidities, total number of visits, visit intervals, location and alternative pain treatment modalities. Efficacy was determined by postprocedure surveys. Results: A demographic analysis from the 74 included individuals revealed a female predominance (N=51, 69%). Ages at the initiation of injection ranged from 23 to 76 years. Chronic myofascial syndrome (n=26, 35%) and chronic back pain (n=25, 34%) were the most common etiologies. The common sites of injections were neck and/or shoulder muscles (n=66, 89%). The visit interval varied in monthly increments with the majority of this cohort at 1-2 month intervals (n=58, 79%). Of the 24 patient-answered questionnaires, 22 (92%, P<0.0001) reported pain relief. The mean reported pain level on a scale of 1-10 was 8.9 ± 0.4 ( ± SE) prior to treatment, which was reduced (70%) to 2.7 ± 0.5 after treatment (P<0.0001). The patients reported benefit upto 26 ± 5 ( ± SE) days post injection. Discussion: From our cohort study, long-term trigger point injection appears to be a well-tolerated adjunct treatment modality for various types of myofascial pain. The efficacy was demonstrated by a questionnaire answered by a smaller cohort. Further prospective study is suggested to attest this conclusion.