Clinical Question

Is trigger point injection therapy an effective treatment for low back pain?

Evidence-Based Answer

Trigger point injections with lidocaine or saline can be used for patients presenting to the emergency department with acute low back pain. (Strength of Recommendation: B, consistent, small randomized controlled trials [RCTs].) Trigger point injections, compared with intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) or standard care, reduce pain by 2 to 3 points on a 10-point pain scale, decrease the length of stay in the emergency department by two hours, and decrease the short-term need for opioids by almost 50%.

Evidence Summary

A 2019 RCT of 54 adults in Turkey compared the effectiveness of trigger point injections to intravenous NSAIDs.¹ Participants presented to the emergency department with at least one trigger point as the cause of acute low back pain. Trigger points were diagnosed using the Delphi consensus criteria of a taut band, hypersensitive spot, and referred pain. One physician performed trigger point injections in the treatment group using a mixture of 2% lidocaine and saline. The comparison group received 50 mg of dexketoprofen (not available in the United States) in 100 mL of isotonic solution over five minutes. Visual analog scale (VAS) scores for pain on a 0 to 10 scale were obtained at zero, five, 10, 15, 30, and 60 minutes. At zero minutes, the mean VAS scores were similar in both groups (7.6 vs. 7.2; P = .339). At all other time intervals, the mean pain scores in the intervention group were significantly lower than in the NSAID group (five minutes; 2.8 vs. 6.2; P < .001), and this difference in pain persisted throughout the study (60 minutes; 0.4 vs. 2.6; P < .0001).