Trigger Point Injections using Botox

Published: 30 July 2020
on channel: The London Pain Clinic

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When we do trigger point injections with Botox we use anatomical landmarks so the first thing we do is to palpate or press on the areas. What I tend to do in my practice is I ask patients to locate the areas before they have them injected and they may do this with their partner or with a friend; they will locate the areas and then they will circle them with an indelible marker.

We clean up the area so for example a common one we do with the muscles at the back of the neck, the trapezius muscle here, and we would clean up the area with some antiseptic solution; we have already marked them up with little circles and then we put local anaesthetic in the skin and then we will put a little needle down to the trigger point and we will inject the solution.

It is either with local anaesthetic and Botox, sometimes we add a little bit of liquid steroid to that. It is possible to do it that way. Sometimes we use ultrasound guidance particularly if it is near important structures like the ribs, the lungs, that sort of thing and sometimes if they are large trigger points we may use a nerve stimulator in order to locate it as well. So there are multiple ways of doing it. It is thought that where the injection goes in, the Botox can spread up to approximately 1 to 1.5cm around that injection site so it is important to get the right place but there will be a certain spread of the liquid, or diffusion into the local areas that are affected.

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