LOW BACK PAIN;

TRIGGER POINT INJECTIONS IN PATIENTS WITH LOW BACK PAIN.

Abstract

Objectives: To know about the efficacy of trigger point injections in low back pain. Study Design: Prospective observational study. Setting: Out-patient Department of Naseer Teaching Hospital, Peshawar, and private clinic of the author. Period: March 2016 to January 2017. Materials and Methods: All patients with low back pain were evaluated. Inclusion criteria was; all patients with low back pain greater than 3 months duration whether operated or not, patients with non-radiating symptoms, patients with acceptable radiology (no listhesis, obvious stenosis/disk, albeit some degree of degeneration was acceptable), further helping points were morning exacerbations and elicitation of tender spot by the patient. The exclusion criteria was Low back pain with less than 3 months duration, obvious pathology on radiological examination, radiating symptoms, generalized low back pain without any point tenderness elicitation. The patients were sent home on medications and asked to avoid strenuous activity for a couple of weeks, they were followed after one month and asked about their pain satisfaction. Results: Approximately 2800 patients were evaluated for low back pain and of them 237 (8.46%) patients were upto the inclusion criteria, only 112 patients had agreed to have a TPI, which showed an acceptance rate of 47.25%. There were 65 males and 58 females, with a male to female ratio approaching almost 1:1. The age range was from 18 to 48 years, and the mean age was 32 years. The minimum duration of pain was 3 months and the maximum duration was 4 years, 4 patients had undergone back surgery. Almost all patients pointed out the pain spot, but a typical trigger point was elicited in 58(51.78%) patients, while morning exacerbation was present in 43(38.38%). Radiological examination was performed on all patients in the form of simple xrays and Magnetic resonance imaging scans, it was acceptable in 67%, as patients with radiating symptoms were already excluded. 10.71% (n=12) patients had some problems. Conclusion: In patients with chronic low back pain due to Myofascial Pain Syndrome (MPS) eliciting the trigger points by either elaboration through history or physical examination and treating them with a TP injection with lignocaine and a steroids has good short term results.