Norman Marcus, MD
We believe that the current use of Trigger Point Injections leads to limited results based on problems identifying the proper source of the pain as well as the lack of a uniform approach to treat the identified painful region. Instead, at NMPI we perform muscle-tendon injections, which target the true source of the patient's pain, thereby eliminating that pain and allowing the patient to return to a normal, healthy, active and pain-free life.
What is a Trigger Point Injection?
"Kathy" is a 50-year-old woman who more than five years ago developed severe pain in her foot and lower leg following fractures to her leg bones. She was diagnosed with Reflex Sympathetic Dystrophy, now called Complex Regional Pain Syndrome. This is a very severe and poorly understood pain syndrome that generally follows some damage to an area of the body. The painful area is very sensitive to even light touch. The skin changes color and may become warmer or colder than the opposite side of the body.
"Jane" is a 48-year-old woman who came to the office with a 31-year history of migraine-like headaches. These crippling headaches happened at least once a week and could last for up to three days, severely impairing her ability to function.
A muscle causing pain in your body will often produce pain in an adjacent muscle.
There are three different mechanisms that affect your pain when it is related to muscles- and that means most of the pain you will experience in your life.
1. Referred pain patterns- Pain may be referred from one muscle to another when the nerves carrying painful sensations in a muscle stimulates the same area in the spinal cord as an adjacent muscle.
Pain that never goes away completely can undermine your quality of life. It can prevent you from particiapting in activities that bring you pleasure and security. The medications that we use to deal with the pain, while being life-savers in terms of providing relief from the suffering, expose us to potential harm.
Muscles are thought to be the cause of low back and other common pain problems by some clinicians. Myofascial pain (syndrome), which actually means pain that originates in the muscles and connective tissue (i.e. tendons, ligaments and fascia) is the diagnosis that is frequently used and it is often considered to be the same as trigger point pain. Trigger points are small nodules or knots in the muscle that when pressed produce pain locally and often at a distant area, i.e. a trigger point in the trapezius muscle may radiate pain to the upper arm.
With severe back pain we frequently worry about having a herniated disc. If you have back pain and get an MRI chances are you'll find something. At NY Hospital/Weill-Cornell, 90% of the MRIs of the low back are read as abnormal. But most back pain is diagnosed as "Idiopathic /Non-specific", referring to sprains and strains of soft tissue such as muscle.
It is my wish to inform patients and colleagues about the possibilities of eliminating pain even when it is thought to be permanent (chronic) or require an invasive proceedure such as surgery, nerve injections, spinal cord stimulation or a morphine pump to achieve any relief. Our story begins with the recogniton that the current standard of care doesn't work very well. An article in the Jouranl of the American Medical Association (JAMA), in February, 2008, by Martin, Deyo, et al..