Pain is among the most common reasons for emergency department (ED) visits, and myofascial pain represents a frequently overlooked etiology. Myofascial pain syndrome is characterized by trigger points—hyperirritable nodules within taut muscle bands that produce local and referred pain. Although trigger point injections (TPIs) are well established in chronic pain clinics, their use in the ED remains limited despite growing evidence supporting their effectiveness. This tutorial aims to describe the clinical features and diagnostic considerations of myofascial pain syndrome and to provide a practical guide to ultrasound-guided trigger point injections, including patient selection, preparation, safe needle insertion, anesthetic administration, and the peppering technique for trigger point deactivation. Ultrasound guidance enhances diagnostic accuracy, improves procedural safety, and may increase therapeutic success, with emerging technologies such as shear wave elastography offering additional future potential. Reported complications are rare; however, appropriate patient selection, adherence to contraindications, and attention to safety principles are essential. Current literature suggests that TPIs can reduce pain scores, decrease opioid prescribing, and in some cases shorten ED length of stay. Nevertheless, research specifically evaluating TPIs in the ED setting remains limited. Ultrasound-guided TPIs represent a practical, evidence-based, and potentially opioid-sparing intervention that may be incorporated into multimodal ED pain management strategies. Further prospective ED-focused studies are needed to better define their clinical impact and implementation pathways.
Bradshaw et al. (Wed,) studied this question.