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Question answered:06/11/07 Warning! this question is over two years old.
We searched the NLH Specialist Library for Musculoskeletal Diseases and the TRIP, Cochrane and Medline databases but found very little information on the use of injectable NSAIDS for the treatment of localized muscular pain.
A 2002 article on the diagnosis and management of trigger points states:
“Trigger-point injection has been shown to be one of the most effective treatment modalities to inactivate trigger points and provide prompt relief of symptoms…
Injection Solutions. An injectable solution of 1 percent lidocaine or 1 percent procaine is usually used. Several other substances, including diclofenac (Voltaren), botulinum toxin type A (Botox), and corticosteroids, have been used in trigger-point injections. However, these substances have been associated with significant myotoxicity. Procaine has the distinction of being the least myotoxic of all local injectable anesthetics.” [1]
An e-Medicine article on myofascial pain makes no reference to injectable NSAIDS being used in trigger point injections:
“TrP injections sometimes are performed with bupivacaine, etidocaine, lidocaine, saline, or sterile water. Occasionally, dry needling is performed without injection of any substance. Steroids may be used in areas possibly associated with inflammation, as in frozen shoulder. Botulinum toxin (BOTOX®) shows promise as a substance that can provide long-lasting relief. The mechanism of its action may be related to blocking of acetylcholine release at the neuromuscular junction of the dysfunctional motor endplates.” [2]
A second e-Medicine article, one on piriformis syndrome, also does not refer to injectable NSAIDS, notes:
“The most widely recognized treatment is local injection. Local anesthetics (eg, lidocaine, bupivacaine) can be injected in trigger points. The painful piriformis muscle can be identified by palpating the buttocks or by palpating transrectally in males and transvaginally in females. A spinal needle or 25-gauge 1.5-inch needle is directly aimed at the examining finger. The location is usually through the sciatic notch and inferior to the bony margin; the most common trigger point is 1 inch lateral and caudal to the midpoint of the lateral border of the sacrum. A dose of 50-100 mg IM can be injected…” [3]
References
1. Alvarez D and Rockwell P. Trigger points: diagnosis and management. American Family Physician 2002; 65(4). (http://www.aafp.org/afp/20020215/653.html)
2. Finley J. Myofascial pain. E-Medicine. March 2006. (http://www.emedicine.com/pmr/topic84.htm#section~treatment)
3. Shah. S. Piriformis Syndrome. E-Medicine.August 2006. (http://www.emedicine.com/sports/topic102.htm)
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