What Medication is Used for Trigger Points? A Comprehensive Guide

October 7, 2025 •

4 min read

According to the American Academy of Family Physicians, trigger points, or painful muscle knots, are a common cause of chronic musculoskeletal pain, affecting a significant portion of patients experiencing regional pain. When considering what medication is used for trigger points, the answer is not a single drug but a range of options, from localized injections to oral and topical treatments, which can be part of a comprehensive pain management plan.

Quick Summary

Several medications can address painful trigger points, including local anesthetics like lidocaine and corticosteroids delivered via injection, and oral options such as NSAIDs and muscle relaxants. Botulinum toxin is also an effective choice for persistent cases. Dry needling offers an alternative, non-pharmacological approach, providing both short- and long-term relief.

Key Points

Trigger point injections offer targeted relief: Local anesthetics like lidocaine or bupivacaine are injected directly into the muscle knot to provide immediate pain relief by numbing the area.
Corticosteroids can be added to injections for long-term inflammation: Medications like cortisone can be combined with anesthetics in injections to reduce inflammation and swelling, though evidence suggests they may not offer significant additional pain relief over anesthetic alone.
Botulinum toxin (Botox) is an option for resistant cases: For chronic, treatment-resistant pain, Botox can be injected into trigger points to temporarily paralyze the muscle and provide relief for several months.
Oral medications address systemic symptoms: Over-the-counter NSAIDs (ibuprofen, naproxen), muscle relaxants (cyclobenzaprine), and certain antidepressants (amitriptyline) can manage broader pain and associated issues like inflammation and sleep disturbances.
Dry needling is a non-medication alternative: This technique involves inserting a needle into the trigger point without injecting medication, with some research suggesting the needling itself may provide therapeutic benefit comparable to injections with saline or local anesthetic.
Multimodal treatment is most effective: The most successful approach to managing trigger points often combines medication with non-pharmacological methods like physical therapy, massage, and therapeutic exercise.

What Exactly Are Trigger Points?

Trigger points are hyperirritable spots within a taut band of skeletal muscle that are painful upon compression and can produce referred pain, which is pain felt in other areas of the body. Also known as muscle knots, they can develop from repetitive muscle movements, overuse, stress, or trauma. While less invasive treatments like physical therapy and massage are often recommended first, medication plays a crucial role in managing persistent or severe pain.

Injectable Medications for Direct Relief

Trigger point injections (TPIs) involve administering medication directly into the trigger point to alleviate pain, interrupt the pain-spasm cycle, and promote muscle relaxation. The type of medication used in a TPI can vary based on the patient's specific needs and the provider's preference.

Local Anesthetics

Local anesthetics like lidocaine or bupivacaine are the most common medications used in TPIs. They work by numbing the area to provide immediate pain relief and break the pain-spasm cycle. A provider will inject a small amount of the anesthetic directly into the trigger point, often causing a brief muscle twitch—a sign that the target has been reached. For instance, one study found that TPIs with lidocaine had a superior analgesic effect compared to intravenous (IV) NSAIDs for low back pain within the first hour of intervention.

Corticosteroids

In some cases, a corticosteroid, such as cortisone or methylprednisolone, may be added to the local anesthetic. Corticosteroids help reduce inflammation and swelling within the trigger point, potentially offering longer-term relief. However, studies have shown that adding a corticosteroid does not reliably provide more pain relief than an injection with a local anesthetic alone.

Botulinum Toxin (Botox)

For some chronic, treatment-resistant myofascial pain, botulinum toxin type A (Botox) is used off-label in trigger point injections. Botox works by temporarily paralyzing the affected muscle, which blocks the nerve signals that cause it to contract and reduces tension. Its effects typically last for several months. Research suggests it can be effective for myofascial pain, especially in the neck and shoulder area.

Oral Medications for Systemic Management

Beyond injections, several oral medications can help manage myofascial pain and associated symptoms, often as part of a broader treatment plan.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can help with pain and inflammation. Stronger prescription NSAIDs may also be used.
Muscle Relaxants: Medications such as cyclobenzaprine (Flexeril) or tizanidine (Zanaflex) can reduce muscle spasms and relieve associated pain.
Antidepressants: Tricyclic antidepressants like amitriptyline are sometimes prescribed to help manage chronic pain and improve sleep, which is often disrupted by myofascial pain.
Anticonvulsants: Certain anticonvulsants, including gabapentin and pregabalin, can have analgesic effects and may be considered for myofascial pain, though more research is needed.

Oral vs. Injectable Medications: A Comparison

Choosing between oral and injectable medications for trigger points depends on the severity and persistence of the pain, as well as the patient's overall health.


Feature	Injectable Medications (e.g., Lidocaine, Corticosteroids)	Oral Medications (e.g., NSAIDs, Muscle Relaxants)
Onset of Action	Immediate relief for anesthetics; corticosteroids may take longer.	Slower onset, as the medication must be absorbed systemically.
Targeted Relief	Directly targets the specific trigger point, offering localized relief.	Provides systemic relief, affecting the entire body.
Effectiveness	Can be highly effective for disabling, localized trigger points.	May be less effective for specific trigger points but helps with general muscle pain and inflammation.
Duration of Effect	Varies depending on the medication; local anesthetics offer shorter-term relief, while corticosteroids and Botox offer longer-lasting results.	Requires consistent, daily use to manage chronic symptoms.
Side Effects	Potential risks include temporary soreness, bruising, bleeding, or infection at the injection site. Steroids can cause temporary side effects like insomnia or facial flushing.	Side effects can affect the entire body, including GI upset with NSAIDs or drowsiness with muscle relaxants and antidepressants.
Use Case	Often used when other, more conservative treatments have failed.	Can be a first-line treatment for milder symptoms or used in conjunction with other therapies.

Other Interventions for Trigger Points

While medication is a key component, it is often most effective as part of a multimodal treatment approach that also includes non-pharmacological therapies.

Dry Needling: This technique involves inserting a sterile needle into the trigger point without injecting any medication. Some studies suggest that the physical needling itself may be the primary mechanism of relief in trigger point injections, as it can be as effective as injecting medication. Dry needling can help break up muscle tension and elicit a "local twitch response" that helps inactivate the trigger point.
Physical Therapy and Massage: These are cornerstone treatments for myofascial pain. Therapists use techniques to stretch and strengthen the affected muscles, improve range of motion, and reduce overall tension.
Spray and Stretch: This technique involves applying a topical coolant spray, such as ethyl chloride, to the muscle followed by a manual stretch. The cooling sensation can help distract from the discomfort and aid in stretching the muscle.

Conclusion

The choice of what medication is used for trigger points is highly individualized and depends on the specific patient and their condition. While injections with local anesthetics, sometimes combined with corticosteroids or botulinum toxin, offer targeted and often rapid relief for persistent and localized pain, oral medications can help manage broader symptoms like systemic muscle pain, inflammation, and associated sleep disturbances. Crucially, medication should be seen as one part of a holistic treatment plan that often includes non-pharmacological interventions like physical therapy and dry needling to achieve the best long-term outcomes for managing myofascial pain. Patients should always consult with a healthcare professional to determine the most appropriate course of action.

Frequently Asked Questions

The most common medication used in trigger point injections is a local anesthetic, such as lidocaine. It provides immediate, temporary numbing to the area and helps to break the pain-spasm cycle within the muscle.

Yes, over-the-counter pain relievers like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, or acetaminophen, can be used to treat mild to moderate myofascial pain and inflammation associated with trigger points.

Yes, botulinum toxin can be used for trigger points, especially in cases that are resistant to more conventional treatments. It is injected directly into the muscle to cause temporary paralysis, which helps the muscle relax and reduces pain for several months.

Muscle relaxants, such as cyclobenzaprine, can help reduce the muscle spasms and tightness that contribute to myofascial pain and trigger points. They are typically prescribed for short-term use to relieve associated muscle pain.

No, dry needling is a non-pharmacological technique. It involves inserting a thin needle into the trigger point without injecting any medication, and studies suggest that the physical needling itself provides significant therapeutic benefit by disrupting the trigger point.

Trigger point injections offer targeted, and often immediate, relief for specific, stubborn muscle knots, while oral medication provides more general pain management. The best approach depends on the patient's condition, but many treatment plans combine both methods.

While generally safe, trigger point injections carry potential risks, including temporary soreness, bruising, bleeding, or infection at the injection site. If a steroid is used, temporary side effects like insomnia or facial flushing can occur.