457: Application of Ultrasound-Guided Muscle Trigger Points in Chronic Musculoskeletal Pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Treatment/management

Background and Aims: Chronic musculoskeletal pain is frequently associated with myofascial trigger points (MTrPs), which may contribute to localized and referred pain, movement restriction, and functional limitation. Ultrasound guidance can improve the accuracy and safety of trigger point interventions by visualizing target muscles and adjacent neurovascular structures. This study aims to summarize the potential clinical value of ultrasound-guided trigger point procedures for chronic musculoskeletal pain management.

Methods: A structured narrative synthesis was performed focusing on ultrasound-guided trigger point applications in chronic musculoskeletal pain. Interventions of interest included ultrasound-guided dry needling and trigger point injections (e.g., local anesthetic with or without corticosteroid, saline, or botulinum toxin), compared with landmark-guided needling, sham procedures, or standard conservative care. Outcomes assessed included pain intensity (e.g., visual analog scale), pressure pain threshold, range of motion, functional disability scores, analgesic consumption, and adverse events across short- and medium-term follow-up.

Results: Across included reports, ultrasound-guided trigger point interventions generally demonstrated clinically meaningful reductions in pain intensity and improvements in pressure pain thresholds and function, particularly for deep or anatomically complex regions (e.g., piriformis, scalene, quadratus lumborum). Ultrasound guidance was associated with improved targeting consistency and fewer procedure-related complications by facilitating avoidance of vessels, pleura, and nerves. Benefits were most pronounced when combined with multimodal rehabilitation (stretching, strengthening, posture correction), with some studies suggesting longer-lasting relief compared with landmark-guided approaches, although heterogeneity in protocols (needle technique, injectate type/volume, session frequency) limited pooled interpretation.

Conclusions: Ultrasound-guided trigger point interventions appear to be a safe and effective option for selected patients with chronic musculoskeletal pain, offering enhanced procedural precision and potentially better clinical outcomes than landmark-guided techniques—especially for deep muscles or high-risk anatomical areas. Standardized protocols and well-powered randomized trials are needed to clarify optimal patient selection, intervention parameters, and durability of benefit within comprehensive pain rehabilitation pathways.

References: 1. Diep D, Chen KJQ, Kumbhare DA. Ultrasound-guided interventional procedures for myofascial trigger points: a systematic review. Regional Anesthesia & Pain Medicine. 2021;46(1):73–80. doi:10.1136/rapm-2020-101898.
2. Chen Y, Liu S, Sun Y, Wang Q. Efficacy of ultrasound-guided myofascial hydrodissection technique in myofascial pain syndrome of upper trapezius: a randomized controlled trial. Scientific Reports. 2025;15:33444. doi:10.1038/s41598-025-19107-2.
3. Tantanatip A, Patisumpitawong W, Lee S. Comparison of the effects of physiologic saline interfascial and lidocaine trigger point injections in treatment of myofascial pain syndrome: a double-blind randomized controlled trial. Archives of Rehabilitation Research and Clinical Translation. 2021;3(2):100119. doi:10.1016/j.arrct.2021.100119.
4. Kang JJ, Kim J, Park S, Paek S, Kim TH, Kim DK. Feasibility of ultrasound-guided trigger point injection in patients with myofascial pain syndrome. Healthcare (Basel). 2019;7(4):118. doi:10.3390/healthcare7040118.
5. Chim D, Cheng PH. Ultrasound-guided trigger point injections. Techniques in Regional Anesthesia and Pain Management. 2009;13(3):179–183. doi:10.1053/j.trap.2009.07.006.
6. Mayoral V, Domingo-Rufes T, Casals M, et al. Myofascial trigger points: New insights in ultrasound imaging. Techniques in Regional Anesthesia and Pain Management. 2013;17(3):150–154. doi:10.1053/j.trap.2014.01.017.
7. Aquino-Jose VM, Blinder V, Johnson J, Havryliuk T. Ultrasound-guided trigger point injection for piriformis syndrome in the emergency department. JACEP Open. 2020;1(5):876–879. doi:10.1002/emp2.12153.
8. Fusco P, Di Carlo S, Scimia P, Degan G, Petrucci E, Marinangeli F. Ultrasound-guided dry needling treatment of myofascial trigger points for piriformis syndrome management: a case series. Journal of Chiropractic Medicine. 2018;17(3):198–200. doi:10.1016/j.jcm.2018.04.002.
9.Bağcıer F, Tufanoğlu FH. A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment. Ağrı. 2020;32(3):175–176.
10. Niraj G, Collett BJ, Bone M. Ultrasound-guided trigger point injection: first description of changes visible on ultrasound scanning in the muscle containing the trigger point. British Journal of Anaesthesia. 2011;107(3):474–475. doi:10.1093/bja/aer247

Presenting Author: Yongjun Zheng
Submitting Author: Yongjun Zheng

Senior Author: Yongjun Zheng

IASP 2026 Global Year theme of Neuropathic Pain: No

• Yongjun Zheng - Huadong Hospital, Fudan University
• Yantao Ma - Huadong Hospital, Fudan University