Painful conditions of the musculoskeletal system, including myofascial pain syndrome, constitute some of the most important chronic problems encountered in a clinical practice. A myofascial trigger point is a hyperirritable spot, usually within a taut band of skeletal muscle, which is painful on compression and can give rise to characteristic referred pain, motor dysfunction, and autonomic phenomena. Trigger points may be relieved through noninvasive measures, such as spray and stretch, transcutaneous electrical stimulation, physical therapy, and massage. Invasive treatments for myofascial trigger points include injections with local anesthetics, corticosteroids, or botulism toxin or dry needling. The etiology, pathophysiology, and treatment of myofascial trigger points are addressed in this article.

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Intra-articular injections are one method that physicians may use to treat joint pain. This method offers direct access to the source of pain for the troubled patient. Substances ranging from steroids to hyaluronic acid have been injected successfully into the various joints of the body in an attempt to provide relief for chronic joint pain. Anesthesiologists and orthopedic surgeons have begun to use intra-articular injections of local anesthetics for postoperative analgesia. The history, agents, and methods of intra-articular injections are reviewed.

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