Acupuncture Combined with Trigger Point Injection in Patient with Chronic Myofascial and Referred Pain

Here, we report a case in which acupuncture combined with trigger point injection was effective in a patient with chronic myofascial pain with referred pain in the masticatory muscles. The patient was a 46-year-old woman with the chief complaint of chronic persistent pain in the region of the left mandibular first molar, which had been extracted 5 months earlier. Stellate ganglion block was performed and amitriptyline administered at another hospital, but were ineffective. At her initial visit to our hospital, her primary complaint was chronic persistent pain in the region of the bilateral mandibular first molars. Several tender points were found on the masseter, temporalis, and sternocleidomastoid muscles, with bilateral referred pain. The pain score according to the visual analogue scale was 85. No significant psychological factors were found, however. Based on these findings, the diagnosis was chronic myofascial pain with referred pain in the masticatory muscles. Therefore, stretching of masticatory muscle and trigger point injection were performed. Two months later, the patient requested trigger point injections to be performed at all tender points, as the previous injections had been effective. The total volume of local anesthetic that this would require was considered to be excessive as there was a large number of tender points, however, and it was feared that a toxic reaction might occur. Therefore, acupuncture in combination with trigger point injection was selected instead. The symptoms disappeared within 9 months after commencement of this therapy, and treatment was completed within 1 year. The present results suggest that acupuncture therapy is effective when used in combination with trigger point injection.