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Image by Philippe Gauthier

What is actually in my orange juice?

What is in the syringe?

You go to the grocery store thinking that you'll be drinking some fresh squeezed fruit in your glass and only fresh squeezed fruit, only to find out that there are additives or preservatives. Now it doesn't mean they are bad for you, but sometimes it is just nice to know what you're getting so there are no surprises.


Ok, so we aren't actually talking about orange juice here, but similar question. You want to know what is actually in that syringe that we are injecting into your body. Completely normal inquiry, and even healthy for you to wonder and ask questions about any part of your treatment. 

Injections and procedures that are offered in pain medicine are really meant to help you gain better function, return to work, return to daily activities or social engagements that you may have missed because of the pain and get back to a better quality of life. They are meant to help. That doesn't mean that they can't cause side effects or have risks, but these are generally very low for most of the population. However, this is the place and time to ask. 

This page will go over the most common procedures I do here at Moderni Spine and what exactly the end goal of the injection is and what is in the injection (or your orange juice :) 🍊

Trigger Point 

A "trigger point" is more commonly known as a muscle knot. These points can be "active" meaning that they are currently causing pain and will cause pain when pressure is applied. "Latent" trigger points do not cause pain with pressure but can still cause dysfunction in the muscle and it can also develop back into an active state. Not only does a trigger point cause pain but it also causes inadequate blood flow and delivery of oxygen to the muscle and causes the release of cells that mediate inflammation, and this activates pain sensing nerves. 

Trigger point injections are designed to disrupt the continued cycle of trigger point injections. Essentially a trigger point injection is trying to rid of the trigger point so the muscle can be restored to is baseline function. 

A very important thing to remember is trigger points can occur from as well as cause a dysfunction in the muscle, so combining trigger point injections with rehab such as physical therapy to correct these issues is very important. Even continued disruption of the triggers with massage or even TENS (transcutaneous electrical nerve stimulation) can be very helpful. 

These injections have been studied with many types of injectates including steroids, numbing agents (local anesthetics) and even plain 'ol saline. 

My trigger point injections are done without steroids, using the latter two in a solution or alone. This is because research shows no benefit of adding steroid to trigger point injections and actually more bad than good can come out of it as muscle does not tend to agree with steroid directly injected into it and the skin/fat around the muscle can start to show dimpling or deformity at the site of injection if steroid is used. Another benefit of not using steroid in these injections is we do not have to adhere to the strict rules of how often steroids can be done, therefore these trigger point injections can be repeated and done more frequently if needed.

Botox Injections

Botox (onabotulinum toxin A) is an FDA approved treatment for chronic migraines. There are a few ways that Botox works with the body. One way is that the toxin causes paralysis of the muscles that can be involved in a migraine. This can be especially helpful if you have tension type headaches that develop into migraines. It also blocks certain signals (neurotransmitters) reaching the nerves.  

The injection paradigm for botox injections is 31 injection sites that includes facial muscles, head as well as neck and upper shoulder muscles. Sometimes the pattern of injections can change depending on the person if needed, however the studies show significant relief with use of the paradigm and that is the most common injection pattern for migraine treatment. 

Botox can also be used for trigger points, jaw pain or abnormal muscle contractions, that aren't responding to other methods such as trigger point injections. 

***It should be noted that Botox injections for pain relief should not be mixed with cosmetic Botox. If you are getting cosmetic Botox you need to let both your pain provider and aesthetic provider know. If there is a need for you to receive both treatments a plan will need to be made to make sure your total dose, type of toxin, and location of injections are appropriate to avoid unwanted risks/side effects***

Steroid Injections

Steroids are a widely used medication, with use in many diseases from dermatitis, pulmonary (lung) diseases, as well as inflammatory diseases and pain. 

There are lots of names for steroid injections and many people use these names interchangeably, such as "I had a shot of cortisone" vs "I got a steroid shot". Cortisone is a synthetic (man-made) steroid, but it is not the only steroid type used for treatments. There are many others including (generics) dexamethasone, triamcinalone, (Brand names) Kenalog, Celestone, Depo-Medrol. All these steroids have slightly different mechanisms in the body including how long they may last, how good they are at reducing inflammation, how long they take to start working. We utilize steroids that have a high anti-inflammatory effect to make sure that pain due to damage and inflammation can be relieved. 

Steroids are generally very effective and very safe (this of course depends on everyone's individual medical history). However, steroids in one particular area of the body need to be limited and taken into consideration other areas of the body that are receiving injections or oral (pills) steroids. Too much steroid for too long of a period can expose the joint/cartilage/bone to become weaker, it can also cause side effects throughout the body including issues with blood sugar control, weight gain and other imbalances. 

Overall, steroids are a great option to control pain and regain function so other methods (such as physical therapy or chiropractic) can be more effective. Steroid injections are safe to be used in moderation. Your provider should always be aware of any other steroids you are receiving (injections or medication pills), and along with you they should be keeping a close eye on the number of injections you are having cumulatively. 


Hyaluronic Acid is an acid that naturally occurs in the body. You may have heard or seen it in many advertisements for skin care. It helps with maintaining hydration, "plumpness" and lubrication in many different areas of the body. It is a natural part of the synovial fluids found in joint spaces. As the joint ages and degenerative changes occur, this fluid gets depleted.


Hyaluronic Acid injections help reinstate some of that fluid loss and give the arthritic joint some lubrication again. Unlike steroids this does not have a specific "anti-inflammatory" mechanism behind its chemical composition, however being able to decrease friction of the joint may likely support decreased irritation and inflammation. Usually, insurance will entertain Hyaluronic Acid injections if you have failed steroid injections, and sometimes clinically if there is a lot of inflammation it may makes sense to do a steroid injection first. 

Usually, Hyaluronic Acid injections can last about 6 months and be repeated at that frequency. These injections are most commonly done in the knees but can be done at other joints that have limited fluidity. 

Everyone responds differently to treatments. Although there are lots of treatment options, there may be a reason why one might be recommended for you. 

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