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Licensed Unlicensed Requires Authentication Published by De Gruyter March 10, 2021

Granisetron vs. lidocaine injection to trigger points in the management of myofascial pain syndrome: a double-blind randomized clinical trial

Zahra Rezasoltani, Hanna Ehyaie, Reza Kazempour Mofrad, Fatemeh Vashaei, Reza Mohtasham and Sharif Najafi



Granisetron and lidocaine injections have been used for the management of myofascial pain syndrome. This study was aimed to compare the efficacy of granisetron and lidocaine injections to trigger points of upper trapezius in the management of myofascial pain syndrome.


We performed a double-blind randomized clinical trial in an outpatient clinic of physical medicine and rehabilitation at a teaching hospital. A total of 40 patients aged ≥18 with neck pain due to myofascial pain syndrome were included. They had pain for at least one month with the intensity of at least 30 mm on a 100 mm visual analog scale. Each participant received a single dose of 1 mL lidocaine 2% or 1 mg (in 1 mL) granisetron. The solutions were injected into a maximum of three trigger points of the upper trapezius. We instructed all patients to remain active while avoiding strenuous activity for three or four days, and to perform stretch exercise and massage of their upper trapezius muscles. We assessed the patients before the interventions, and one month and three months post-injection. The primary outcome was the Neck Disability Index and the secondary outcome was the Neck Pain and Disability Scale.


Both interventions were successful in reducing neck pain and disability (all p-values <0.001). However, the neck pain and disability responded more favorably to lidocaine than granisetron (p=0.001 for Neck Disability Index, and p=0.006 for Neck Pain and Disability Scale). No significant side-effect was recognized for both groups.


Both lidocaine and granisetron injections to trigger points are effective and safe for the management of the syndrome and the benefits remain at least for three months. However, lidocaine is more effective in reducing pain and disability. The injections are well-tolerated, although a transient pain at the site of injections is a common complaint. One mL of lidocaine 2% is more effective than 1 mg (in 1 mL) granisetron for injecting into the trigger points of the upper trapezius in myofascial pain syndrome.

Corresponding author: Sharif Najafi, Clinical Biomechanics and Ergonomics Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Aja University of Medical Sciences, Etemadzadeh St, Western Fatemi, Tehran 1411718541, Islamic Republic of Iran, Phone: +98 21 43823476, Fax: +98 21 88028724, E-mail:

  1. Research funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

  2. Author contributions: ZR contributed to the design and development of the study protocols, supervised physical examinations, and contributed to the decision on eligibility. HE helped with the literature review and performed statistical analyses. RKM contributed to the literature review and design and helped with statistical analyses. FV and RM participated in the design of the study, guided the recruitment process, interviewed patients, and performed physical examinations. SN conceptualized and designed the study, guided the development of the protocols and performed the injections, helped with the decision on patients’ eligibility, and the interpretation of the results. All the authors participated in drafting and its final approval.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent has been obtained from all individuals included in this study.

  5. Ethics approval: Obtained from the Institutional Review Board of Aja University of Medical Sciences with the Ethics Committee reference number of IR.AJAUMS.REC.1398.202.

  6. Registration: Iranian Registry of Clinical Trials (IRCT) website, a WHO Primary Register setup, with registration code: IRCTID: IRCT20200114046128N1.


1. Vadasz, B, Gohari, J, West, D, Grosman-Rimon, L, Wright, E, Ozcakar, L, et al.. Improving characterization and diagnosis quality of myofascial pain syndrome: a systematic review of the clinical and biomarker overlap with delayed onset muscle soreness. Eur J Phys Rehabil Med 2020;56:469–78.10.23736/S1973-9087.20.05820-7Search in Google Scholar

2. Phan, V, Shah, J, Tandon, H, Srbely, J, DeStefano, S, Kumbhare, D, et al.. Myofascial pain syndrome: a narrative review identifying inconsistencies in nomenclature. PM R; 2019;12:916–25.10.1002/pmrj.12290Search in Google Scholar

3. Al-Moraissi, EA, Alradom, J, Aladashi, O, Goddard, G, Christidis, N. Needling therapies in the management of myofascial pain of the masticatory muscles: a network meta-analysis of randomized clinical trials. J Oral Rehabil 2020;47:910–22.10.1111/joor.12960Search in Google Scholar

4. Dommerholt, J, Chou, LW, Finnegan, M, Hooks, T. A critical overview of the current myofascial pain literature – February 2019. J Bodyw Mov Ther 2019;23:295–305. in Google Scholar

5. Yaghoubi, Z, Pardehshenas, H, Takamjani, IE. The effect of upper trapezius muscle dry needling treatment on sleep quality: a case report. J Bodyw Mov Ther 2018;22:333–6. in Google Scholar

6. Nouged, E, Dajani, J, Ku, B, Al-Eryani, K, Padilla, M, Enciso, R. Local anesthetic injections for the short-term treatment of head and neck myofascial pain syndrome: a systematic review with meta-analysis. J Oral Facial Pain Headache 2019;33:183–98. in Google Scholar

7. Christidis, N, Omrani, S, Fredriksson, L, Gjelset, M, Louca, S, Hedenberg-Magnusson, B, et al.. Repeated tender point injections of granisetron alleviate chronic myofascial pain – a randomized, controlled, double-blinded trial. J Headache Pain 2015;16:104. in Google Scholar

8. Christidis, N, Kopp, S, Ernberg, M. The effect on mechanical pain threshold over human muscles by oral administration of granisetron and diclofenac-sodium. Pain 2005;113:265–70. in Google Scholar

9. Ernberg, M, Lundeberg, T, Kopp, S. Effect of propranolol and granisetron on experimentally induced pain and allodynia/hyperalgesia by intramuscular injection of serotonin into the human masseter muscle. Pain 2000;84:339–46. in Google Scholar

10. Christidis, N, Ioannidou, K, Milosevic, M, Segerdahl, M, Ernberg, M. Changes of hypertonic saline-induced masseter muscle pain characteristics, by an infusion of the serotonin receptor type 3 antagonist granisetron. J Pain 2008;9:892–901. in Google Scholar PubMed

11. Espejo-Antunez, L, Tejeda, JF, Albornoz-Cabello, M, Rodriguez-Mansilla, J, de la Cruz-Torres, B, Ribeiro, F, et al.. Dry needling in the management of myofascial trigger points: a systematic review of randomized controlled trials. Compl Ther Med 2017;33:46–57. in Google Scholar

12. Liu, L, Huang, QM, Liu, QG, Thitham, N, Li, LH, Ma, YT, et al.. Evidence for dry needling in the management of myofascial trigger points associated with low back pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2018;99:144–52 e2. in Google Scholar

13. Han, JJ, Kraft, GH. Electrodiagnosis of neck pain. Phys Med Rehabil Clin 2003;14:549–67. in Google Scholar

14. Akamatsu, FE, Ayres, BR, Saleh, SO, Hojaij, F, Andrade, M, Hsing, WT, et al.. Trigger points: an anatomical substratum. BioMed Res Int 2015;2015:623287. in Google Scholar PubMed PubMed Central

15. Myburgh, C, Larsen, AH, Hartvigsen, J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 2008;89:1169–76. in Google Scholar PubMed

16. Barbero, M, Cescon, C, Tettamanti, A, Leggero, V, Macmillan, F, Coutts, F, et al.. Myofascial trigger points and innervation zone locations in upper trapezius muscles. BMC Musculoskelet Disord 2013;14:179. in Google Scholar PubMed PubMed Central

17. Donnelly, JM, Simons, DG. Travell, Simons & Simons’ myofascial pain and dysfunction: the trigger point manual, 3rd ed.; 2019. p. 764.Search in Google Scholar

18. Young, IA, Dunning, J, Butts, R, Mourad, F, Cleland, JA. Reliability, construct validity, and responsiveness of the neck disability index and numeric pain rating scale in patients with mechanical neck pain without upper extremity symptoms. Physiother Theory Pract 2019;35:1328–35. in Google Scholar PubMed

19. Vernon, H, Mior, S. The neck disability index: a study of reliability and validity. J Manip Physiol Ther 1991;14:409–15.Search in Google Scholar

20. Young, IA, Dunning, J, Butts, R, Cleland, JA, Fernandez-de-Las-Penas, C. Psychometric properties of the numeric pain rating scale and neck disability index in patients with cervicogenic headache. Cephalalgia 2019;39:44–51. in Google Scholar PubMed

21. Stefanovitch-Lawbuary, N, Amirfeyz, R, Lovell, R, Bannister, G. Reliability and responsiveness of patient-reported outcome measures of neck disability to physical therapy: comparison of the Copenhagen, Northwick Park, and neck Bournemouth questionnaires and the neck disability index. J Manip Physiol Ther 2019;42:104–7. in Google Scholar PubMed

22. Moses, MJ, Tishelman, JC, Stekas, N, Jevotovsky, DS, Vasquez-Montes, D, Karia, R, et al.. Comparison of patient reported outcome measurement information system with neck disability index and visual analog scale in patients with neck pain. Spine (Phila Pa 1976) 2019;44:E162–E7.10.1097/BRS.0000000000002796Search in Google Scholar PubMed

23. Monticone, M, Ambrosini, E, Vernon, H, Brunati, R, Rocca, B, Foti, C, et al.. Responsiveness and minimal important changes for the neck disability index and the neck pain disability scale in Italian subjects with chronic neck pain. Eur Spine J 2015;24:2821–7. in Google Scholar PubMed

24. Mousavi, SJ, Parnianpour, M, Montazeri, A, Mehdian, H, Karimi, A, Abedi, M, et al.. Translation and validation study of the Iranian versions of the neck disability index and the neck pain and disability scale. Spine (Phila Pa 1976) 2007;32:E825–31. in Google Scholar

25. Blozik, E, Himmel, W, Kochen, MM, Herrmann-Lingen, C, Scherer, M. Sensitivity to change of the neck pain and disability scale. Eur Spine J 2011;20:882–9. in Google Scholar PubMed PubMed Central

26. Yao, M, Xu, BP, Tian, ZR, Ye, J, Zhang, Y, Wang, YJ, et al.. Cross-cultural adaptation of the neck pain and disability scale: a methodological systematic review. Spine J 2019;19:1057–66. in Google Scholar PubMed

27. Salehi, R, Negahban, H, Saghayezhian, N, Saadat, M. The responsiveness of the Persian version of neck disability index and functional rating index following physiotherapy intervention in people with chronic neck pain. Iran J Med Sci 2019;44:390–6. in Google Scholar PubMed PubMed Central

28. Ansari, NN, Feise, RJ, Naghdi, S, Mohseni, A, Rezazadeh, M. The functional rating index: reliability and validity of the Persian language version in patients with neck pain. Spine (Phila Pa 1976) 2012;37:E844–8. in Google Scholar PubMed

29. Naghdi, S, Nakhostin Ansari, N, ShamsSalehi, S, Feise, RJ, Entezary, E. Validation of the functional rating index for the assessment of athletes with neck pain. World J Orthoped 2016;7:507–12. in Google Scholar PubMed PubMed Central

30. Cohen, J. A power primer. Psychol Bull 1992;112:155–9. in Google Scholar

31. Kamanli, A, Kaya, A, Ardicoglu, O, Ozgocmen, S, Zengin, FO, Bayik, Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int 2005;25:604–11. in Google Scholar PubMed

32. Ay, S, Evcik, D, Tur, BS. Comparison of injection methods in myofascial pain syndrome: a randomized controlled trial. Clin Rheumatol 2010;29:19–23. in Google Scholar PubMed

33. Choi, JW, Lee, CJ, Lee, SM, Shin, BS, Jun, B, Sim, WS. Effect of hyaluronidase addition to lidocaine for trigger point injection in myofascial pain syndrome. Pain Pract 2016;16:1019–26. in Google Scholar PubMed

Received: 2020-10-04
Accepted: 2021-01-12
Published Online: 2021-03-10
Published in Print: 2021-10-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

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