Intraosseous Lidocaine Trigger Point Injection for Vertebrogenic Pain: From Molecular Principles to Clinical Applications: A Narrative Review
9 affiliations
- 1Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia
- 2Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, 3 Bekhterev St., 192019 St. Petersburg, Russia
- 3Shared Core Facilities “Molecular and Cell Technologies”, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 1 Partizan Zheleznyak St., 660022 Krasnoyarsk, Russia
- 4Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- 5Department of Restorative Medicine and Neurorehabilitation, Medical Dental Institute, 127253 Moscow, Russia
- 6Department of General Medical Practice and Outpatient Therapy, Siberian State Medical University, 634050 Tomsk, Russia
- 7Federal State Budgetary Institution “United Hospital with a Polyclinic” of the Executive Office of the President of the Russian Federation, 119330 Moscow, Russia
- 8Department of Cardiology, Functional and Clinical Laboratory Diagnostics, Institute of Postgraduate Education, V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, 1 Partizan Zheleznyak Str., 660022 Krasnoyarsk, Russia
- 9Federal Siberian Research and Clinical Center of the Federal Medical and Biological Agency, 26 Kolomenskaya St., 660037 Krasnoyarsk, Russia
Abstract
Intraosseous lidocaine trigger point injection (LTPI) has been utilized for an extended period in the management of chronic vertebrogenic pain; yet, its molecular mechanisms and clinical efficacy require critical appraisal. This narrative review highlights the milestones of osteoreception and elucidates the molecular mechanisms driving intraosseous receptor irritation and its pivotal role in chronic pain development. Pathological vertebral bone remodeling triggers a receptor activator of nuclear factor-kappa B ligand/osteoprotegerin (RANKL/OPG) imbalance, accelerating hyperactive osteoclastogenesis. Enhanced osteoclastic vacuolar-type H+-ATPase (V-ATPase) expression drives microenvironment acidity and intraosseous hypertension, persistently stimulating acid-sensing ion channel 3 (ASIC3) and purinergic P2X2/3 receptors on intraosseous afferents. Concurrently, upregulated nerve growth factor (NGF) binds to tropomyosin receptor kinase A (TrkA), driving peripheral sensitization via transient receptor potential vanilloid 1 (TRPV1) phosphorylation. The available clinical studies investigating intraosseous LTPI for vertebrogenic pain are scarce and heterogeneous, focusing primarily on low back pain, cervicalgia, and residual chronic pain after degenerative lumbar spinal stenosis decompression surgery. The reviewed data provide preliminary signals of potential benefit, observing a statistically significant analgesic effect of intraosseous LTPI within the studied cohorts. In two trials comparing it to intramuscular LTPI, one of which utilized a randomized controlled design, the intraosseous approach was reported to provide more pronounced short-term pain relief. However, these trials are limited by small sample sizes, heterogeneous designs, and a lack of active long-term safety monitoring. Nevertheless, although current data provide promising but still limited insights, future double-blinded, multicenter randomized controlled trials are required to comprehensively establish the clinical efficacy, safety profile, and prolonged effect of intraosseous LTPI in the treatment of vertebrogenic pain.
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BibTeX
@article{alzamil2026intraosseous,
title = {{Intraosseous Lidocaine Trigger Point Injection for Vertebrogenic Pain: From Molecular Principles to Clinical Applications: A Narrative Review}},
author = {Mustafa Al-Zamil and Natalia A. Shnayder and Marina M. Petrova and Margarita V. Naprienko and Ivan V. Zhelambekov and Olga V. Goncharova and Natalia P. Garganeeva and Svetlana V. Kuleshova and Oxana V. Eremina and Anna O. Dobrosmyslova},
journal = {International journal of molecular sciences},
year = {2026},
month = oct,
doi = {10.3390/ijms27198935},
url = {https://europepmc.org/article/PMC/PMC13665498},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intraosseous Lidocaine Trigger Point Injection for Vertebrogenic Pain: From Molecular Principles to Clinical Applications: A Narrative Review
AU - Mustafa Al-Zamil
AU - Natalia A. Shnayder
AU - Marina M. Petrova
AU - Margarita V. Naprienko
AU - Ivan V. Zhelambekov
AU - Olga V. Goncharova
AU - Natalia P. Garganeeva
AU - Svetlana V. Kuleshova
AU - Oxana V. Eremina
AU - Anna O. Dobrosmyslova
PY - 2026
DA - 2026/10/01
JO - International journal of molecular sciences
DO - 10.3390/ijms27198935
UR - https://europepmc.org/article/PMC/PMC13665498
AB - Intraosseous lidocaine trigger point injection (LTPI) has been utilized for an extended period in the management of chronic vertebrogenic pain; yet, its molecular mechanisms and clinical efficacy require critical appraisal. This narrative review highlights the milestones of osteoreception and elucidates the molecular mechanisms driving intraosseous receptor irritation and its pivotal role in chronic pain development. Pathological vertebral bone remodeling triggers a receptor activator of nuclear factor-kappa B ligand/osteoprotegerin (RANKL/OPG) imbalance, accelerating hyperactive osteoclastogenesis. Enhanced osteoclastic vacuolar-type H+-ATPase (V-ATPase) expression drives microenvironment acidity and intraosseous hypertension, persistently stimulating acid-sensing ion channel 3 (ASIC3) and purinergic P2X2/3 receptors on intraosseous afferents. Concurrently, upregulated nerve growth factor (NGF) binds to tropomyosin receptor kinase A (TrkA), driving peripheral sensitization via transient receptor potential vanilloid 1 (TRPV1) phosphorylation. The available clinical studies investigating intraosseous LTPI for vertebrogenic pain are scarce and heterogeneous, focusing primarily on low back pain, cervicalgia, and residual chronic pain after degenerative lumbar spinal stenosis decompression surgery. The reviewed data provide preliminary signals of potential benefit, observing a statistically significant analgesic effect of intraosseous LTPI within the studied cohorts. In two trials comparing it to intramuscular LTPI, one of which utilized a randomized controlled design, the intraosseous approach was reported to provide more pronounced short-term pain relief. However, these trials are limited by small sample sizes, heterogeneous designs, and a lack of active long-term safety monitoring. Nevertheless, although current data provide promising but still limited insights, future double-blinded, multicenter randomized controlled trials are required to comprehensively establish the clinical efficacy, safety profile, and prolonged effect of intraosseous LTPI in the treatment of vertebrogenic pain.
SN - 1422-0067
ER -