Les injections/infiltrations ont plusieurs actions

1. The needle will have a trp and regenerative effect like a physio’s dry needling.
2. The infiltration will have a central or systemic effect if the quantity of the medication permits it. Xylocaine if used at 300mg and more will have a systemic effect similar to IV xylocaine protocols used for severe fibromyalgia and CRPS. Cortisone infiltrations, when used at sufficient doses will sometimes have a favorable systemic effect on arthritis distant from the original site of injection.
3. A TRP injection is more efficient if done deep and started close to the enthesis. It is better wet than dry, meaning with injection of distensive volume which increases the reflex relaxation.
4. One is sure of placing his needle correctly only if guided by finger and needle bone referencing.

Evidence based medicine (EBM)

• EBM is very difficult to demonstrate in pain management involving infiltrations because of the technician bias. It takes many years of practice and a natural ability to be an expert in musculoskeletal infiltrations.