Erector Spinae Plane Block Versus Trigger Point Injection for Chronic Thoracic Myofascial Pain

Chronic thoracic (mid-back) pain can be difficult to treat, and there is limited evidence to guide the use of injection therapies for pain arising from muscles and surrounding soft tissues. Two commonly used treatments are trigger point injections (TPI) and erector spinae plane (ESP) blocks, but no studies have directly compared their effectiveness for chronic thoracic myofascial pain. The purpose of this study is to compare pain relief, physical function, emotional well-being, patient satisfaction, and safety following treatment with either an ESP block or TPI. Participants will be randomly assigned to receive one of the two treatments. Researchers will follow participants for up to 12 weeks after the procedure and collect information through questionnaires and pain assessments.

Inclusion Criteria: * Adults aged 18-80 years * Chronic thoracic myofascial pain lasting at least three months * Pain intensity of ≥4 on 11-point NRS * At least two of three following conditions: Focal thoracic paraspinal pain, palpable taut band, referred pain pattern with palpation Exclusion Criteria: * Thoracic radiculopathy * Cervical myelopathy with neurological deficit * Prior cervicothoracic spine surgery * Pregnancy or lactation * Contraindication to local anesthetic * Active malignancy * Fibromyalgia * BMI \>40 kg/m2 * Workers' compensation or active litigation related to thoracic pain * Acute herpes zoster or history of postherpetic neuralgia involving thoracic dermatomes * Current opioid use \>50 morphine milligram equivalents daily * Severe psychiatric or cognitive disorders, specifically history of schizophrenia, chronic psychotic disorders, dementia * History of substance use disorder * Inability to provide informed consent