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Trigger point injections are most commonly recommended for patients who have neck or back pain associated with muscle spasm, with or without an underlying spinal condition

Reclast is contraindicated in patients with creatinine clearance less than 35 mL/min and in those with evidence of acute renal impairment due to an increased risk of renal failure [see Contraindications (4), Warnings and Precautions (5.3), Use in Specific Populations (8.6)]

PLoS One 13(5):e0196436

For example, if the risk of anesthesia is high (due to severe illness or an underlying heart condition), there is a lack of access to facilities offering endoscopy, or the owner cannot afford the procedure