Volume 26 Issue 10 - July 4, 2014 PDF
Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back:
A Review from a Clinical Perspective
José M. Climent1, Ta-Shen Kuan2,*,Pedro Fenollosa3, Francisco Martin-del-Rosario4
1 Physical and Rehabilitation Medicine Department, Alicante University General Hospital, C/Pintor Baeza s/n, 03010 Alicante, Spain
2 Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
3 Pain Clinic, La Fe Hospital, 46026 Valencia, Spain
4 Physical and Rehabilitation Medicine Department, Gran Canaria Insular Hospital, Avenida Mar ́ıtima del Sur, 35006 Las Palmas de Gran Canaria, Spain
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Myofascial pain syndrome (MPS) is characterized by the existence of a myofascial trigger point (MTrP). The pathogenesis of MTrP could be related to excessive leakage of acetylcholine (ACh) in the neuromuscular junction. Botulinum toxin type A, through blocking the release of ACh in the neuromuscular junction, and also probably blocking some nociceptive neurotransmitters, is beneficial in the management of MPS. Many clinical trials evaluating the therapeutic effect of botulinum toxin on MPS has been done, however, the results are contradictory. The purpose of this paper is to identify sources of variability that could explain these differences in the results. A content analysis of the clinical trials and systematic reviews of botulinum toxin on MPS has been done. Our results showed that the sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of follow-up. The inconsistent results regarding the therapeutic efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be rejected or be recommended. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. Botulinum toxin could also be beneficial in patients with refractory MPS that has not responded to conventional myofascial injection therapies.
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