A Double-Blind, Controlled, Randomized Trial to Evaluate the Efficacy of Botulinum Toxin for the Treatment of Lumbar Myofascial Pain in Humans

Abstract

BTX-A seems to provide significant postintervention pain relief. However, considering its high cost and the small differences compared with control treatments, its use should be reserved only for patients with pain refractory to other invasive treatments.

Recruitment of Discrete Regions of the Psoas Major and Quadratus Lumborum Muscles Is Changed in Specific Sitting Postures in Individuals With Recurrent Low Back Pain

“…34 Evidence of increased activation of the PM-v and QL-p in the LBP ESlow group while maintaining specific sitting postures parallels the clinical assumption of muscular overactivity in individuals with LBP. Although activity is not directly related to muscle-length changes, this augmented activity may underpin a tendency for these muscles to be shorter in those with LBP 14,15,38 and is consistent with the observed greater asymmetry of the QL, with marked hypertrophy on the dominanthand side, in cricket fast bowlers with LBP compared to those who were pain free. 16,18 A greater muscular activation level appears consistent with the goal to maintain upright posture and may have both positive and negative implications for spine control.…”

“…4,12 Yet activity of the deeply situated PM and QL muscles may also change. Disagreement on whether PM and QL activity is compromised 5,11,18 or augmented 15,38 has led to contrasting assumptions that clinical interventions should increase 27,30 or reduce 14,15,38 activity. Resolution of this debate has been compromised by a lack of direct EMG recordings and a failure to consider the potential for unique changes in separate LBP subgroups and different regions of these multifascicular muscles.…”

“…Few clinical interventions consider different anatomical regions of the PM and QL. Thus, clinical interventions designed to reduce activity of the PM and QL by myofascial stretching, manipulation, 22 treatment of trigger points, 15,38 or the injection of botulinum toxin A 14 or contrasting clinical interventions with the intent to strengthen these muscles 27,30 may be appropriate for specific groups of patients and most effective when directed at specific anatomical regions of the muscles. Further investigation is required to examine the effectiveness of interventions targeting control of specific regions of the PM and QL.…”

Changes in Regional Activity of the Psoas Major and Quadratus Lumborum With Voluntary Trunk and Hip Tasks and Different Spinal Curvatures in Sitting

“…Second, clinical interventions have been designed to reduce activity of psoas in people with back pain. These include muscle stretching, 11 injection of Botulinum toxin A into PM, 10 and treatment of trigger points. 23 Further investigation is required to determine whether such treatments are effective, whether the interventions should target specific regions of PM, and whether these interventions affect neuromuscular control of the spine in sitting.…”

“…10,23 Due to their close proximity and relative orientation to the instantaneous axes of rotation of the lumbar motion segments, discrete fascicles within a single muscle may generate torque in opposite directions. Consequently, anatomically discrete regions within each muscle may have differential actions on the lumbar spine, which may be an important consideration when designing treatments that target these muscles.…”