Botulinum toxin for myofascial pain syndromes in adults

Soares, Adriana; Andriolo, Régis B; Atallah, Álvaro Nagib; Silva, Edina MK da

doi:10.1002/14651858.cd007533.pub2

Cited by 51 publications

(43 citation statements)

References 61 publications

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“…To resolve these issues, further studies must be performed that take into account these and other sources of variability described in the literature [45, 46]. The studies must apply strict criteria for the diagnosis of MPS and must evaluate the basic clinical parameters of the MTrPs.…”

Section: Discussionmentioning

confidence: 99%

“…Recommendations are usually cautious and make reference to suggestions of possible usefulness with some improvement in pain intensity and in the daily duration of pain but with more side effects with botulinum toxin. However these findings provide inconclusive evidence to support the use of botulinumtoxin in the treatment of MPS [46]. …”

Section: Systematic Reviewsmentioning

confidence: 99%

See 1 more Smart Citation

Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back: A Review from a Clinical Perspective

Climent

Kuan

Fenollosa³

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. 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 followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Systematic Reviewsmentioning

confidence: 99%

Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back: A Review from a Clinical Perspective

Climent

Kuan

Fenollosa³

et al. 2013

Evidence-Based Complementary and Alternative Medicine

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“…Several authors have demonstrated the therapeutic effectiveness of pain control by MTrP injection with botulinum toxin A [30–32]. But the latest Cochrane review [33] suggested that there is inconclusive evidence to support the use of botulinum toxin in the treatment of myofascial pain syndrome.…”

Section: Needling Therapy For Myofascial Pain Syndromementioning

confidence: 99%

Probable Mechanisms of Needling Therapies for Myofascial Pain Control

Chou

Kao

Lin

2012

Evidence-Based Complementary and Alternative Medicine

114

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Myofascial pain syndrome (MPS) has been defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs) clinically. MTrP is defined as the hyperirritable spot in a palpable taut band of skeletal muscle fibers. Appropriate treatment to MTrPs can effectively relieve the clinical pain of MPS. Needling therapies, such as MTrP injection, dry needling, or acupuncture (AcP) can effectively eliminate pain immediately. AcP is probably the first reported technique in treating MPS patients with dry needling based on the Traditional Chinese Medicine (TCM) theory. The possible mechanism of AcP analgesia were studied and published in recent decades. The analgesic effect of AcP is hypothesized to be related to immune, hormonal, and nervous systems. Compared to slow-acting hormonal system, nervous system acts in a faster manner. Given these complexities, AcP analgesia cannot be explained by any single mechanism. There are several principles for selection of acupoints based on the TCM principles: “Ah-Shi” point, proximal or remote acupoints on the meridian, and extra-meridian acupoints. Correlations between acupoints and MTrPs are discussed. Some clinical and animal studies of remote AcP for MTrPs and the possible mechanisms of remote effectiveness are reviewed and discussed.

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“…26,40 In our opinion, the efficacy of these methods would be enhanced if the physician were able to more accurately localize the trigger point, which can be achieved through the use of an imaging modality. We believe there is strong justification to use US-guided TPI given the results of the 2 studies using US guidance, and strong reasoning that visualization with US is more likely to offer improved identification and localization of trigger points than often unreliable manual palpation.…”

Section: The Evidencementioning

confidence: 99%

“…Given this information, we suggest that accurate injection is challenging without image guidance. The poor detection accuracy of MTrPs is highly likely the reason that previous studies 25, 26 have failed to identify benefits from TPIs. Therefore, we believe that the use of an imaging modality is necessary to improve MTrP detection rate, reliability, and diagnostic objectivity.…”

mentioning

confidence: 99%