Evidence against Trigger Point Injection Technique for the Treatment of Cervicothoracic Myofascial Pain with Botulinum Toxin Type A

Ferrante, F. Michael; Bearn, Lisa; Rothrock, Robert J.; King, Laurence

doi:10.1097/00000542-200508000-00021

Cited by 146 publications

(128 citation statements)

References 28 publications

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“…Botulinum toxin is on option for patients with refractory, highly symptomatic myofascial pain. However, the evidence is unconvincingly either for or against benefit [16][17][18][19] (NCCN Category 3). The associated expense, questionable benefit, and difficulty in obtaining coverage for botulinum toxin, makes this option unfeasible for many patients.…”

Section: Common Rehabilitation Problems and Their Treatment Myofasciamentioning

confidence: 99%

Barriers to rehabilitation following surgery for primary breast cancer

Cheville

Tchou

2007

Journal of Surgical Oncology

221

171

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Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.

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Section: Common Rehabilitation Problems and Their Treatment Myofasciamentioning

confidence: 99%

Barriers to rehabilitation following surgery for primary breast cancer

Cheville

Tchou

2007

Journal of Surgical Oncology

221

171

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“…Its conclusion merely implies that a fi xed dosage design does not work for Gobel et al's ( 2006 ) protocol. The study of Ferrante et al ( 2005 ), comparable in size to Gobel's study (large number of patients) sheds negative light on the effi cacy of BoNT (in this case onaA) in MPS. It is fundamentally different from Gobel's study since investigators injected only a limited number of trigger points (no more than fi ve).…”

Section: Commentmentioning

confidence: 84%

“…Other negative studies have found BoNT effi cacy statistically similar to placebo, but, in these studies, both BoNT and placebo alleviated pain signifi cantly compared to baseline pain (Wheeler et al 1998 ;Ferrante et al 2005 ;Querma et al 2006). As emphasized by Gerwin ( 2014 ), in this scenario, the only possible conclusion is that the study showed a large placebo effect precluding proper assessment of BoNT effi cacy.…”

Section: Commentmentioning

confidence: 92%

“…Both onaA and saline groups showed signifi cant improvement in all assessments (except SF36), but the difference between the drug and placebo groups was not signifi cant. Ferrante et al ( 2005 ) conducted a large single-center study on 132 patients with MPS. Subjects were randomized into four groups (three onaA groups and one saline) and studied blindly over 16 weeks.…”

Section: Double-blind Placebo-controlled Studiesmentioning

confidence: 99%

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Botulinum Toxin Treatment of Myofascial Pain Syndrome and Fibromyalgia

Jabbari

2015

Botulinum Toxin Treatment of Pain Disorders

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Myofascial pain is one of the most common forms of human pain characterized by spontaneous and pressure-induced pain in muscle trigger points. Treatment of myofascial pain syndrome is partially successful with conventional analgesics, but a large number of patients remain unsatisfi ed.Botulinum neurotoxins (BoNTs) can relieve myofascial pain by blocking the release of acetylcholine and pain mediators (substance P, glutamate, calcitonin gene-related peptide) from presynaptic vesicles. Ten double-blind, placebocontrolled studies have been published in this area; some of these strongly support the palliative role of BoNTs in myofascial pain syndrome. Using onaA and abobotulinumtoxinA, the successful studies emphasize the importance of a fl exible rather than a fi xed pattern of injection and injection of more than fi ve trigger points in moderate or severe cases. Although the literature remains controversial, there is hope that future studies taking advantage of our current knowledge derived from positive studies can provide further support for the role of BoNT in management of myofascial pain syndrome.Fibromyalgia is a systemic disease characterized by diffuse muscle pain, fatigue, headaches, mood disorders, sleep disturbance, bowel disorders, and endocrine dysfunction. Lack of controlled data prohibits the use botulinum toxins for treatment of fi bromyalgia. Keywords

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“…Ferrante et al compared the effects of TPI and a placebo and reported no statistically significant difference 18) . Ga et al compared the effects of intramuscular stimulation (IMS) and TPI, and reported that the former was better at alleviating pain and increasing the range of motion in the neck joint 19) .…”

Section: Discussionmentioning

confidence: 99%

Comparison of Extracorporeal Shock Wave Therapy and Trigger Point Injection in Terms of Their Effects on Pain and Bodily Functions of Myofascial Pain Syndrome Patients

et al. 2012

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Abstract. [Purpose] This study examined how the non-invasive method of extracorporeal shock wave therapy (ESWT) and the invasive method of trigger point injection (TPI) affected subjects with myofascial pain syndrome (MPS) in the trapezius muscle in terms of alleviation pain and enhancement of bodily functions, and proposes a more effective treatment method.[Subjects] Thirty-one patients with MPS in the trapezius muscle were divided into three groups: an ESWT group (n=10), a TPI group (n=13), and a control group (n=8).[Methods] The degree of pain was measured using a visual analog scale (VAS). Pressure pain threshold (PPT) was measured at trigger points in the trapezius muscle using a pressure algometer, and the Constant-Murley scale (CMS) was used for functional evaluation.[Results] All three groups showed statistically significant improvements in terms of VAS following treatment. For the pressure pain threshold, only the TPI group showed a statistically significant improvement. CMS showed statistically significant improvements in all three groups, following the treatment. A comparison of the effects of the different treatment methods revealed no significant differences among the groups in terms of VAS and PPT, but CMS showed significant differences between the control and treatment groups. However, between the ESWT group and the TPI group, no significant difference was found in any category.[Conclusion] The study results suggest that the non-invasive method of ESWT is as effective as the invasive method of TPI in the treatment of myofascial pain syndrome.

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Evidence against Trigger Point Injection Technique for the Treatment of Cervicothoracic Myofascial Pain with Botulinum Toxin Type A

Abstract: Injection of BoNT-A directly into trigger points did not improve cervicothoracic myofascial pain. The role of direct injection of trigger points with BoNT-A is discussed in comparison to other injection methodologies in the potential genesis of pain relief.

Cited by 146 publications

References 28 publications

Barriers to rehabilitation following surgery for primary breast cancer

Barriers to rehabilitation following surgery for primary breast cancer

Botulinum Toxin Treatment of Myofascial Pain Syndrome and Fibromyalgia

Comparison of Extracorporeal Shock Wave Therapy and Trigger Point Injection in Terms of Their Effects on Pain and Bodily Functions of Myofascial Pain Syndrome Patients

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