Safety and Efficacy of PrabotulinumtoxinA (Nabota®) Injection for Cervical and Shoulder Girdle Myofascial Pain Syndrome: A Pilot Study

Abstract

Myofascial pain syndrome is a common painful condition encountered in the general population. Previous studies evaluating the efficacy of botulinum toxin for the treatment of myofascial pain syndrome are limited, with variable results. This prospective study investigated the efficacy and safety of direct injection of Prabotulinumtoxin A (Nabota®) into painful muscle groups for cervical and shoulder girdle myofascial pain. Twelve patients with chronic myofascial pain syndrome of the neck and shoulder underwent an injection of Prabotulinumtoxin A. Painful muscles containing trigger points were injected in the mid-belly. Pain scores and quality of life measurements were assessed at baseline, as well as 6 weeks and 12 weeks post-injection. Safety and tolerability were also assessed. This trial is registered under clinical research information service (CRIS) number KCT0001634. Patients injected with Prabotulinumtoxin A showed a significant improvement in pain at 12 weeks (p < 0.001). At 6 weeks, the pain had not significantly improved compared with baseline (p = 0.063). However, at that time, 41.7% of patients were characterized as Prabotulinumtoxin A responders, with a 30% reduction in pain rating score compared to baseline. In the Neck Disability Index scores, the patients demonstrated significant improvement at both 6 weeks and 12 weeks. No serious adverse effects occurred during the study. Prabotulinumtoxin A injection into chronically painful muscles associated with cervical and shoulder girdle myofascial pain syndrome resulted in an improvement in pain scores and quality of life lasting at least 12 weeks. Additionally, the injections were well tolerated. As these are preliminary findings in a pilot study, future studies should carefully consider using randomized, controlled, prospective trials.

Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials

“…This might mitigate the power of the conclusion derived from the present meta-analysis. Nevertheless, some case series investigating BoNT injections also demonstrated pain reduction and functional improvement in shoulder joint and myofascial pain [13,53], which were compatible with our findings.…”

“…After excluding 108 duplicated articles and 439 non-relevant articles by screening titles and abstracts, 19 studies were deemed eligible for subsequent evaluation. Ten were further excluded because four lacked a control group [10,[13][14][15], five targeted myofascial pain in regions other than shoulder areas [16][17][18][19][20], and one used an enriched protocol design to assess the effect of repeated BoNT injections [14] (Figure 1). The final meta-analysis consisted of seven 2-armed [21][22][23][24][25][26][27], one 3-armed [28], and one 4-armed [29] trials.…”

Myofascial Pain Syndrome: Looked through the Lens of 11 Cases Managed by Myofascial Trigger Point Massage Therapy, Riyadh, Saudi Arabia

“…A typical case of MPS requires a comprehensive plan: a pertinent history, physical examination (palpation), and systemic evaluation, a battery of laboratory investigation, advanced neuroimaging techniques, ultrasound, and histopathological studies [1][2][3]16,[23][24][25][26][27][28]. However, in our case series the diagnosis of MPS was based on myofascial pain and tenderness of muscle, recognition of taut muscle, palpation of MTrPs, local twitch response, referred pain symptoms such as goose-bumps and numbness, referred pain to other specific regions such as shoulder, neck and back, chest, hands and limitation of motion, and repeated injuries including forceful trauma and muscle strains as described by Gerwin and other researchers [1][2][3][4][7][8][9]11,18,29,30].…”

Expert consensus on the diagnosis and treatment of myofascial pain syndrome

“…Type A is conventionally prescribed, while type B is only prescribed for cases with type A failure[ 49 , 50 ]. The suggested dose for a single trigger point or an individual “tight bandage” in muscles is 5 U, with a total dose of 15 U to 35 U in a 2-wk interval[ 51 ]. The stretching exercise is also comprehensively required during injection therapies to consolidate the effects of the botulinum toxin with affected muscles.…”