A Critical Appraisal of the Evidence for Botulinum Toxin Type A in the Treatment for Cervico‐Thoracic Myofascial Pain Syndrome

Abstract

Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence-based medicine to the treatment for cervico-thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al.'s as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.

Current Status and Future Directions of Botulinum Neurotoxins for Targeting Pain Processing

“…In humans, myofascial pain syndromes, characterized by activation of multiple bilateral local pain state trigger points, have been shown to be attenuated by local delivery of BoNT/A1 [ 127 , 128 ]. However, systematic trials appear to be lacking [ 129 , 130 ]. Intra-articular delivery of BoNT/A1 has been shown to have attenuating effects upon inflammatory and chronic joint pain in the shoulder [ 37 , 38 , 39 , 40 , 131 ].…”

Botulinum Toxin Treatment of Myofascial Pain Syndrome and Fibromyalgia

“…This interest is refl ected in a recent increase in the number of reviews published on this subject (Gerwin 2014 ;Adelowo et al 2013 ;Zhou and Wang 2014 ;Desai et al 2014 ).…”

“…It is fundamentally different from Gobel's study since investigators injected only a limited number of trigger points (no more than fi ve). We and others (Gerwin 2014 ;Zhou and Wang 2014 ;Desai et al 2014 ) believe that the limited number of injections is a major issue which signifi cantly and negatively impacts the response to BoNT treatment in the moderate to severe forms of myofascial pain syndrome.…”

“…Trigger point injections with anesthetic agents and steroids are also often used. Despite the availability of a wide range of treatment modalities for deactivation of trigger points in MPS, it is generally believed that current strategies offer only transient pain relief (Desai et al 2014 ;Zhou and Wang 2014 ). Novel therapeutic modalities with acceptable safety profi le and infrequent side effects are needed to provide more sustained relief.…”

Eficacia de medicamentos antihomotóxicos en el tratamiento del síndrome miofascial cervical y de cintura escapular: estudio comparativo versus toxina botulínica tipo A

“…En los estudios de revisión sistemática (21)(22)(23), se ha reportado un efecto favorable de la toxina botulínica en la disminución del dolor por SDM, sin embargo también se concluye que son necesarios más estudios para poder establecer el grado de recomendación para su uso.…”