Botulinum Toxin Treatment of Myofascial Pain Syndrome and Fibromyalgia

Abstract

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