Therapeutic Use of Botulinum Toxin Type A in Treating Neck and Upper-Back Pain of Myofascial Origin: A Pilot Study

• Published in: Archives of physical medicine and rehabilitation Vol. 89; no. 1; pp. 75 - 80
• Main Authors: Lew, Henry L., MD, PhD, Lee, Eun Ha, MD, PhD, Castaneda, Annabel, MD, MPH, Klima, Roger, MD, Date, Elaine, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2008; Elsevier
• Subjects: Aged; Back pain; Back Pain - drug therapy; Biological and medical sciences; Botulinum toxin type A; Botulinum Toxins, Type A - therapeutic use; Diseases of the osteoarticular system; Diseases of the osteoarticular system. Orthopedic treatment; Diseases of the spine; Double-Blind Method; Female; Health Status Indicators; Humans; Male; Medical sciences; Miscellaneous. Osteoarticular involvement in other diseases; Myofascial pain syndromes; Myofascial Pain Syndromes - drug therapy; Neck Pain - drug therapy; Neuromuscular Agents - therapeutic use; Pain Measurement; Physical Medicine and Rehabilitation; Pilot Projects; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Treatment Outcome; Back pain; Myofascial pain syndromes; Rehabilitation; Botulinum toxin type A; Prognosis; Lumbar spine; Toxicity; Low back pain; Diseases of the osteoarticular system; Mental health; Metalloendopeptidases; Spine disease; Neck pain; Disability; Bontoxilysin; Pain; Reeducation; Dorsalgia; Rachialgia; Ambulatory; Neck; Hospital; Human; Enzyme; Myalgia; Physical rehabilitation; Medicine; Peptidases; Striated muscle disease; Survey; Treatment; Follow up study; Double blind study; Dorsal spine; Hydrolases; Cervical spine
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2007.08.133

Abstract Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study. Objective To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin. Design A randomized, double-blind, placebo-controlled pilot study. Setting Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital. Participants A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred. Intervention Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6. Main Outcome Measures Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36). Results Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported. Conclusions Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.