Original articleTherapeutic Use of Botulinum Toxin Type A in Treating Neck and Upper-Back Pain of Myofascial Origin: A Pilot Study
Section snippets
Participants
Twenty-nine adult subjects with diagnoses of cervical or upper-back pain of myofascial origin participated in the study. Through flyers and advertisements, subjects were recruited from the general population and the patient population of the physical medicine and rehabilitation clinic in a university-affiliated tertiary hospital. The study was approved by the institutional review board of the hospital’s affiliated university. Subjects were included if they (1) had been diagnosed as having neck
Demographics
Thirty subjects consented and were randomized to the study. One subject was excluded in the analysis because his age exceeded 70 years, which was a protocol deviation. There were 20 men and 9 women among the 29 subjects included in the analysis. An analysis of the group characteristics regarding age, sex, and race yielded no significant group differences between the treatment and control subjects (table 1). A comparison of the BTX-A and control groups showed no baseline differences in the
Discussion
BTX-A inhibits acetylcholine release from motor nerve terminals at the neuromuscular junction, resulting in reversible chemical denervation and temporary (3–4mo) relief of muscle spasm.2, 3, 4 But it has also been proposed that the pain relief resulting from BTX-A injection is due to mechanisms other than chemodenervation. Precisely what these mechanisms are remain unclear, but it has been postulated that BTX-A acts centrally on spinal interneurons, through antagonism with substance P, and
Conclusions
This study is among few randomized controlled investigations on the use of trigger point injections of BTX-A for the treatment of myofascial neck and upper back pain. Within the limitations of this pilot study, when compared with saline, BTX-A injections did not result in statistically significant changes in NDI and VAS measures. However, compared with controls, BTX-A injections produced significantly better outcomes in bodily pain (at 2 and 4 months postinjection) and mental health scales (at
Acknowledgment
Data analysis conducted by ethica Clinical Research Inc.
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Supported in part by Allergan Inc.
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