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For: Foster L, Clapp L, Erickson M, Jabbari B. Botulinum toxin A and chronic low back pain: A randomized, double-blind study. Neurology 2001;56:1290-3. [PMID: 11376175 DOI: 10.1212/wnl.56.10.1290] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open

For:	Foster L, Clapp L, Erickson M, Jabbari B. Botulinum toxin A and chronic low back pain: A randomized, double-blind study. Neurology 2001;56:1290-3. [PMID: 11376175 DOI: 10.1212/wnl.56.10.1290] [Citation(s) in RCA: 172] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open

Number

Cited by Other Article(s)

Wagrees W, Kelani H, Salamah HM, Mahmoud A, Khlidj Y, Abdelraouf MR, Sharaf B, Elnewishy M, Albaramony N, Naeem A, Elazim AA, El-Ghanem M, Greene-Chandos D, Jadidi M, Lerner DP, Kay AD, Merlin LR, Brock C. The Efficacy and Safety of Botulinum Neurotoxin Type A in Treating Chronic Low Back Pain: A Systematic Review, Meta-Analysis, Trial Sequential Analysis, and Meta-Regression. Eur J Pain 2025;29:e4796. [PMID: 39985117 DOI: 10.1002/ejp.4796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 01/23/2025] [Accepted: 01/27/2025] [Indexed: 02/24/2025]

Abstract

BACKGROUND

Chronic low back pain (CLBP) is a leading cause of disability. Botulinum neurotoxin type A (BoNT-A) has strong anti-spasmodic and analgesic effects, suggesting that its local muscular injection can reduce CLBP compared to other therapies. In this systematic review and meta-analysis, we investigated the efficacy and safety of BoNT-A on patients with CLBP.

METHODS

We searched PubMed, Scopus, Cochrane, and Web of Science databases for studies comparing BoNT-A to other therapies in terms of functional improvement and pain improvement as measured by visual analog scale (VAS) and clinically significant improvement in pain (50% or greater reduction in VAS score). We employed trial sequential analysis (TSA) to confirm the findings. The GRADE approach was employed to assess the overall quality of the evidence.

RESULTS

The search yielded nine studies, seven randomised clinical trials (RCTs), and two prospective observational studies. Compared to the control, BoNT-A increased the incidence of clinically significant improvement in pain (RR = 4.82, 95% CI (3.00, 7.76), p < 0.00001) and functional improvement (RR = 3.81, 95% CI (2.40, 6.04), p < 0.00001) (low-certainty evidence), and reduced VAS score (MD = -1.62, 95% CI (-3.13, -0.11), p = 0.04) (very low-certainty evidence). Subgroup analysis showed that BoNT-A is effective against normal saline (moderate-certainty evidence), and it was comparable to steroids and local anaesthetics (very low-certainty evidence). TSA confirmed the findings regarding clinical improvement in pain and functional improvement.

CONCLUSION

BoNT-A is a tolerable and effective treatment for CLBP with a longer duration of action. Future high-quality studies are needed to confirm our findings.

SIGNIFICANCE

This paper provides good evidence that BoNT-A may be employed in patients suffering from resistant chronic low back pain not responding to normal saline injection due to its higher efficacy and longer duration of action. Compared to steroids and local anaesthetics injections, there is not enough data to draw a firm conclusion and future studies are needed.

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Affiliation(s)

Waseem Wagrees Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
Hesham Kelani Department of Neurology, SUNY Downstate Health Sciences University at One Brooklyn Health, Brooklyn, New York, USA
Hazem Mohamed Salamah Faculty of Medicine, Zagazig University, Zagazig, Egypt
Abdelrahman Mahmoud Faculty of Medicine, Minia University, Minia, Egypt
Yehya Khlidj Faculty of Medicine, University of Algiers, Algiers, Algeria
Mohamed R Abdelraouf Faculty of Medicine, Alexandria University, Alexandria, Egypt
Bahaa Sharaf Faculty of Molecular Biotechnology, Helwan University, Helwan, Egypt
Moustafa Elnewishy Faculty of Medicine, Cairo University, Cairo, Egypt
Nadia Albaramony Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ahmed Naeem Al-Azhar Faculty of Medicine, Asyut, Egypt
Ahmed Abd Elazim Department of Neurology, University of South Dakota Sanford Medical Center, Sioux Falls, South Dakota, USA
Mohammad El-Ghanem Department of Clinical Science, HCA Houston-Northwest Medical Center, University of Houston, Houston, Texas, USA
Diana Greene-Chandos Department of Neurology, School of Medicine, University of Saint Louis, Saint Louis, Missouri, USA
Mohammad Jadidi Department of Neurology, SUNY Downstate Health Sciences University at One Brooklyn Health, Brooklyn, New York, USA
David P Lerner Department of Neurology, SUNY Downstate Health Sciences University at One Brooklyn Health, Brooklyn, New York, USA
Arthur D Kay Department of Neurology, SUNY Downstate Health Sciences University at One Brooklyn Health, Brooklyn, New York, USA
Lisa R Merlin Department of Neurology, SUNY Downstate Health Sciences University at One Brooklyn Health, Brooklyn, New York, USA Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA Department of Physiology and Pharmacology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
Charles Brock Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA

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Jain M, Khan S, Varghese P, Tripathy SK, Mangaraj M. Botulinum toxin type A for treating chronic low back pain: A double blinded randomized control study. World J Methodol 2024;14:93854. [PMID: 39310232 PMCID: PMC11230068 DOI: 10.5662/wjm.v14.i3.93854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 06/25/2024] Open

Abstract

BACKGROUND

Low back pain (LBP) is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting. LBP can arise from various causes, with stiffness in the paraspinal muscles being a notable contributor. The administration of Botulinum toxin type A (BoNT-A) has been found to alleviate back pain by relaxing these stiff muscles. While BoNT-A is approved for use in numerous conditions, a limited number of randomized clinical trials (RCTs) validate its efficacy specifically for treating LBP.

AIM

To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP (CLBP).

METHODS

In this RCT, adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled. Participants were allocated to either the Drug group, receiving 200 Ipsen Units (2 mL) of BoNT-A, or the Control group, which received a 2 mL placebo. Over a 2-month follow-up period, both groups were assessed using the Visual Analog Scale (VAS) for pain intensity and the Oswestry Disability Index (ODI) for disability at the start and conclusion of the study. A decrease in pain by 50% was deemed clinically significant.

RESULTS

The study followed 40 patients for two months, with 20 in each group. A clinically significant reduction in pain was observed in 36 participants. There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months. Nonetheless, when comparing the mean score changes, only the reduction in ODI scores (15 in the placebo group vs 16.5 in the drug group, clinically insignificant) was statistically significant (P = 0.012), whereas the change in mean VAS scores was not significant (P = 0.45).

CONCLUSION

The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

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Pozo-Rosich P, Alpuente A, Silberstein SD, Burstein R. Insights from 25 years of onabotulinumtoxinA in migraine - mechanisms and management. Nat Rev Neurol 2024;20:555-568. [PMID: 39160284 DOI: 10.1038/s41582-024-01002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/21/2024]

De la Torre Canales G, Câmara-Souza MB, Ernberg M, Al-Moraissi EA, Grigoriadis A, Poluha RL, Christidis M, Jasim H, Lövgren A, Christidis N. Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews. Drugs 2024;84:779-809. [PMID: 38900335 PMCID: PMC11289222 DOI: 10.1007/s40265-024-02048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/21/2024]

Abstract

OBJECTIVE

Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs.

METHOD

An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included.

RESULTS

In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments.

CONCLUSION

The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

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Alonge P, Brighina F, Maccora S, Pilati L, Di Marco S, Ventimiglia D, Maggio B, Cutrò I, Camarda C, Torrente A. Beyond Pain: The Effects of OnabotulinumtoxinA Therapy on Sensitization and Interictal Symptoms in Chronic Migraine. Toxins (Basel) 2024;16:203. [PMID: 38787055 PMCID: PMC11125997 DOI: 10.3390/toxins16050203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open

Affiliation(s)

Paolo Alonge Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
Filippo Brighina Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
Simona Maccora Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.) Neurology Unit, ARNAS Civico di Cristina and Benfratelli Hospitals, 90127 Palermo, Italy
Laura Pilati Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.) Neurology and Stroke Unit, P.O. “S. Antonio Abate”, 91016 Erice, Italy
Salvatore Di Marco Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.) Neurology and Stroke Unit, P.O. “S. Antonio Abate”, 91016 Erice, Italy
Davide Ventimiglia Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
Bruna Maggio Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
Ivana Cutrò Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
Cecilia Camarda Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)
Angelo Torrente Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy; (P.A.); (S.M.); (L.P.); (S.D.M.); (D.V.); (B.M.); (I.C.); (C.C.); (A.T.)

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De la Torre Canales G, Poluha RL, Bonjardim LR, Ernberg M, Conti PCR. Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial. Sci Rep 2024;14:4201. [PMID: 38378855 PMCID: PMC10879180 DOI: 10.1038/s41598-024-54906-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open

Abstract

The antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann-Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.

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Özdemir A, Güleç A, Yurteri A, Odabaşı E, Acar MA. Effect of pronator teres muscle botulinum neurotoxin type-A injection on proximal median nerve entrapment. HAND SURGERY & REHABILITATION 2024;43:101604. [PMID: 37797787 DOI: 10.1016/j.hansur.2023.09.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]

Bodine N. An overview of myofascial pain syndrome with a focus on trigger point injection. Nurse Pract 2023;48:18-25. [PMID: 37884018 DOI: 10.1097/01.npr.0000000000000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]

Long-Term Effects of a Single Application of Botulinum Toxin Type A in Temporomandibular Myofascial Pain Patients: A Controlled Clinical Trial. Toxins (Basel) 2022;14:toxins14110741. [PMID: 36355991 PMCID: PMC9721314 DOI: 10.3390/toxins14110741] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023] Open

Kwon SY, Jun EH, Park SJ, Kim Y. Botulinum toxin injection strategy of intractable and relapsed piriformis syndrome: A case report. Medicine (Baltimore) 2022;101:e30950. [PMID: 36281083 PMCID: PMC9592348 DOI: 10.1097/md.0000000000030950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open

Ferrillo M, Giudice A, Marotta N, Fortunato F, Di Venere D, Ammendolia A, Fiore P, de Sire A. Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022;23:12164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open

McDonald A. Primary Care-Based Interventional Procedures for Chronic Pain. Prim Care 2022;49:425-437. [DOI: 10.1016/j.pop.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Helmi ZR. Comparative Study of 150 vs. 200 Units of Botulinum Toxin as Treatment for Vaginismus. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022;44:854-865. [PMID: 35817081 PMCID: PMC9948261 DOI: 10.1055/s-0042-1751287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]

Lippi L, de Sire A, Folli A, D’Abrosca F, Grana E, Baricich A, Carda S, Invernizzi M. Multidimensional Effectiveness of Botulinum Toxin in Neuropathic Pain: A Systematic Review of Randomized Clinical Trials. Toxins (Basel) 2022;14:308. [PMID: 35622555 PMCID: PMC9145715 DOI: 10.3390/toxins14050308] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open

Affiliation(s)

Lorenzo Lippi Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.) Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
Alessandro de Sire Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, 88100 Catanzaro, Italy;
Arianna Folli Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
Francesco D’Abrosca Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.)
Elisa Grana Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, 1004 Lausanne, Switzerland; (E.G.); (S.C.)
Alessio Baricich Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.) Physical and Rehabilitation Medicine, “Ospedale Maggiore della Carità” University Hospital, 28100 Novara, Italy
Stefano Carda Neuropsychology and Neurorehabilitation Service, Department of Clinical Neuroscience, Lausanne University Hospital, 1004 Lausanne, Switzerland; (E.G.); (S.C.)
Marco Invernizzi Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (F.D.); (A.B.) Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy

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Sahoo J, Jena D, Viswanath A, Barman A. Injection Botulinum Toxin A in Treatment of Resistant Chronic Low Back Pain: A Prospective Open-Label Study. Cureus 2021;13:e17811. [PMID: 34660021 PMCID: PMC8500249 DOI: 10.7759/cureus.17811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/27/2022] Open

Liu Y, Kao DS. Nonsurgical Approaches to Neuroma Management. Hand Clin 2021;37:323-333. [PMID: 34253306 DOI: 10.1016/j.hcl.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]

Cashin AG, Folly T, Bagg MK, Wewege MA, Jones MD, Ferraro MC, Leake HB, Rizzo RRN, Schabrun SM, Gustin SM, Day R, Williams CM, McAuley JH. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ 2021;374:n1446. [PMID: 34233900 PMCID: PMC8262447 DOI: 10.1136/bmj.n1446] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]

Abstract

OBJECTIVE

To investigate the efficacy, acceptability, and safety of muscle relaxants for low back pain.

DESIGN

Systematic review and meta-analysis of randomised controlled trials.

DATA SOURCES

Medline, Embase, CINAHL, CENTRAL, ClinicalTrials.gov, clinicialtrialsregister.eu, and WHO ICTRP from inception to 23 February 2021.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Randomised controlled trials of muscle relaxants compared with placebo, usual care, waiting list, or no treatment in adults (≥18 years) reporting non-specific low back pain.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently identified studies, extracted data, and assessed the risk of bias and certainty of the evidence using the Cochrane risk-of-bias tool and Grading of Recommendations, Assessment, Development and Evaluations, respectively. Random effects meta-analytical models through restricted maximum likelihood estimation were used to estimate pooled effects and corresponding 95% confidence intervals. Outcomes included pain intensity (measured on a 0-100 point scale), disability (0-100 point scale), acceptability (discontinuation of the drug for any reason during treatment), and safety (adverse events, serious adverse events, and number of participants who withdrew from the trial because of an adverse event).

RESULTS

49 trials were included in the review, of which 31, sampling 6505 participants, were quantitatively analysed. For acute low back pain, very low certainty evidence showed that at two weeks or less non-benzodiazepine antispasmodics were associated with a reduction in pain intensity compared with control (mean difference -7.7, 95% confidence interval-12.1 to-3.3) but not a reduction in disability (-3.3, -7.3 to 0.7). Low and very low certainty evidence showed that non-benzodiazepine antispasmodics might increase the risk of an adverse event (relative risk 1.6, 1.2 to 2.0) and might have little to no effect on acceptability (0.8, 0.6 to 1.1) compared with control for acute low back pain, respectively. The number of trials investigating other muscle relaxants and different durations of low back pain were small and the certainty of evidence was reduced because most trials were at high risk of bias.

CONCLUSIONS

Considerable uncertainty exists about the clinical efficacy and safety of muscle relaxants. Very low and low certainty evidence shows that non-benzodiazepine antispasmodics might provide small but not clinically important reductions in pain intensity at or before two weeks and might increase the risk of an adverse event in acute low back pain, respectively. Large, high quality, placebo controlled trials are urgently needed to resolve uncertainty.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019126820 and Open Science Framework https://osf.io/mu2f5/.

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Affiliation(s)

Aidan G Cashin Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
Thiago Folly Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
Matthew K Bagg Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia New College Village, University of New South Wales, Sydney, NSW, Australia
Michael A Wewege Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Matthew D Jones Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Michael C Ferraro Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Hayley B Leake IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
Rodrigo R N Rizzo Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Siobhan M Schabrun Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
Sylvia M Gustin Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
Richard Day Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, NSW, Australia St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
Christopher M Williams School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
James H McAuley Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia School of Health Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia

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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021;63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]

Yi KH, Lee KL, Lee JH, Hu HW, Lee K, Seo KK, Kim HJ. Guidelines for botulinum neurotoxin injections in piriformis syndrome. Clin Anat 2020;34:1028-1034. [PMID: 33347678 DOI: 10.1002/ca.23711] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]

Treatment of "plantar fasciitis"/Plantar Heel Pain Syndrome with botulinum toxin - A novel injection paradigm pilot study. Foot (Edinb) 2020;45:101711. [PMID: 33038660 DOI: 10.1016/j.foot.2020.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]

Dawson A, Dawson J, Ernberg M. The effect of botulinum toxin A on patients with persistent idiopathic dentoalveolar pain-A systematic review. J Oral Rehabil 2020;47:1184-1191. [PMID: 32640063 DOI: 10.1111/joor.13053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/01/2020] [Accepted: 06/30/2020] [Indexed: 01/16/2023]

Treatment methods for post-traumatic elbow stiffness caused by heterotopic ossification. J Shoulder Elbow Surg 2020;29:1380-1386. [PMID: 32553438 DOI: 10.1016/j.jse.2020.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]

Diep D, Ko J, Lan J, Koprowicz KT, Ko G. Benefits, Safety, and Adjunct Modality Prevalences of Long-Term Botulinum Toxin Injections for Cervical Dystonia and Myofascial Neck Pain: A Retrospective Cohort Study. J Pain Res 2020;13:1297-1304. [PMID: 32581571 PMCID: PMC7276373 DOI: 10.2147/jpr.s254032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/29/2020] [Indexed: 12/15/2022] Open

Abstract

Introduction

There is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices.

Objective

To assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients.

Design

Retrospective cohort study.

Setting

Private practice tertiary care clinics in Toronto.

Patients

Convenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2±4.3 and 8.3±4.7 years, respectively.

Interventions

BTX-A injections administered at least once yearly, for a duration longer than 1 year.

Main Outcome Measures

Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities.

Results

CD patients experienced improvements in TWSTRS disability (17.57±6.79 to 9.81±4.35, p<0.001) and pain (14.61±3.08 to 9.05±3.49, p<0.001) scores as well as PGIC score (52.00%±23.60% to 64.80%±23.60%, p=0.007). MPS patients experienced improvements in TWSTRS disability (15.86±7.70 to 10.07±7.01, p=0.01) and pain (15.25±4.09 to 10.85±4.49, p=0.01) scores. In both cohorts, there were no changes in time to peak effect and duration of total response. Adverse effects were minimal and self-limiting. Prevalences of adjunct modalities used by CD versus MPS patients were 28.13% versus 50.00% for anesthetic procedures, 23.08% versus 15.38% for image-guidance, 65.71% versus 56.25% for pectoralis minor injections, and 47.06% versus 53.13% for cannabis-use.

Conclusion

There were demonstrated and comparable treatment benefit, safety, and adjunct modality prevalences. Our study is the first to demonstrate that long-term BTX-A injections for MPS, although commonly used off-label, can be effective and safe.

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Kim YG, Bae JH, Kim H, Wang SJ, Kim ST. A Proposal for Botulinum Toxin Type A Injection Into the Temporal Region in Chronic Migraine Headache. Toxins (Basel) 2020;12:toxins12040214. [PMID: 32231158 PMCID: PMC7232308 DOI: 10.3390/toxins12040214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 01/03/2023] Open

Jarrell JF, Vilos GA, Allaire C, Burgess S, Fortin C, Gerwin R, Lapensee L, Lea RH, Leyland NA, Martyn P, Shenassa H, Taenzer P. No. 164-Consensus Guidelines for the Management of Chronic Pelvic Pain. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019;40:e747-e787. [PMID: 30473127 DOI: 10.1016/j.jogc.2018.08.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]

Abstract

OBJECTIVE

To improve the understanding of chronic pelvic pain (CPP) and to provide evidence-based guidelines of value to primary care health professionals, general obstetricians and gynaecologists, and those who specialize in chronic pain.

BURDEN OF SUFFERING

CPP is a common, debilitating condition affecting women. It accounts for substantial personal suffering and health care expenditure for interventions, including multiple consultations and medical and surgical therapies. Because the underlying pathophysiology of this complex condition is poorly understood, these treatments have met with variable success rates.

OUTCOMES

Effectiveness of diagnostic and therapeutic options, including assessment of myofascial dysfunction, multidisciplinary care, a rehabilitation model that emphasizes achieving higher function with some pain rather than a cure, and appropriate use of opiates for the chronic pain state.

EVIDENCE

Medline and the Cochrane Database from 1982 to 2004 were searched for articles in English on subjects related to CPP, including acute care management, myofascial dysfunction, and medical and surgical therapeutic options. The committee reviewed the literature and available data from a needs assessment of subjects with CPP, using a consensus approach to develop recommendations.

VALUES

The quality of the evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice were ranked according to the method described in that report (Table 1).

RECOMMENDATIONS

The recommendations are directed to the following areas: (a) an understanding of the needs of women with CPP; (b) general clinical assessment; (c) practical assessment of pain levels; (d) myofascial pain; (e) medications and surgical procedures; (d) principles of opiate management; (f) increased use of magnetic resonance imaging (MRI); (g) documentation of the surgically observed extent of disease; (h) alternative therapies; (i) access to multidisciplinary care models that have components of physical therapy (such as exercise and posture) and psychology (such as cognitive-behavioural therapy), along with other medical disciplines, such as gynaecology and anesthesia; G) increased attention to CPP in the training of health care professionals; and (k) increased attention to CPP in formal, high-calibre research. The committee recommends that provincial ministries of health pursue the creation of multidisciplinary teams to manage the condition.

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Matak I, Bölcskei K, Bach-Rojecky L, Helyes Z. Mechanisms of Botulinum Toxin Type A Action on Pain. Toxins (Basel) 2019;11:E459. [PMID: 31387301 PMCID: PMC6723487 DOI: 10.3390/toxins11080459] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/31/2022] Open

Joussain C, Le Coz O, Pichugin A, Marconi P, Lim F, Sicurella M, Salonia A, Montorsi F, Wandosell F, Foster K, Giuliano F, Epstein AL, Aranda Muñoz A. Botulinum Neurotoxin Light Chains Expressed by Defective Herpes Simplex Virus Type-1 Vectors Cleave SNARE Proteins and Inhibit CGRP Release in Rat Sensory Neurons. Toxins (Basel) 2019;11:toxins11020123. [PMID: 30791373 PMCID: PMC6409900 DOI: 10.3390/toxins11020123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023] Open

Affiliation(s)

Charles Joussain UMR U1179 INSERM/Université de Versailles Saint Quentin en Yvelines (UVSQ)-Paris Saclay, 78180 Montigny-le-Bretonneux, France. Neuro-Urology R. Poincaré Hospital AP-HP, 92380 Garches, France. Ipsen Innovation SAS, 91940 Les Ulis, France.
Olivier Le Coz UMR U1179 INSERM/Université de Versailles Saint Quentin en Yvelines (UVSQ)-Paris Saclay, 78180 Montigny-le-Bretonneux, France.
Andrey Pichugin UMR U1179 INSERM/Université de Versailles Saint Quentin en Yvelines (UVSQ)-Paris Saclay, 78180 Montigny-le-Bretonneux, France.
Peggy Marconi Department of Chemical and Pharmaceutical Sciences (DipSCF), University of Ferrara, 44121 Ferrara, Italy.
Filip Lim Centro de Biologia Molecular Severo Ochoa, CSIC-UAM, Universidad Autonoma de Madrid (UAM), 28049 Cantoblanco, Madrid, Spain.
Mariaconcetta Sicurella Department of Chemical and Pharmaceutical Sciences (DipSCF), University of Ferrara, 44121 Ferrara, Italy. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20129 Milan, Italy.
Andrea Salonia Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20129 Milan, Italy. University Vita-Salute San Raffaele, 20129 Milan, Italy.
Francesco Montorsi Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, 20129 Milan, Italy. University Vita-Salute San Raffaele, 20129 Milan, Italy.
Francisco Wandosell Centro de Biologia Molecular Severo Ochoa, CSIC-UAM, Universidad Autonoma de Madrid (UAM), 28049 Cantoblanco, Madrid, Spain.
Keith Foster Ipsen Bioinnovation Ltd., Abingdon, Oxon OX14 4RY, UK.
François Giuliano UMR U1179 INSERM/Université de Versailles Saint Quentin en Yvelines (UVSQ)-Paris Saclay, 78180 Montigny-le-Bretonneux, France. Neuro-Urology R. Poincaré Hospital AP-HP, 92380 Garches, France.
Alberto L Epstein UMR U1179 INSERM/Université de Versailles Saint Quentin en Yvelines (UVSQ)-Paris Saclay, 78180 Montigny-le-Bretonneux, France.
Alejandro Aranda Muñoz UMR U1179 INSERM/Université de Versailles Saint Quentin en Yvelines (UVSQ)-Paris Saclay, 78180 Montigny-le-Bretonneux, France.

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Jarrell JF, Vilos GA, Allaire C, Burgess S, Fortin C, Gerwin R, Lapensée L, Lea RH, Leyland NA, Martyn P, Shenassa H, Taenzer P. No 164 - Directive clinique de consensus pour la prise en charge de la douleur pelvienne chronique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018;40:e788-e836. [DOI: 10.1016/j.jogc.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]

Tavee JO, Levin KH. Low Back Pain. Continuum (Minneap Minn) 2018;23:467-486. [PMID: 28375914 DOI: 10.1212/con.0000000000000449] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Park TSW, Kuo A, Smith MT. Chronic low back pain: a mini-review on pharmacological management and pathophysiological insights from clinical and pre-clinical data. Inflammopharmacology 2018;26:10.1007/s10787-018-0493-x. [PMID: 29754321 DOI: 10.1007/s10787-018-0493-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/01/2018] [Indexed: 12/19/2022]

Abstract

Globally, low back pain (LBP) is one of the most common health problems affecting humans. The lifetime prevalence of non-specific LBP is approximately 84%, with the chronic prevalence at about 23%. Chronic LBP in humans is defined as LBP that persists for more than 12 weeks without a significant pain improvement. Although there are numerous evidence-based guidelines on the management of acute LBP, this is not the case for chronic LBP, which is regarded as particularly difficult to treat. Research aimed at discovering new drug treatments for alleviation of chronic mechanical LBP is lacking due to the paucity of knowledge on the pathobiology of this condition, despite its high morbidity in the affected adult population. For a debilitating condition such as chronic LBP, it is necessary to assess the sustained effects of pharmacotherapy of various agents spanning months to years. Although many rodent models of mechanical LBP have been developed to mimic the human condition, some of the major shortcomings of many of these models are (1) the presence of a concurrent neuropathic component that develops secondary to posterior intervertebral disc puncture, (2) severe model phenotype, and/or (3) use of behavioural endpoints that have yet to be validated for pain. Hence, there is a great, unmet need for research aimed at discovering new biological targets in rodent models of chronic mechanical LBP for use in drug discovery programs as a means to potentially produce new highly effective and well-tolerated analgesic agents to improve relief of chronic LBP. On a cautionary note, it must be borne in mind that because humans and rats display orthograde and pronograde postures, respectively, the different mechanical forces on their spines add to the difficulty in translation of promising rodent data to humans.

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Gabriel A, Maxwell GP. Commentary on: Effect of Botulinum Toxin A on Muscle Healing and its Implications in Aesthetic and Reconstructive Surgery. Aesthet Surg J 2018;38:562-564. [PMID: 29340596 DOI: 10.1093/asj/sjx243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open

Koes BW, Backes D, Bindels PJE. Pharmacotherapy for chronic non-specific low back pain: current and future options. Expert Opin Pharmacother 2018;19:537-545. [PMID: 29578822 DOI: 10.1080/14656566.2018.1454430] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]

Wang YF, Liu F, Lan J, Bai J, Li XQ. The Effect of Botulinum Neurotoxin Serotype a Heavy Chain on the Growth Related Proteins and Neurite Outgrowth after Spinal Cord Injury in Rats. Toxins (Basel) 2018;10:toxins10020066. [PMID: 29393906 PMCID: PMC5848167 DOI: 10.3390/toxins10020066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 12/16/2022] Open

Abstract

(1) Background: The botulinum toxin A (BoNT-A) heavy chain (HC) can stimulate the growth of primary motor neurites. (2) Methods: A recombinant BoNT/A HC was injected locally plus interval intrathecal catheter of BoNT/A HC to rats with ipsilateral semi-dissociated lumbar spinal cord injuries (SCIs). First, 2D gel with a silver nitrate stain was applied to detect the general pattern of protein expression. Growth associated protein 43 (GAP-43) and superior cervical ganglion 10 (SCG10) were chosen to represent the altered proteins, based on their molecular weight and pI, and were used to further detect their expression. Meanwhile, the neuronal processes were measured. The measurements of thermal hyperalgesia and grasp power at the ipsilateral hindlimb were used to evaluate spinal sensory and motor function, respectively. (3) Results: The local injection of BoNT/A HC followed by its intrathecal catheter intervally altered the spinal protein expression pattern after an SCI; protein expression was similar to normal levels or displayed a remarkable increase. The changes in the expression and distribution of phosphorylated growth associated protein 43(p-GAP 43) and superior cervical ganglion 10 (SCG 10) indicated that the administration of BoNT/A HC to the SCI significantly amplified the expression of p-GAP43 and SCG10 (p < 0.05). Meanwhile, the positive immunofluorescent staining for both p-GAP43 and SCG10 was mainly present near the rostral aspect of the injury, both in the cytoplasm and the neuronal processes. Moreover, the outgrowth of neurites was stimulated by the BoNT/A HC treatment; this was evident from the increase in neurite length, number of branches and the percentage of cells with neuronal processes. The results from the spinal function tests suggested that the BoNT/A HC did not affect sensation, but had a large role in improving the ipsilateral hindlimb grasp power (p < 0.05). (4) Conclusions: The local injection with the intermittent intrathecal administration of BoNT/A heavy chain to rats with SCI increased the local expression of GAP-43 and SCG 10, which might be affiliated with the regeneration of neuronal processes surrounding the injury, and might also be favorable to the relief of spinal motor dysfunction.

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Safarpour Y, Jabbari B. Botulinum toxin treatment of pain syndromes -an evidence based review. Toxicon 2018;147:120-128. [PMID: 29409817 DOI: 10.1016/j.toxicon.2018.01.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/18/2017] [Accepted: 01/28/2018] [Indexed: 02/07/2023]

Cogné M, Petit H, Creuzé A, Liguoro D, de Seze M. Are paraspinous intramuscular injections of botulinum toxin a (BoNT-A) efficient in the treatment of chronic low-back pain? A randomised, double-blinded crossover trial. BMC Musculoskelet Disord 2017;18:454. [PMID: 29141611 PMCID: PMC5688690 DOI: 10.1186/s12891-017-1816-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/08/2017] [Indexed: 12/03/2022] Open

Nicol AL, Hurley RW, Benzon HT. Alternatives to Opioids in the Pharmacologic Management of Chronic Pain Syndromes: A Narrative Review of Randomized, Controlled, and Blinded Clinical Trials. Anesth Analg 2017;125:1682-1703. [PMID: 29049114 DOI: 10.1213/ane.0000000000002426] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Park J, Park HJ. Botulinum Toxin for the Treatment of Neuropathic Pain. Toxins (Basel) 2017;9:E260. [PMID: 28837075 PMCID: PMC5618193 DOI: 10.3390/toxins9090260] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/18/2017] [Accepted: 08/21/2017] [Indexed: 01/23/2023] Open

Müller-Schwefe G, Morlion B, Ahlbeck K, Alon E, Coaccioli S, Coluzzi F, Huygen F, Jaksch W, Kalso E, Kocot-Kępska M, Kress HG, Mangas AC, Margarit Ferri C, Mavrocordatos P, Nicolaou A, Hernández CP, Pergolizzi J, Schäfer M, Sichère P. Treatment for chronic low back pain: the focus should change to multimodal management that reflects the underlying pain mechanisms. Curr Med Res Opin 2017;33:1199-1210. [PMID: 28277866 DOI: 10.1080/03007995.2017.1298521] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]

Abstract

UNLABELLED

Chronic low back pain: Chronic pain is the most common cause for people to utilize healthcare resources and has a considerable impact upon patients' lives. The most prevalent chronic pain condition is chronic low back pain (CLBP). CLBP may be nociceptive or neuropathic, or may incorporate both components. The presence of a neuropathic component is associated with more intense pain of longer duration, and a higher prevalence of co-morbidities. However, many physicians' knowledge of chronic pain mechanisms is currently limited and there are no universally accepted treatment guidelines, so the condition is not particularly well managed.

DIAGNOSIS

Diagnosis should begin with a focused medical history and physical examination, to exclude serious spinal pathology that may require evaluation by an appropriate specialist. Most patients have non-specific CLBP, which cannot be attributed to a particular cause. It is important to try and establish whether a neuropathic component is present, by combining the findings of physical and neurological examinations with the patient's history. This may prove difficult, however, even when using screening instruments. Multimodal management: The multifactorial nature of CLBP indicates that the most logical treatment approach is multimodal: i.e. integrated multidisciplinary therapy with co-ordinated somatic and psychotherapeutic elements. As both nociceptive and neuropathic components may be present, combining analgesic agents with different mechanisms of action is a rational treatment modality. Individually tailored combination therapy can improve analgesia whilst reducing the doses of constituent agents, thereby lessening the incidence of side effects.

CONCLUSIONS

This paper outlines the development of CLBP and the underlying mechanisms involved, as well as providing information on diagnosis and the use of a wide range of pharmaceutical agents in managing the condition (including NSAIDs, COX-2 inhibitors, tricyclic antidepressants, opioids and anticonvulsants), supplemented by appropriate non-pharmacological measures such as exercise programs, manual therapies, behavioral therapies, interventional pain management and traction. Surgery may be appropriate in carefully selected patients.

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Rashid S, Fields AR, Baumrucker SJ. Subcutaneous Botulinum Toxin Injection for Post-Thoracotomy Pain Syndrome in Palliative Care: A Case Report. Am J Hosp Palliat Care 2017. [PMID: 28641445 DOI: 10.1177/1049909117716460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open

Nonparalytic botulinum molecules for the control of pain. Pain 2017;157:1045-1055. [PMID: 26761389 PMCID: PMC4834813 DOI: 10.1097/j.pain.0000000000000478] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]

Abstract

BiTox attenuated A-nociceptor-mediated mechanosensitivity in rat models of chronic pain. Plasma extravasation and keratinocyte proliferation were also inhibited but C-fiber nociception was not impaired.

Local injections of botulinum toxins have been reported to be useful not only for the treatment of peripheral neuropathic pain and migraine but also to cause long-lasting muscle paralysis, a potentially serious side effect. Recently, a botulinum A-based molecule (“BiTox”) has been synthesized that retains neuronal silencing capacity without triggering muscle paralysis. In this study, we examined whether BiTox delivered peripherally was able to reduce or prevent the increased nociceptive sensitivity found in animal models of inflammatory, surgical, and neuropathic pain. Plasma extravasation and edema were also measured as well as keratinocyte proliferation. No motor deficits were seen and acute thermal and mechanical nociceptive thresholds were unimpaired by BiTox injections. We found reduced plasma extravasation and inflammatory edema as well as lower levels of keratinocyte proliferation in cutaneous tissue after local BiTox injection. However, we found no evidence that BiTox was transported to the dorsal root ganglia or dorsal horn and no deficits in formalin-elicited behaviors or capsaicin or formalin-induced c-Fos expression within the dorsal horn. In contrast, Bitox treatment strongly reduced A-nociceptor-mediated secondary mechanical hyperalgesia associated with either complete Freund’s adjuvant (CFA)-induced joint inflammation or capsaicin injection and the hypersensitivity associated with spared nerve injury. These results imply that although local release of neuromodulators from C-fibers was inhibited by BiTox injection, C-nociceptive signaling function was not impaired. Taken together with recent clinical data the results suggest that BiTox should be considered for treatment of pain conditions in which A-nociceptors are thought to play a significant role.

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Abobotulinum Toxin A in the Treatment of Chronic Low Back Pain. Toxins (Basel) 2016;8:toxins8120374. [PMID: 27983689 PMCID: PMC5198568 DOI: 10.3390/toxins8120374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 12/01/2022] Open

Cartagena-Sevilla J, García-Fernández MR, Vicente-Villena JP. Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids. J Pain Palliat Care Pharmacother 2016;30:269-275. [DOI: 10.1080/15360288.2016.1231742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]

Kermen R. Botulinum toxin for chronic pain conditions. Dis Mon 2016;62:353-7. [DOI: 10.1016/j.disamonth.2016.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]

Bomba-Warczak E, Vevea JD, Brittain JM, Figueroa-Bernier A, Tepp WH, Johnson EA, Yeh FL, Chapman ER. Interneuronal Transfer and Distal Action of Tetanus Toxin and Botulinum Neurotoxins A and D in Central Neurons. Cell Rep 2016;16:1974-87. [PMID: 27498860 DOI: 10.1016/j.celrep.2016.06.104] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022] Open

Rostami R, Mittal SO, Radmand R, Jabbari B. Incobotulinum Toxin-A Improves Post-Surgical and Post-Radiation Pain in Cancer Patients. Toxins (Basel) 2016;8:E22. [PMID: 26771640 PMCID: PMC4728544 DOI: 10.3390/toxins8010022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/10/2015] [Accepted: 12/23/2015] [Indexed: 11/17/2022] Open

The Effect of Botulinum Toxin A Injections in the Spine Muscles for Cerebral Palsy Scoliosis, Examined in a Prospective, Randomized Triple-blinded Study. Spine (Phila Pa 1976) 2015;40:E1205-11. [PMID: 26165216 DOI: 10.1097/brs.0000000000001049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]

Abstract

STUDY DESIGN

A prospective, randomized triple-blinded cross-over design treating with either botulinum toxin A (BXT) or saline (NaCl).

OBJECTIVE

To examine the efficacy of BTX treatment in cerebral palsy scoliosis (CPS).

SUMMARY OF BACKGROUND DATA

Intramuscular injections with BTX have been used off label in treating CPS. 1 prospective study has been conducted, demonstrating in both radiological and clinical improvement, whereas showing no side effects or complications.

METHODS

Subjects (brace-treated CPS between 2 and 18 yr) were injected using ultrasonic-guidance with either NaCl or BTX in selected spine muscles with 6 mo intervals (block randomization, sealed envelope). Radiographs of the spine and clinical follow-up were captured before and 6 weeks after each injection. Primary outcome parameter was radiological change in Cobb angle, where a 7° change was regarded as an effect (1 SD). Radiological parameters were measured before and 6 weeks after treatment by 3 experienced doctors separately. Moreover, clinical results were evaluated by the pediatric quality of life score and systematic open questioning of the parents about the child's wellbeing. Subjects, researchers, and monitors were blinded during the trial. Appropriate permissions (2008-004584-19) and no funding were obtained.

RESULTS

16 cerebral palsy patients (GFMCS III-V) with CPS were consecutively included, whereas 6 patients were excluded. There were no drop-outs to follow-up, but 1 possible serious adverse event of pneumonia resulting in death was recorded and the study was terminated. No significant radiological or clinical changes were detected when compared with NaCl injections using Wilcoxon matched pair signed-rank test.

CONCLUSION

No positive radiological or clinical effects were demonstrated by this treatment, except for the parent's initial subjective but positive appraisal of the effect. However, the study was terminated due to 1 possible severe adverse event and scheduled numbers needed to treat (hence power) were not reached.

LEVEL OF EVIDENCE

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The effects of intraplantar and intrathecal botulinum toxin type B on tactile allodynia in mono and polyneuropathy in the mouse. Anesth Analg 2015;121:229-238. [PMID: 26039418 DOI: 10.1213/ane.0000000000000777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]

Kim HJ, Lee GW, Kim MJ, Yang KY, Kim ST, Bae YC, Ahn DK. Antinociceptive Effects of Transcytosed Botulinum Neurotoxin Type A on Trigeminal Nociception in Rats. THE KOREAN JOURNAL OF PHYSIOLOGY & PHARMACOLOGY : OFFICIAL JOURNAL OF THE KOREAN PHYSIOLOGICAL SOCIETY AND THE KOREAN SOCIETY OF PHARMACOLOGY 2015;19:349-55. [PMID: 26170739 PMCID: PMC4499647 DOI: 10.4196/kjpp.2015.19.4.349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/07/2015] [Accepted: 04/17/2015] [Indexed: 01/24/2023]

Gabriel A, Champaneria MC, Maxwell GP. The efficacy of botulinum toxin A in post-mastectomy breast reconstruction: a pilot study. Aesthet Surg J 2015;35:402-9. [PMID: 25825421 DOI: 10.1093/asj/sjv040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/13/2022] Open

Abstract

BACKGROUND

Botulinum toxin A has been successfully used in a variety of areas to temporarily obliterate muscle mobility for either functional or aesthetic gain. Tissue expander-based breast reconstruction has been plagued with pain and discomfort.

OBJECTIVE

The purpose of this pilot study was to evaluate the role of a neurotoxin (Botulinum toxin A) in expander-based breast reconstruction.

METHODS

Thirty patients underwent mastectomies with immediate expander or acellular dermal matrix reconstruction. The neurotoxin group (n = 15) received 40 units of neurotoxin (Botulinum toxin A, Allergan, Inc, Irvine, CA) into each pectoralis major muscle through 4 serial injections and the placebo group (n = 15) received 4 serial injections of 0.9% NaCl. All patients were followed over 1 year, and patient demographics, VAS (visual analog score), laterality, office visits, amount of expansion and number of times to full expansion, and amount of narcotics required were recorded. Statistical significance was considered as p < .05.

RESULTS

There were no significant differences between the two groups in terms of age, laterality, expander size, or complications (p = .46-.66). There was a significant difference between the two groups in the VAS score, demonstrating decreased pain in the neurotoxin group (p < .05). In addition, there was a significant increase in the volume of expansion per visit in the neurotoxin group as compared to the placebo group (p < .05). There was no significant difference in narcotic use in the first 3 days after surgery; however, there was a significant decrease in use of narcotics from 7 to 45 days in the neurotoxin group (p < .05). There were no complications associated with the use of the neurotoxin.

CONCLUSIONS

The infiltration of the pectoralis major muscle with neurotoxin in immediate, expander-based reconstruction may be beneficial in reducing pain and expediting expansions.

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Blanquer SBG, Grijpma DW, Poot AA. Delivery systems for the treatment of degenerated intervertebral discs. Adv Drug Deliv Rev 2015;84:172-87. [PMID: 25451138 DOI: 10.1016/j.addr.2014.10.024] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/29/2014] [Accepted: 10/20/2014] [Indexed: 12/25/2022]