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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]
Abstract
OnabotulinumtoxinA (BTX-A) was first linked to beneficial effects in migraine 25 years ago and was approved by the FDA for preventive treatment of chronic migraine in 2010. The treatment has since had a major impact on the well-being of people with chronic migraine. The clinical development programme for BTX-A and research since its approval have provided insights into the neuromodulatory sensory effect of BTX-A, how it can control chronic migraine despite its peripheral action, and the underlying biology of migraine as a disease. In this Review, we consider the impact that BTX-A has had on the management of chronic migraine and on the research field. We discuss the insights provided by clinical research, encompassing the clinical trials and subsequent real-world evidence, and the mechanistic insights provided by preclinical and translational research. We also provide an overview of future directions of research in the field BTX-A in migraine and the clinical translation of this research.
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Affiliation(s)
- Patricia Pozo-Rosich
- Headache & Neurological Pain Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Alicia Alpuente
- Headache & Neurological Pain Clinic, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Headache and Neurological Pain Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesia, Harvard Medical School, Boston, MA, USA
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Agee OA, Leggit JC. Ultrasound-Guided Lidocaine Injection as a Novel Predictor of Response to Botulinum for Patients With Myofascial Pain Syndrome: A Case Report. Mil Med 2024:usae201. [PMID: 38758085 DOI: 10.1093/milmed/usae201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/18/2024] Open
Abstract
Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.
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Affiliation(s)
- Olivia A Agee
- The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jeffery C Leggit
- The Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Košenina S, Škerlová J, Zhang S, Dong M, Stenmark P. The cryo-EM structure of the BoNT/Wo-NTNH complex reveals two immunoglobulin-like domains. FEBS J 2024; 291:676-689. [PMID: 37746829 DOI: 10.1111/febs.16964] [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: 07/03/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
The botulinum neurotoxin-like toxin from Weissella oryzae (BoNT/Wo) is one of the BoNT-like toxins recently identified outside of the Clostridium genus. We show that, like the canonical BoNTs, BoNT/Wo forms a complex with its non-toxic non-hemagglutinin (NTNH) partner, which in traditional BoNT serotypes protects the toxin from proteases and the acidic environment of the hosts' guts. We here report the cryo-EM structure of the 300 kDa BoNT/Wo-NTNH/Wo complex together with pH stability studies of the complex. The structure reveals molecular details of the toxin's interactions with its protective partner. The overall structural arrangement is similar to other reported BoNT-NTNH complexes, but NTNH/Wo uniquely contains two extra bacterial immunoglobulin-like (Big) domains on the C-terminus. Although the function of these Big domains is unknown, they are structurally most similar to bacterial proteins involved in adhesion to host cells. In addition, the BoNT/Wo protease domain contains an internal disulfide bond not seen in other BoNTs. Mass photometry analysis revealed that the BoNT/Wo-NTNH/Wo complex is stable under acidic conditions and may dissociate at neutral to basic pH. These findings established that BoNT/Wo-NTNH/Wo shares the general fold of canonical BoNT-NTNH complexes. The presence of unique structural features suggests that it may have an alternative mode of activation, translocation and recognition of host cells, raising interesting questions about the activity and the mechanism of action of BoNT/Wo as well as about its target environment, receptors and substrates.
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Affiliation(s)
- Sara Košenina
- Department of Biochemistry and Biophysics, Stockholm University, Sweden
| | - Jana Škerlová
- Department of Biochemistry and Biophysics, Stockholm University, Sweden
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Sicai Zhang
- Department of Urology, Boston Children's Hospital, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Min Dong
- Department of Urology, Boston Children's Hospital, MA, USA
- Department of Microbiology, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Pål Stenmark
- Department of Biochemistry and Biophysics, Stockholm University, Sweden
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Lee HJ, Lee JH, Yi KH, Kim HJ. Anatomical analysis of the motor endplate zones of the suprascapular nerve to the infraspinatus muscle and its clinical significance in managing pain disorder. J Anat 2023; 243:467-474. [PMID: 36988105 PMCID: PMC10439366 DOI: 10.1111/joa.13868] [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: 12/06/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Myofascial pain syndrome caused by myofascial trigger points is a musculoskeletal disorder commonly encountered in clinical practice. The infraspinatus muscle is the region most frequently involved in the myofascial pain syndrome in the scapular region. The characteristics of the myofascial trigger points are that they can be found constantly in the motor endplate zone. However, localizing myofascial trigger points within the motor endplate zone and establishing an accurate injection site of the infraspinatus muscle has been challenging because the anatomical position of the motor endplate zone of the infraspinatus muscle is yet to be described. Therefore, this cadaveric study aimed to scrutinize the motor endplate zone of the infraspinatus muscle, propose potential myofascial trigger points within the muscle, and recommend therapeutic injection sites. Twenty specimens of the infraspinatus muscle for nerve staining and 10 fresh frozen cadavers for evaluation of the injection were used in this study. The number of nerve branches penetrating the infraspinatus muscle and their entry locations were analyzed and photographed. Modified Sihler's staining was performed to examine the motor endplate regions of the infraspinatus muscle. The nerve entry points were mostly observed in the center of the muscle belly. The motor endplate was distributed equally throughout the infraspinatus muscle, but the motor endplate zone was primarily identified in the B area, which is approximately 20-40% proximal to the infraspinatus muscle. The second-most common occurrence of the motor endplate zone was observed in the center of the muscle. These detailed anatomical data would be very helpful in predicting potential pain sites and establishing safe and effective injection treatment using botulinum neurotoxin, steroids, or lidocaine to alleviate the pain disorder of the infraspinatus muscle.
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Affiliation(s)
- Hyung-Jin Lee
- Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, Seongnam, 13120, South Korea
| | - Kyu-Ho Yi
- COVID-19 Division, Wonju City Public Health Center, Wonju-Si, 26417, Republic of Korea
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Republic of Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, 03722, Republic of Korea
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Debrosse M, Shergill S, Shah A, Patel K, Gulati A, Rajput K. Trigger point injection therapies for chronic myofascial neck and back pain: A systematic review. INTERVENTIONAL PAIN MEDICINE 2022; 1:100076. [PMID: 39238525 PMCID: PMC11373026 DOI: 10.1016/j.inpm.2022.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 09/07/2024]
Abstract
Objective To assess the comparative effectiveness and harms of trigger point injections (TPI) for myofascial neck and back pain. Methods Electronic literature databases were searched to identify articles pertaining to TPI for chronic myofascial neck and back pain. Searches were done from database start dates up to April 2020. Inclusion criteria were randomized controlled trials, cohorts, and case control studies. Pain, functional outcomes, and harms were extracted. Outcome time points were divided into short term (7 days to <6 weeks), intermediate term (6 weeks to < 3 months), long term (3 months to < 6 months), and longest term (>6 months). Quality assessment was done using the Cochrane Back Review Group (CBRG) checklist for RCTs, and the Newcastle-Ottawa Quality Assessment Scale for cohort and case control studies. Results 14 studies met inclusion criteria. Six studies compared TPI of Botulinum toxin A (five with Onabutulinum toxin A, and one with Abobotulinum toxin A) with normal saline (NS). Two of the Onabotulinum toxin A studies showed greater pain improvement in the Onabotulinum toxin A group at short, intermediate, compared with NS. The Abobotulinum study showed pain improvement at short, intermediate, and long terms. Of note Onabotulinum toxin A was associated with improved anxiety and depression in two studies. Two studies compared Onabotulinum toxin A to local anesthetic, one to methylprednisolone, and one to dry needling (DN), all of which showed no difference. One study compared Ozone to Lidocaine and DN, and it showed no difference. Two studies compared sterile water to NS; they both found no difference in pain outcomes at the short term time point. However one of these two studies showed improved pain at intermediate, long, and longest terms in the sterile water group. Tropisetron showed no difference vs. NS. Adverse effects were mostly reported for Onabotulinum toxin A and Abobotulinum toxin A. Conclusion Given the mixed results, we are unable to conclude whether an injectate composition is superior to another, or make recommendations in that regard. Further studies will help elucidate the ideal injectate composition and parameters.
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Affiliation(s)
- Maxime Debrosse
- Yale University School of Medicine, Department of Anesthesiology, United States
| | - Sukhman Shergill
- Yale University School of Medicine, Department of Anesthesiology, United States
| | - Achal Shah
- Yale University School of Medicine, Department of Anesthesiology, United States
| | - Kaiwal Patel
- Yale University School of Medicine, Department of Anesthesiology, United States
| | - Amitabh Gulati
- Weill Cornell Medicine, Department of Anesthesiology, United States
- Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care, United States
| | - Kanishka Rajput
- Yale University School of Medicine, Department of Anesthesiology, United States
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Lee HJ, Lee JH, Yi KH, Kim HJ. Intramuscular Innervation of the Supraspinatus Muscle Assessed Using Sihler’s Staining: Potential Application in Myofascial Pain Syndrome. Toxins (Basel) 2022; 14:toxins14050310. [PMID: 35622557 PMCID: PMC9143847 DOI: 10.3390/toxins14050310] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Despite the positive effects of botulinum neurotoxin (BoNT) injection into the neural arborized area, there is no anatomical evidence in the literature regarding the neural arborization of the supraspinatus muscle. The present study aimed to define the intramuscular neural arborized pattern of the supraspinatus muscle using the modified Sihler’s staining method to facilitate the establishment of safe and effective injection sites in patients with myofascial pain in the supraspinatus muscle. Seventeen supraspinatus muscles from 15 embalmed cadavers were dissected. Precise suprascapular nerve entry locations were also observed. Intramuscular neural arborization was visualized by Sihler’s staining. The supraspinatus muscle was divided into four portions named A, B, C, and D. The nerve entry points were observed in 88.2% (15 of 17 cases) of section B and 76.5% (13 of 17 cases) of section C of the supraspinatus muscle, respectively. The concentration of intramuscular neural arborization was highest in section B of the supraspinatus muscle, which was the center of the supraspinatus muscle. When the clinician performs a trigger point and a BoNT injection into the supraspinatus muscle, injection within the medial 25–75% of the supraspinatus muscle will lead to optimal results when using small amounts of BoNT and prevent undesirable paralysis.
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Affiliation(s)
- Hyung-Jin Lee
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Ji-Hyun Lee
- BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (K.-H.Y.)
| | - Kyu-Ho Yi
- BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (K.-H.Y.)
- COVID-19 Division, Wonju City Public Health Center, Wonju-Si 26417, Korea
| | - Hee-Jin Kim
- BK21 FOUR Project, Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (K.-H.Y.)
- Department of Materials Science & Engineering, College of Engineering, Yonsei University, Seoul 03722, Korea
- Correspondence:
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Effectiveness of training about kinesiotaping in myofascial pain syndrome: A prospective, single-blind, randomized-controlled study. Turk J Phys Med Rehabil 2021; 67:17-24. [PMID: 33948539 PMCID: PMC8088793 DOI: 10.5606/tftrd.2021.4258] [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] [Received: 01/31/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives
In this study, we aimed to investigate whether there was any difference in kinesiotaping (KT) application on the upper trapezius muscle between a trained and untrained physiatrist in the management of patients with myofascial pain syndrome (MPS).
Patients and methods
Between April 2013 and July 2015, a total of 45 patients (44 females, 1 males; mean age 31.9±8.0 years; range, 18 to 55 years) with MPS were included in this prospective, single-blind, randomized-controlled study. The patients were randomly divided into two groups. The first group (intervention group, n=24) was administered KT band with the muscle in a tense condition according to the muscle technique performed by a trained physiatrist, from the muscle origo toward its insertion point. The second group (control group, n=21) received no technique and KT was applied to the painful area by an untrained physiatrist using a randomly selected method. Primary outcome measures were pain at rest, during activity (0-10 cm visual analog scale), and threshold measurement with algometry (kg/cm2). Secondary outcome measures were function (Neck Pain and Disability Scale), degree of palpable muscle spasm, and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, at three and six weeks after the treatment.
Results
There were significant improvements in all parameters in both groups. There were no significant differences in any parameters at six weeks. We demonstrated that KT, which was applied on active trigger points on the upper trapezius muscle by trained and untrained physiatrists, improved pain, palpable muscle spasm, neck function, quality of life, and patient satisfaction degree in patients with MPS.
Conclusion
Our study results show that KT, which is applied by trained and untrained physiatrists, improves pain, palpable muscle spasm, neck function, quality of life in patients with MPS.
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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]
Abstract
Randomized controlled trials over the last two decades, although promising with favorable results, have shown varied efficacy in treatment of "plantar fasciitis" with botulinum toxin injection1. One reason may be due to conflating the variabilities of plantar heel conditions solely as plantar fasciitis. Plantar Heel Pain Syndrome can be of one or more etiologies and symptoms which refutes the mistaken tendency to categorize all plantar heel pain singularly as either plantar fasciitis or fasciosis. Recognizing that there is likely an interplay of inflammatory, degenerative, and neuropathic etiologic conditions of this often-difficult malady to treat, a novel injection paradigm of botulinum toxin is explored in the treatment of 4 distinct presentations of Plantar Heel Pain Syndrome with encouraging results. Botulinum toxin injection into two intrinsic foot muscles; Abductor Hallucis and Quadratus Plantae at their origins with electrical stimulation is presented as novel method to treat four distinct etiologies of Plantar Heel Pain Syndrome. This method of botulinum toxin injection resulted in significant prolonged improvement of patient function and pain reduction in four variations of Plantar Heel Pain Syndrome. A precise injection paradigm facilitated with direct intrinsic muscle stimulation of the Abductor Hallucis and Quadratus Plantae at their origins may prove to be effective in reducing the disabilities of Plantar Heel Pain Syndrome and its associated pain.
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Botulinum injections for myofascial pelvic pain. Int Urogynecol J 2020; 32:1151-1156. [PMID: 32696187 DOI: 10.1007/s00192-020-04435-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/18/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to assess the impact of botulinum toxin injection in women with myofascial pelvic pain (MFPP) syndrome of the pelvic floor who had failed conservative treatment. METHODS This was a retrospective descriptive observational study of 48 consecutive patients receiving botulinum toxin to the pelvic floor for MFPP syndrome in a tertiary teaching hospital over an 8-year period. Trigger points were identified, and botulinum toxin was injected into the pelvic floor at the trigger points in doses ranging from 50 to 200 units. The patient-reported global impression of improvement scale was used to evaluate the success at follow-up, and adverse effects were recorded. RESULTS Forty-six women attended for follow-up at 3-6 months. Of these, 34 (74%) reported an improvement in their symptoms (slightly better, much better, very much better), 12 (26%) had no change, and no patients reported worsening of symptoms. One patient (2%) reported transient postoperative faecal incontinence, which resolved after 2 weeks. There appeared to be no difference in outcome between the doses. CONCLUSIONS Botulinum toxin injection into the pelvic floor of women with MFPP appears to be beneficial in those who have failed conservative treatment. Prospective studies, including dose-finding studies, are now required.
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Luo FY, Nasr-Esfahani M, Jarrell J, Robert M. Botulinum toxin injection for chronic pelvic pain: A systematic review. Acta Obstet Gynecol Scand 2020; 99:1595-1602. [PMID: 32597494 DOI: 10.1111/aogs.13946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Botulinum toxin has proven therapeutic effects in alleviating pain in several myofascial disorders, with an expanding potential in chronic pelvic pain. The objective of this systematic review is to evaluate the efficacy and safety of botulinum toxin injection as an off-label treatment for female chronic pelvic pain. MATERIAL AND METHODS Using PRISMA guidelines, MEDLINE, EBM Reviews, PubMed, CINAHL, TRIP Database, EMBASE, Web of Science and gray literature were searched. Studies assessing the efficacy of botulinum toxin for chronic pelvic pain in adult females, with 10 or more women, published in English up to 13 January 2020, were included. All eligible studies were reviewed and data were extracted by two independent reviewers using a standardized form. Quality of evidence was graded using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the Ottawa-Newcastle scale for observational studies. RESULTS In all, 491 records were screened. Seventeen articles were included in the final review: 5 randomized controlled trials and 12 observational studies. The quality of evidence ranged from low to high. There was a large degree of heterogeneity in study designs, and thus a meta-analysis was not feasible. All observational studies concluded that botulinum toxin was an effective treatment for chronic pelvic pain, with the greatest change in visual analog scale from 8.69 at baseline to 3.07 at 24 months post-injection. However, only one of the five randomized controlled trials found statistical significant differences favoring botulinum toxin in the reporting of the EQ-5D (botulinum 0.78 [0.69-1.00], control 0.69 [0.25-0.81], P = .03) and frequency of intercourse (botulinum 1 [1-1.75], placebo 1 [0-1], P = .025). The most common adverse effect was transient localized pain at injection site (6%-88%). No serious adverse events were reported. CONCLUSIONS Although observational studies were encouraging, there is insufficient high quality evidence to recommend botulinum toxin injection for chronic pelvic pain. However, it appears to be safe to use. Future studies of higher quality in its treatment efficacy are indicated.
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Affiliation(s)
- Fang Yuan Luo
- Department of Obstetrics and gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Maryam Nasr-Esfahani
- Department of Obstetrics and gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - John Jarrell
- Department of Obstetrics and gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Magali Robert
- Department of Obstetrics and gynecology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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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: 1.5] [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
Abstract
Botulinum toxin type-A (BTX-A) injection for treating chronic migraine (CM) has developed into a new technique covering distinct injection points in the head and neck regions. The postulated analgesic mechanism implies that the injection should be administered to sensory nerves rather than to muscles. This study aimed to determine the topographical site of the auriculotemporal nerve (ATN) and to propose the effective injection points for treating CM. ATNs were investigated on 36 sides of 25 Korean cadavers. The anatomical structures of the ATN were investigated focusing on the temporal region. A right-angle ruler was positioned based on two clearly identifiable orthogonal reference lines based on the canthus and tragus as landmarks, and photographs were taken. The ATN appeared superficially in the anterosuperior region of the tragus. The nerve is located deeper than the superficial temporal artery. And it runs between the artery and the superficial temporal vein. In the superficial layer, it is divided into anterior and posterior divisions. The anterior division runs in a superior direction, while the posterior division runs in front of the ear and the several branches are distributed to the skin. We suggest that the optimal BTX-A injection points for CM are in the temporal region. The first point is about 2 cm anterior and 3 cm superior to two orthogonal reference lines defined based on the tragus and canthus, and the second point is about 4 cm superior to the first point. The third and fourth points are recommended about 2 cm superior to the first point, but respectively 1 cm anterior and posterior to it.
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Affiliation(s)
- Young-gun Kim
- Department of Orofacial Pain & Oral Medicine, Yonsei University College of dentistry, Seoul 03722, Korea;
- Department of Oral Medicine, Sun Dental Hospital, Sun Medical Center, Daejeon 34813, Korea
| | - Jung-Hee Bae
- Department of Dental Hygiene, Division of Health Sciences, Namseoul University, Cheonan 31020, Korea;
| | - Hyeyun Kim
- Department of Neurology, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, Incheon 22711, Korea;
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 112, Taiwan
| | - Seong Taek Kim
- Department of Orofacial Pain & Oral Medicine, Yonsei University College of dentistry, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-3110
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12
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Shahimoridi D, Shafiei SA, Yousefian B. The Effectiveness of the Polarized Low-Level Laser in the Treatment of Patients With Myofascial Trigger Points in the Trapezius Muscles. J Lasers Med Sci 2020; 11:14-19. [PMID: 32099622 DOI: 10.15171/jlms.2020.04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: This study assessed the effect of polarized low-level laser therapy (PLLLT) on the treatment of myofascial trigger points (MTrPs) in the trapezius muscles. Its effectiveness in pain reduction was compared to low-level laser therapy (LLLT). Methods: Sixty-four patients with MTrPs were randomly divided into 2 groups, namely PLLLT and LLLT. Each patient received treatment for a period of 2 weeks, 5 sessions a week. The intensity of laser irradiation to the skin surface was 6 J/cm2 . The system exit power was 160 mw at a 755 nm wavelength. The visual analog scale (VAS) for the 1st, 5th and 10th sessions was analyzed through two-way repeated measures ANOVA. Results: Increasing the number of treatment sessions was effective in reducing pain intensity (P>0.05). The effect of LLLT on pain reduction was significantly greater than that of PLLLT (P>0.05). Referred pain (RP), the limitation of neck movement (LNM), the presence of muscular taut band (PMTB) and the sensitivity of muscular taut band (SMTB) were reduced significantly by the end of the 10th session, compared with participants' condition at the beginning of the 1st session in both groups. Conclusion: PLLLT and LLLT can effectively treat MTrPs in the trapezius muscles and they reduce RP, LNM, PMTB, and SMTB in particular. However, the effect of the LLLT was significantly greater than that of PLLLT. In accordance with the observed results, LLLT is recommended as an effective method for treating MTrPs.
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Affiliation(s)
- Dadollah Shahimoridi
- Department of Basic Sciences, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Seyed Ali Shafiei
- Neuroscience Research Center, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Bahram Yousefian
- Department of Radiology, School of Allied Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Botulinum toxin infiltrations versus local anaesthetic infiltrations in pelvic floor myofascial pain: Multicentre, randomized, double-blind study. Ann Phys Rehabil Med 2020; 64:101354. [PMID: 31981833 DOI: 10.1016/j.rehab.2019.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 11/30/2019] [Accepted: 12/08/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Many studies have demonstrated a link between pelvic floor myofascial syndromes and chronic pelvic pain. Botulinum toxin has been extensively used for several years in the field of pain, especially due to its action on muscle spasm. However, the efficacy of botulinum toxin in the context of chronic pelvic pain remains controversial. OBJECTIVES This multicentre, randomized, controlled, double-blind study was designed to compare the efficacy of botulinum toxin and local anaesthetic (LA) injection versus LA injection alone for pelvic floor myofascial syndrome and chronic pelvic pain. METHODS According to the number of painful trigger points detected on physical examination, patients received from 1 to 4 injections of botulinum toxin with LA (BTX) or LA alone. The primary endpoint was Patient Global Impression of Improvement (PGI-I) score on day 60 after infiltration. Secondary endpoints were pain intensity, number of painful trigger points on palpation, analgesic drug consumption and quality of life. RESULTS We included 80 patients, 40 in each group. This study failed to demonstrate a significant difference between the 2 groups on day 60 in the primary endpoint or secondary endpoints (PGI-I score≤2=20% [LA] versus 27.5% [BTX], P=0.43). However, both groups showed significant alleviation of global pain. CONCLUSION This study does not justify the use of botulinum toxin in the context of chronic pelvic pain with myofascial syndrome but does justify muscle injections with LA alone. ClinicalTrials.gov: NCT01967524.
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Kwon KH, Shin KS, Yeon SH, Kwon DG. Application of botulinum toxin in maxillofacial field: Part II. Wrinkle, intraoral ulcer, and cranio-maxillofacial pain. Maxillofac Plast Reconstr Surg 2019; 41:42. [PMID: 31649903 PMCID: PMC6795672 DOI: 10.1186/s40902-019-0224-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Botulinum toxin (BTX) is used in various ways such as temporarily resolving muscular problems in musculoskeletal temporomandibular disorders, inducing a decrease in bruxism through a change in muscular patterns in a patient’s bruxism, and solving problems in patients with tension headache. And also, BTX is widely used in cosmetic applications for the treatment of facial wrinkles after local injection, but conditions such as temporomandibular joint disorders, headache, and neuropathic facial pain could be treated with this drug. In this report, we will discuss the clinical use of BTX for facial wrinkle, intraoral ulcer, and cranio-maxillofacial pain with previous studies and share our case.
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Affiliation(s)
- Kyung-Hwan Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, South Korea
| | - Kyung Su Shin
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, South Korea
| | - Sung Hee Yeon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, South Korea
| | - Dae Gun Kwon
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Wonkwang University, Iksan, South Korea
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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: 6.4] [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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Roldan CJ, Osuagwu U, Cardenas-Turanzas M, Huh BK. Normal Saline Trigger Point Injections vs Conventional Active Drug Mix for Myofascial Pain Syndromes. Am J Emerg Med 2019; 38:311-316. [PMID: 31477359 DOI: 10.1016/j.ajem.2019.158410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Myofascial pain syndrome (MPS) originates in the muscle and fascia. MPS presents with referred pain specific for each muscle and a trigger point that reproduces the symptoms. Trigger-point-injection (TPI) is an effective approach to treating MPS. Some TPI agents, however, are associated with systemic and local side effects. OBJECTIVE The aim of this study was to evaluate the effectiveness of TPI with a conventional active drug mixture (CADM) vs. that with normal saline solution (NS) alone in patients with MPS presenting to the emergency department (ED). METHODS Adults with MPS diagnosed in the ED, participants were randomly assigned to receive TPI with NS or with CADM. Pain intensity was scored using a 0-10 numeric rating scale prior to and after TPI, before discharge and 2 weeks after TPI. RESULTS Among 48 patients analyzed, 23 received TPI with NS. The mean pain scores were as follows: immediately before TPI, 7.59 (NS) and 7.44 (CADM); immediately after TPI, 2.22 (NS) and 1.76 (CADM); prior to discharge, 1.52 (NS) and 1.76 (CADM). At 2-week follow up, the mean pain scores were 4.29 (NS) and 4.14 (CADM). Pain was significantly reduced after TPI in both groups. At 2 weeks, the mean pain scores were similar between the groups. No adverse events were reported. CONCLUSION In cases of MPS in the ED, pain can be controlled with TPI independent of the injectate. TPI with NS may be preferred over CADM because of its lower cost and more favorable side effect profile.
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Affiliation(s)
- Carlos J Roldan
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.
| | - Uzondu Osuagwu
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marylou Cardenas-Turanzas
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Billy K Huh
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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]
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18
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Bak DH, Na J, Im SI, Oh CT, Kim JY, Park SK, Han HJ, Seok J, Choi SY, Ko EJ, Mun SK, Ahn SW, Kim BJ. Antioxidant effect of human placenta hydrolysate against oxidative stress on muscle atrophy. J Cell Physiol 2018; 234:1643-1658. [PMID: 30132871 DOI: 10.1002/jcp.27034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/25/2018] [Indexed: 01/07/2023]
Abstract
Sarcopenia, which refers to the muscle loss that accompanies aging, is a complex neuromuscular disorder with a clinically high prevalence and mortality. Despite many efforts to protect against muscle weakness and muscle atrophy, the incidence of sarcopenia and its related permanent disabilities continue to increase. In this study, we found that treatment with human placental hydrolysate (hPH) significantly increased the viability (approximately 15%) of H2 O2 -stimulated C2C12 cells. Additionally, while H2 O2 -stimulated cells showed irregular morphology, hPH treatment restored their morphology to that of cells cultured under normal conditions. We further showed that hPH treatment effectively inhibited H2 O2 -induced cell death. Reactive oxygen species (ROS) generation and Mstn expression induced by oxidative stress are closely associated with muscular dysfunction followed by atrophy. Exposure of C2C12 cells to H2 O2 induced abundant production of intracellular ROS, mitochondrial superoxide, and mitochondrial dysfunction as well as myostatin expression via nuclear factor-κB (NF-κB) signaling; these effects were attenuated by hPH. Additionally, hPH decreased mitochondria fission-related gene expression (Drp1 and BNIP3) and increased mitochondria biogenesis via the Sirt1/AMPK/PGC-1α pathway and autophagy regulation. In vivo studies revealed that hPH-mediated prevention of atrophy was achieved predominantly through regulation of myostatin and PGC-1α expression and autophagy. Taken together, our findings indicate that hPH is potentially protective against muscle atrophy and oxidative cell death.
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Affiliation(s)
- Dong-Ho Bak
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.,Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Jungtae Na
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Song I Im
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.,Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
| | - Chang Taek Oh
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Jeom-Yong Kim
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Sun-Kyu Park
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Hae Jung Han
- Research Institute, Research & Development Center, Green Cross WellBeing Corporation, Seongnam, Korea
| | - Joon Seok
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sun Young Choi
- Department of Dermatology, College of Medicine, Seoul Paik Hospital Inje University, Seoul, Korea
| | - Eun Jung Ko
- Myongji Hospital, College of Medicine, Seonam University, Goyang, Korea
| | - Seog-Kyun Mun
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Suk-Won Ahn
- Department of Neurology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Beom Joon Kim
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea.,Department of Medicine, Graduate School, Chung-Ang University, Seoul, Korea
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Cinone N, Letizia S, Santoro L, Gravina M, Amoruso L, Molteni F, Ranieri M, Santamato A. Intra-articular injection of botulinum toxin type A for shoulder pain in glenohumeral osteoarthritis: a case series summary and review of the literature. J Pain Res 2018; 11:1239-1245. [PMID: 29983587 PMCID: PMC6025770 DOI: 10.2147/jpr.s159700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Shoulder pain is one of the most common musculoskeletal diseases, and can be due to glenohumeral osteoarthritis, rotator cuff tear, impingement, tendinitis, adhesive capsulitis, and subacromial bursitis. Several therapies have been proposed, including steroids, nonsteroidal anti-inflammatory drugs, intra-articular injections, and physical therapies. Many published studies have reported on the employment of botulinum toxin type A (BoNT-A) to reduce pain in subjects with neurological and musculoskeletal diseases by inhibiting substance P release and other inflammatory factors. METHODS In the present article, we briefly update current knowledge regarding intra-articular BoNT therapy, reviewing existing literature on intra-articular use of BoNT-A, including nonrandomized and randomized prospective and retrospective cohort studies and case series published from December 1989 to November 2017. We also describe a case series of six subjects treated with intra-articular injection of incobotulinumtoxin A for the treatment of pain deriving from osteoarthritis. CONCLUSION Intra-articular BoNT-A is effective and minimally invasive. Pain reduction with an increase in shoulder articular range of motion in our experience confirms the effectiveness of BoNT-A injection for the management of this syndrome.
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Affiliation(s)
- Nicoletta Cinone
- Physical Medicine and Rehabilitation Unit, Ospedali Riuniti, Università di Foggia, Foggia,
| | - Sara Letizia
- Physical Medicine and Rehabilitation Unit, Ospedali Riuniti, Università di Foggia, Foggia,
| | - Luigi Santoro
- Physical Medicine and Rehabilitation Unit, Ospedali Riuniti, Università di Foggia, Foggia,
| | - Michele Gravina
- Rehabilitation Center, "Padre Pio" Foundation, San Giovanni Rotondo
| | - Loredana Amoruso
- Physical Medicine and Rehabilitation Unit, Ospedali Riuniti, Università di Foggia, Foggia,
| | | | - Maurizio Ranieri
- Physical Medicine and Rehabilitation Unit, Ospedali Riuniti, Università di Foggia, Foggia,
| | - Andrea Santamato
- Physical Medicine and Rehabilitation Unit, Ospedali Riuniti, Università di Foggia, Foggia,
- Rehabilitation Center, "Turati" Foundation, Vieste, Italy,
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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: 0.7] [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
Abstract
BACKGROUND Treatment for patients with chronic low-back pain (LBP) is a public health issue. Intramuscular injections of botulinum toxin A (BoNT-A) have shown an analgesic effect on LBP in two previous randomized controlled studies. The objective of the study was to verify the efficacy of paravertebral injections of BoNT-A in patients with LBP. METHODS Patients were included in this phase 3 randomized double-blinded trial comparing the efficacy of BoNT-A versus placebo in a crossover study on LBP. Both groups received 200 units of BoNT-A in paravertebral muscles or a placebo, and vice versa at Day 120. The main judgment criterion was LBP intensity 1 month after the injections, evaluated by using a visual pain scale (VAS). Secondary assessment criteria included: LBP intensity 90 and 120 days after injection day; number of days when an allowed antalgic oral treatment was needed in between each evaluation; functional disability measured by the Quebec Back Pain Disability Scale; quality of life; inability to work; patient satisfaction in relation to the treatment's effect; spinal mobility; and strength of spinal muscles, measured by isokinetic technique. RESULTS Nineteen patients completed the study. There was no significant difference between the groups' average LBP during the last 8 days at Day30 (p = 0.97). There was no significant difference between the two groups regarding the secondary assessment criteria (p > 0.05). CONCLUSIONS Injections of BoNT-A in the paravertebral muscles were not found to be effective to relieve chronic LBP. The limits of the study are that the dose of BoNT-A used was lower than in other studies, and that the limited number of patients included may explain the negative results. TRIAL REGISTRATIONS Identifiers: NCT03181802 . Unique Protocol ID: CHUBX2003.
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Affiliation(s)
- Mélanie Cogné
- Service de Médecine Physique et de Réadaptation, hôpital Raymond Poincaré, 92380, Garches, France.
- Service de Médecine Physique et de Réadaptation, CHU de Bordeaux, 33076, Bordeaux, France.
- EA4136 Handicap, Activité, Cognition, Santé, Bordeaux University, Bordeaux, France.
| | - Hervé Petit
- Service de Médecine Physique et de Réadaptation, CHU de Bordeaux, 33076, Bordeaux, France
| | - Alexandre Creuzé
- Service de Médecine Physique et de Réadaptation, CHU de Bordeaux, 33076, Bordeaux, France
| | | | - Mathieu de Seze
- Service de Médecine Physique et de Réadaptation, CHU de Bordeaux, 33076, Bordeaux, France
- EA4136 Handicap, Activité, Cognition, Santé, Bordeaux University, Bordeaux, France
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Abboud W, Hassin-Baer S, Joachim M, Givol N, Yahalom R. Localized myofascial pain responds better than referring myofascial pain to botulinum toxin injections. Int J Oral Maxillofac Surg 2017; 46:1417-1423. [DOI: 10.1016/j.ijom.2017.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 12/20/2016] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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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: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chronic pain exerts a tremendous burden on individuals and societies. If one views chronic pain as a single disease entity, then it is the most common and costly medical condition. At present, medical professionals who treat patients in chronic pain are recommended to provide comprehensive and multidisciplinary treatments, which may include pharmacotherapy. Many providers use nonopioid medications to treat chronic pain; however, for some patients, opioid analgesics are the exclusive treatment of chronic pain. However, there is currently an epidemic of opioid use in the United States, and recent guidelines from the Centers for Disease Control (CDC) have recommended that the use of opioids for nonmalignant chronic pain be used only in certain circumstances. The goal of this review was to report the current body of evidence-based medicine gained from prospective, randomized-controlled, blinded studies on the use of nonopioid analgesics for the most common noncancer chronic pain conditions. A total of 9566 studies were obtained during literature searches, and 271 of these met inclusion for this review. Overall, while many nonopioid analgesics have been found to be effective in reducing pain for many chronic pain conditions, it is evident that the number of high-quality studies is lacking, and the effect sizes noted in many studies are not considered to be clinically significant despite statistical significance. More research is needed to determine effective and mechanism-based treatments for the chronic pain syndromes discussed in this review. Utilization of rigorous and homogeneous research methodology would likely allow for better consistency and reproducibility, which is of utmost importance in guiding evidence-based care.
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Affiliation(s)
- Andrea L Nicol
- From the *Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas; †Department of Anesthesiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and ‡Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Abstract
More than 100 million adults in the United States have chronic pain conditions, costing more than $500 billion annually in medical care and lost productivity. They are the most common reason for seeking health care, for disability and addiction, and the highest driver of health care costs. Myofascial pain is the most common condition causing chronic pain and can be diagnosed through identifying clinical characteristics and muscle palpation. Management is focused on integrating patient training in changing lifestyle risk factors with evidence-based treatment. Understanding the cause, diagnosis, and management of myopain conditions will help prevent the impact of chronic pain.
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Affiliation(s)
- James Fricton
- HealthPartners Institute for Education and Research, University of Minnesota School of Dentistry, 4700 Dale Drive, Edina, MN 55424, USA.
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Chen YW, Chuang SK. Botulinum Toxin A Might Be an Alternative or Adjunct Therapy for the Treatment of Trigeminal and Postherpetic Neuralgia. J Evid Based Dent Pract 2017; 17:259-261. [PMID: 28865822 DOI: 10.1016/j.jebdp.2017.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION The efficacy of botulinum toxin for the treatment of trigeminal and postherpetic neuralgia: A systematic review with meta-analyses. Shackleton T, Ram S, Black M, Ryder J, Clark GT, Enciso R. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122(1):61-71. SOURCE OF FUNDING Information not available TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.
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Nagi R, Patil DJ, Sahu S, Jain S, Naidu GS. Botulinum toxin in the management of head and neck disorders. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:419-428. [PMID: 28159584 DOI: 10.1016/j.oooo.2016.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 11/14/2016] [Accepted: 11/25/2016] [Indexed: 11/26/2022]
Abstract
Botulinum toxin is a polypeptide protoxin synthesized by Clostridium botulinum that results in localized reduction of muscle activity by inhibiting acetylcholine release at the neuromuscular junction. In 2004, the US Food and Drug Administration approved its application in the treatment of various medical conditions, such as facial wrinkles, strabismus, cervical dystonia, blepharospasm, and hyperhidrosis. Later, its application extended to improving dental esthetics and gummy smile. It was found to be a safe and effective alternative to medical therapy to treat various head and neck disorders that have a neurologic component. In this review, we will highlight the mechanism of action and therapeutic benefits of botulinum toxin in the management of head and neck disorders.
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Affiliation(s)
- Ravleen Nagi
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India.
| | - Deepa Jatti Patil
- Department of Oral Medicine and Radiology, Swami Devi Dyal Dental College, Panchkula, Haryana, India
| | - Shashikant Sahu
- Burn and Trauma Centre, Department of Plastic Surgery, Bilaspur, Chhattisgarh, India
| | - Supreet Jain
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
| | - Giridhar S Naidu
- Department of Oral Medicine and Radiology, New Horizon Dental College and Research Institute, Sakri, Bilaspur, India
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Chao YW, Lin JJ, Yang JL, Wang WTJ. Kinesio taping and manual pressure release: Short-term effects in subjects with myofasical trigger point. J Hand Ther 2016; 29:23-9. [PMID: 26705672 DOI: 10.1016/j.jht.2015.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Randomized controlled trial. INTRODUCTION Myofascial pain syndrome is characterized by myofascial trigger points (MTrPs) and fascia tenderness. PURPOSE OF THE STUDY We investigated the effects of manual pressure release (MPR) alone or in combination with taping (MPR/MKT) in subjects with MTrPs. METHODS Fifteen and 16 subjects received MPR and MPR/MKT respectively. Outcomes including Pressure pain threshold, muscle stiffness, mechanomyography were assessed at baseline, post-intervention and 7-days later. RESULTS Pressure pain threshold improved significantly (d = 1.79, p < 0.005) in both groups. Significant improvement in muscle stiffness in the MPR/MKT group (0.27-0.49 mm) as compared to the MPR group (-0.02-0.23 mm). Mechanomyography amplitude in the MPR/MKT group was significantly higher than that of the MPR group (p < 0.05). CONCLUSION MPR and MPR/MKT are effective in reducing pain in these subjects. MPR/MKT has a greater effect on muscle stiffness and contraction amplitude. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yu Wen Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiu Jenq Lin
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jing Lan Yang
- Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wendy Tzyy-Jiuan Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
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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: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khalifeh M, Mehta K, Varguise N, Suarez-Durall P, Enciso R. Botulinum toxin type A for the treatment of head and neck chronic myofascial pain syndrome: A systematic review and meta-analysis. J Am Dent Assoc 2016; 147:959-973.e1. [PMID: 27737756 DOI: 10.1016/j.adaj.2016.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The authors conducted a systematic review to study the efficacy of botulinum toxin type A (BoTN-A) in the treatment of myofascial pain syndrome. TYPES OF STUDIES REVIEWED The authors identified randomized, double-masked, placebo-controlled studies on June 1, 2016, from PubMed, Web of Science, and the Cochrane Library. Three of the authors assessed the studies for risk of bias. Outcomes included pain reduction on a visual analog scale, the number of responders, and the posttreatment pain threshold to applied pressure using algometry. RESULTS The initial search strategy yielded 253 unduplicated references, which the authors reduced to 13 relevant studies. The authors included 11 studies in the meta-analyses as the investigators of those studies had reported similar outcomes. Pooled results showed a nonsignificant improvement in the posttreatment intensity of pain in the BoTN-A group compared with the placebo group at 4 to 6 weeks (standardized difference in means [SDM], -0.110; 95% confidence interval [CI], -0.344 to 0.124; P = .356) and a significant improvement at 2 to 6 months (SDM, -0.360; 95% CI, -0.623 to -0.096; P = .008). The number of study participants who responded to treatment was not statistically significantly different between the groups (risk ratio, 1.346; 95% CI, 0.922-1.964; P = .123) nor was the increase of pain threshold to pressure (algometry) at 2 months (SDM, 0.131; 95% CI, -0.178 to 0.440; P = .405). The study investigators reported no major adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS Pain was reduced significantly in the group that received BoTN-A compared with the placebo group at 2 to 6 months but not at 4 to 6 weeks (with moderate quality of the evidence). Additional studies with larger numbers of participants are needed to confirm these results.
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Aldosari SS, McRae SM, MacDonald PB. Surgical reconstruction of chronic latissimus dorsi tear using Achilles tendon allograft. J Shoulder Elbow Surg 2016; 25:e75-9. [PMID: 26927439 DOI: 10.1016/j.jse.2015.11.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/12/2015] [Accepted: 11/22/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Sultan S Aldosari
- Department of Orthopedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | | | - Peter B MacDonald
- Department of Orthopedic Surgery, Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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Abstract
OnabotulinumtoxinA (onabotA) has shown efficacy in chronic migraine (CM). Its mechanism of action, however, remains obscure. We have analysed whether treatment with onabotA is able to induce changes in interictal plasma calcitonin gene-related peptide (CGRP) concentrations, which have been shown to be increased in patients with CM. Calcitonin gene-related peptide levels were determined in samples obtained from the right antecubital vein using ELISA, outside a migraine attack and having taken no symptomatic medication in the previous 24 hours, in 83 patients with CM (average age 44 years; 94% females) before and 1 month after treatment with 155 to 195 U of onabotA. CGRP levels after onabotA treatment (median, 51.89 pg/mL; range, 199.4-10.2) were significantly lower as compared with CGRP levels obtained before onabotA treatment (median, 74.09 pg/mL; range, 241.0-11.4; P = 0.001). Pretreatment CGRP levels in responders (76.85 pg/mL) were significantly higher than those seen in nonresponders (50.45 pg/mL; P = 0.001). One month after treatment, the CGRP levels did not change in nonresponders (51.89 pg/mL; P not significant), but significantly decreased in responders (52.48 pg/mL; P = 0.003). A number of demographic factors, clinical features, and comorbidities were not different in responders as compared with those of nonresponders. These results confirm that interictal CGRP levels can be of help in predicting the response to onabotA and suggest that the mechanism of action of onabotA in CM is the reversal of sensitization as a result of the inhibition of CGRP release.
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Straube S, Werny B, Friede T. A systematic review identifies shortcomings in the reporting of crossover trials in chronic painful conditions. J Clin Epidemiol 2015; 68:1496-503. [DOI: 10.1016/j.jclinepi.2015.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 04/03/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Khenioui H, Houvenagel E, Catanzariti JF, Guyot MA, Agnani O, Donze C. Usefulness of intra-articular botulinum toxin injections. A systematic review. Joint Bone Spine 2015; 83:149-54. [PMID: 26645160 DOI: 10.1016/j.jbspin.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by excessive muscular contractions. Recent studies have assessed the analgesic effect of botulinum toxin in joint pain and started to unravel its mechanisms. LITERATURE-SEARCH-METHODOLOGY We searched the international literature via the Medline database using the term "intraarticular botulinum toxin injection" combined with any of the following terms: "knee", "ankle", "shoulder", "osteoarthritis", "adhesive capsulitis of the shoulder". RESULTS Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized controlled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after joint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indications and the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator was usually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primary outcome measure. DISCUSSION-CONCLUSION The number of randomized trials and sample sizes are too small to provide a satisfactory level of scientific evidence or statistical power. Unanswered issues include the effective dosage and the optimal dilution and injection modalities of botulinum toxin.
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Affiliation(s)
- Hichem Khenioui
- Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord de France, 1, rue Lefèvre, 59000 Lille, France; Université catholique de Lille, 60, boulevard Vauban, 59800 Lille, France.
| | - Eric Houvenagel
- Université Nord de France, 1, rue Lefèvre, 59000 Lille, France; Université catholique de Lille, 60, boulevard Vauban, 59800 Lille, France; Service de rhumatologie, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France
| | - Jean François Catanzariti
- Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord de France, 1, rue Lefèvre, 59000 Lille, France; Service de rhumatologie, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Service de médecine physique et réadaptation, centre de SSR pédiatrique Marc-Sautelet, 10, rue du Petit-Boulevard, 59650 Villeneuve-d'Ascq, France
| | - Marc Alexandre Guyot
- Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord de France, 1, rue Lefèvre, 59000 Lille, France; Service de rhumatologie, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France
| | - Olivier Agnani
- Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord de France, 1, rue Lefèvre, 59000 Lille, France; Service de rhumatologie, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France
| | - Cécile Donze
- Service de médecine physique et de réadaptation, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord de France, 1, rue Lefèvre, 59000 Lille, France; Service de rhumatologie, centre hospitalier Saint-Philibert, groupe hospitalier de l'institut catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex, France
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Current status and future directions of botulinum neurotoxins for targeting pain processing. Toxins (Basel) 2015; 7:4519-63. [PMID: 26556371 PMCID: PMC4663519 DOI: 10.3390/toxins7114519] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/29/2015] [Accepted: 10/19/2015] [Indexed: 12/20/2022] Open
Abstract
Current evidence suggests that botulinum neurotoxins (BoNTs) A1 and B1, given locally into peripheral tissues such as skin, muscles, and joints, alter nociceptive processing otherwise initiated by inflammation or nerve injury in animal models and humans. Recent data indicate that such locally delivered BoNTs exert not only local action on sensory afferent terminals but undergo transport to central afferent cell bodies (dorsal root ganglia) and spinal dorsal horn terminals, where they cleave SNAREs and block transmitter release. Increasing evidence supports the possibility of a trans-synaptic movement to alter postsynaptic function in neuronal and possibly non-neuronal (glial) cells. The vast majority of these studies have been conducted on BoNT/A1 and BoNT/B1, the only two pharmaceutically developed variants. However, now over 40 different subtypes of botulinum neurotoxins (BoNTs) have been identified. By combining our existing and rapidly growing understanding of BoNT/A1 and /B1 in altering nociceptive processing with explorations of the specific characteristics of the various toxins from this family, we may be able to discover or design novel, effective, and long-lasting pain therapeutics. This review will focus on our current understanding of the molecular mechanisms whereby BoNTs alter pain processing, and future directions in the development of these agents as pain therapeutics.
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Zayed O, Khedr M, Sadakah A, El-deeb A. Evaluation of using botulinum toxin (A) in the treatment of myofacial pain syndrome. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.tdj.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Efficacy of Pulsed and Continuous Therapeutic Ultrasound in Myofascial Pain Syndrome: A Randomized Controlled Study. Am J Phys Med Rehabil 2015; 94:547-54. [PMID: 25299534 DOI: 10.1097/phm.0000000000000210] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to compare continuous and pulsed ultrasound therapy with sham ultrasound in terms of pain, severity of muscle spasm, function, depression, and quality of life in patients with myofascial pain syndrome. DESIGN Patients were randomly divided into three groups, including the continuous ultrasound group (3 MHz, 1 W/cm, n = 20), the pulsed ultrasound group (3 MHz, 1 W/cm, 1:1 ratio, n = 20), and control group (sham, n = 20). The primary outcome measures were severity of pain at rest and during activity (visual analog scale, 0-10 cm). The secondary outcome measures were function (Neck Pain and Disability Scale), depressive mood (Beck Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, after treatment, and at the 6th and 12th wks. RESULTS All three groups had significant improvements in all of the pain scores, the severity of muscle spasms, function assessments, and certain subparameters of the quality of life scale (P < 0.05). The continuous ultrasound group had significantly greater improvements in pain at rest (P < 0.05). However, no statistically significant differences were observed in the other parameters (P > 0.05). CONCLUSIONS Continuous ultrasound therapy is more efficient in reducing pain at rest for myofascial pain syndrome patients than is sham or pulsed ultrasound therapy.
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Chen YW, Chiu YW, Chen CY, Chuang SK. Botulinum toxin therapy for temporomandibular joint disorders: a systematic review of randomized controlled trials. Int J Oral Maxillofac Surg 2015; 44:1018-26. [DOI: 10.1016/j.ijom.2015.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
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Ramachandran R, Yaksh TL. Therapeutic use of botulinum toxin in migraine: mechanisms of action. Br J Pharmacol 2015; 171:4177-92. [PMID: 24819339 DOI: 10.1111/bph.12763] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/25/2014] [Accepted: 05/02/2014] [Indexed: 12/30/2022] Open
Abstract
Migraine pain represents sensations arising from the activation of trigeminal afferents, which innervate the meningeal vasculature and project to the trigeminal nucleus caudalis (TNC). Pain secondary to meningeal input is referred to extracranial regions innervated by somatic afferents that project to homologous regions in the TNC. Such viscerosomatic convergence accounts for referral of migraine pain arising from meningeal afferents to particular extracranial dermatomes. Botulinum toxins (BoNTs) delivered into extracranial dermatomes are effective in and approved for treating chronic migraine pain. Aside from their well-described effect upon motor endplates, BoNTs are also taken up in local afferent nerve terminals where they cleave soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins, and prevent local terminal release. However, a local extracranial effect of BoNT cannot account for allthe effects of BoNT upon migraine. We now know that peripherally delivered BoNTs are taken up in sensory afferents and transported to cleave SNARE proteins in the ganglion and TNC, prevent evoked afferent release and downstream activation. Such effects upon somatic input (as from the face) likewise would not alone account for block of input from converging meningeal afferents. This current work suggests that BoNTs may undergo transcytosis to cleave SNAREs in second-order neurons or in adjacent afferent terminals. Finally, while SNAREs mediate exocytotic release, they are also involved in transport of channels and receptors involved in facilitated pain states. The role of such post-synaptic effects of BoNT action in migraine remains to be determined.
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Affiliation(s)
- Roshni Ramachandran
- Anesthesiology Research, Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
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Langevin P, Peloso PMJ, Lowcock J, Nolan M, Weber J, Gross A, Roberts J, Goldsmith CH, Graham N, Burnie SJ, Haines T. WITHDRAWN: Botulinum toxin for subacute/chronic neck pain. Cochrane Database Syst Rev 2015; 2015:CD008626. [PMID: 25994306 PMCID: PMC10637244 DOI: 10.1002/14651858.cd008626.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Withdrawn due to non‐compliance with The Cochrane Collaboration’s Commercial Sponsorship Policy The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Pierre Langevin
- Département de réadaptation, Faculté de Médecine, Université LavalCliniques Physio Interactive3520 rue de l'HêtrièreSt‐Augustin‐de‐DesmauresQCCanadaG3A 2V4
| | - Paul Michael J Peloso
- MRL ‐ MerckDepartment of Clinical DevelopmentRY34‐B272126 E. Lincoln AveRahwayNJUSA07065
| | | | - May Nolan
- University of British ColumbiaSchool of Physiotherapy, Faculty of Medicine212‐2177 Westbrook MallVancouverBCCanadaV6T 1Z3
| | - Jeff Weber
- Family Physiotherapy Inc.G04, 7408 ‐ 139th AvenueEdmontonABCanadaT5C 3H7
| | - Anita Gross
- McMaster UniversitySchool of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics1400 Main Street WestHamiltonONCanadaL8S 1C7
| | - John Roberts
- University of Calgary Sport Medicine CentrePhysiotherapy Department302 838 4th Ave NWCalgaryABCanadaT2N 0M8
| | - Charles H Goldsmith
- Simon Fraser UniversityFaculty of Health SciencesBlossom Hall, Room 95108888 University DriveBurnabyBCCanadaV5A 1S6
| | - Nadine Graham
- McMaster UniversitySchool of Rehabilitation Science1200 Main Street WestHamiltonONCanada
| | - Stephen J Burnie
- Canadian Memorial Chiropractic CollegeDepartment of Clinical Education6100 Leslie StreetTorontoONCanadaM2H 3J1
| | - Ted Haines
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHSC 3H54HamiltonONCanadaL8N 3Z5
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Peloso PMJ, Gross A, Haines T, Trinh K, Goldsmith CH, Burnie SJ. WITHDRAWN: Medicinal and injection therapies for mechanical neck disorders. Cochrane Database Syst Rev 2015; 2015:CD000319. [PMID: 25994305 PMCID: PMC10798413 DOI: 10.1002/14651858.cd000319.pub5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Withdrawn due to non‐compliance with The Cochrane Collaboration’s Commercial Sponsorship Policy The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Paul Michael J Peloso
- MRL ‐ MerckDepartment of Clinical DevelopmentRY34‐B272126 E. Lincoln AveRahwayNJUSA07065
| | - Anita Gross
- McMaster UniversitySchool of Rehabilitation Science & Department of Clinical Epidemiology and Biostatistics1400 Main Street WestHamiltonONCanadaL8S 1C7
| | - Ted Haines
- McMaster UniversityDepartment of Clinical Epidemiology and Biostatistics1200 Main Street WestHSC 3H54HamiltonONCanadaL8N 3Z5
| | - Kien Trinh
- McMaster UniversityDeGroote School of Medicine, Office of MD Admissions1200 Main Street WestMDCL‐3112HamiltonONCanadaL8N 3Z5
| | - Charles H Goldsmith
- Simon Fraser UniversityFaculty of Health SciencesBlossom Hall, Room 95108888 University DriveBurnabyBCCanadaV5A 1S6
| | - Stephen J Burnie
- Canadian Memorial Chiropractic CollegeDepartment of Clinical Education6100 Leslie StreetTorontoONCanadaM2H 3J1
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Blockade of glutamate release by botulinum neurotoxin type A in humans: a dermal microdialysis study. Pain Res Manag 2015; 19:126-32. [PMID: 24851237 DOI: 10.1155/2014/410415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The analgesic action of botulinum neurotoxin type A (BoNTA) has been linked to the blockade of peripheral release of neuropeptides and neurotransmitters in animal models; however, there is no direct evidence of this in humans. OBJECTIVES To investigate the effect of BoNTA on glutamate release in humans, using an experimental model of pain and sensitization provoked by capsaicin plus mild heat. METHODS Twelve healthy volunteers (six men, six women) were pretreated with BoNTA (10 U) on the volar forearm and with a saline control on the contralateral side. Dermal microdialysis was applied one week later to collect interstitial samples before and after the application of a capsaicin patch (8%) plus mild heat (40°C⁄60 min) to provoke glutamate release, pain and vasodilation. Samples were collected every hour for 3 h using linear microdialysis probes (10 mm, 100 kD). Dialysate was analyzed for glutamate concentration. Pain intensity and skin vasomotor reactions (temperature and blood flow changes) were also recorded. RESULTS BoNTA significantly reduced glutamate release compared with saline (P<0.05). The provoked pain intensity was lower in the BoNTA-pretreated arm (P<0.01). The reduction in pain scores was not correlated with glutamate level. Cutaneous blood flow (P<0.05), but not cutaneous temperature (P≥0.05), was significantly reduced by BoNTA. There was a correlation between glutamate level and skin blood flow (r=0.58⁄P<0.05) but not skin temperature (P≥0.05). No differences according to sex were observed in any response. CONCLUSIONS The present study provided the first direct evidence supporting the inhibitory effect of BoNTA on glutamate release in human skin, which is potentially responsible for some of the analgesic action of BoNTA.
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Alshadwi A, Nadershah M, Osborn T. Therapeutic applications of botulinum neurotoxins in head and neck disorders. Saudi Dent J 2014; 27:3-11. [PMID: 25544809 PMCID: PMC4273262 DOI: 10.1016/j.sdentj.2014.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 08/18/2014] [Accepted: 10/20/2014] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area. Study design An extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study. Results Botulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes. Conclusion Botulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.
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Affiliation(s)
- Ahmad Alshadwi
- Department of Oral and Maxillofacial Surgery, Boston University-Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Suite G-407, Boston, MA 02118, United States ; King Feisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Nadershah
- Academic Faculty King Abdulaziz University-Dental School, Jeddah, Saudi Arabia
| | - Timothy Osborn
- Department of Oral and Maxillofacial Surgery, Boston University-Henry M. Goldman School of Dental Medicine, 100 East Newton Street, Suite G-407, Boston, MA 02118, United States
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Zhou JY, Wang D. An update on botulinum toxin A injections of trigger points for myofascial pain. Curr Pain Headache Rep 2014; 18:386. [PMID: 24338700 DOI: 10.1007/s11916-013-0386-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Myofascial pain syndrome (MPS) is a common chronic pain condition that is characterized by distinct "trigger points." Despite current treatments with physical therapy, analgesics, anti-depressants and trigger-point injections, myofascial pain remains a challenging chronic pain condition in clinical practice. Botulinum toxin A (BTX-A) can cause prolonged muscle relaxation through inhibition of acetylcholine release. It may offer some advantages over the current treatments for MPS by providing a longer sustained period of pain relief. Despite numerous clinical trials, the efficacy of BTX-A in alleviating MPS is not well-established due to mixed results from recent clinical trials. Active trigger points are associated with referred pain and greatly impact many aspects of activities of daily living, mood, and health status. This review is designed to analyze the clinical trials regarding the efficacy of BTX-A injection of active trigger points as a treatment for MPS. The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline and EMbase. Our search terms included "Botulinum toxin," "myofascial pain," "trigger points," "myofascial trigger points," "chronic pain." Additional references were retrieved from the reference list of the reports found via this search. Studies were considered eligible for inclusion if they were double-blinded, randomized, controlled trials evaluating the efficacy of BTX-A injections into trigger points for pain reduction, and if the trigger point selection in the trial included referred pain and/or local twitch response. Open-label studies, case reports, and other non-randomized studies were excluded. Eight trials were found according to the above criteria and are summarized in Table 1. There are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS. However, further clinical trials with considerations of minimizing placebo effect, repeated dosing, adequate coverage of trigger points, and using ultrasound confirmation and guidance are required to provide conclusive evidence for BTX-A in the treatment of myofascial pain.
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Affiliation(s)
- Jon Y Zhou
- Department of Anesthesiology, Thomas Jefferson University Hospital, 111. S 11th Street, Suite 8290 Gibbon, Philadelphia, PA, USA,
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Chou LW, Hsieh YL, Kuan TS, Hong CZ. Needling therapy for myofascial pain: recommended technique with multiple rapid needle insertion. Biomedicine (Taipei) 2014; 4:13. [PMID: 25520926 PMCID: PMC4264979 DOI: 10.7603/s40681-014-0013-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 03/31/2014] [Indexed: 11/06/2022] Open
Abstract
Myofascial trigger point (MTrP) is a major cause of muscle pain, characterized with a hyperirritable spot due to accumulation of sensitized nociceptors in skeletal muscle fibers. Many needling therapy techniques for MTrP inactivation exist. Based on prior human and animal studies, multiple insertions can almost completely eliminate the MTrP pain forthwith. It is an attempt to stimulate many sensitive loci (nociceptors) in the MTrP region to induce sharp pain, referred pain or local twitch response. Suggested mechanisms of needling analgesia include effects related to immune, hormonal or nervous system. Compared to slow-acting biochemical effects involving immune or hormonal system, neurological effects can act faster to provide immediate and complete pain relief. Most likely mechanism of multiple needle insertion therapy for MTrP inactivation is to encounter sensitive nociceptors with the high-pressure stimulation of a sharp needle tip to activate a descending pain inhibitory system. This technique is strongly recommended for myofasical pain therapy in order to resume patient's normal life rapidly, thus saving medical and social resources.
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Affiliation(s)
- Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Research Center for Chinese Medicine & Acupuncture, China Medical University Hospital, Taichung, Taiwan
| | - Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chang-Zern Hong
- Department of Physical Therapy, Hung Kuang University, Chung-Chie Road, Taichung, Taiwan
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Soares A, Andriolo RB, Atallah AN, da Silva EMK. Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database Syst Rev 2014; 2014:CD007533. [PMID: 25062018 PMCID: PMC7202127 DOI: 10.1002/14651858.cd007533.pub3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in Issue 4, 2012. Myofascial pain syndrome (MPS) is a regional muscular pain syndrome characterised by the presence of trigger points, which are painful points in one or more muscles. The pain can be felt at the site where the trigger point is located or it can be felt away from that place when the muscle is pressed (referred pain). Botulinum toxin is a protein produced by the bacterium Clostridium botulinum and is a potent neurotoxin that eventually inhibits muscle contractions. It is capable of selectively weakening painful muscles and interrupting the pain cycle. OBJECTIVES To assess the effectiveness and safety of botulinum toxin A (BTXA) in the treatment of myofascial pain syndrome (MPS), excluding MPS in neck and head muscles. SEARCH METHODS This is an updated version of the original Cochrane review published in Issue 4, 2012. The search strategy for the update was the same as in the original review and we searched CENTRAL in The Cochrane Library (2013, Issue 11 of 12), MEDLINE (Ovid) (2012 to 29 November 2013) and EMBASE (Ovid) (2012 to 27 November 2013). The search strategy was composed of terms for myofascial pain and botulinum toxin. For the original review, we also searched the Cochrane Pain, Palliative and Supportive Care (PaPaS) Review Group Specialised Register until December 2011, PubMed (from 1966 to 2011) and LILACS (from 1982 to 2011). There was no language restriction. SELECTION CRITERIA We included randomised controlled trials (RCTs) involving botulinum toxin for treating participants with MPS. We excluded studies with MPS of the neck and head from this review as they have already been assessed in existing systematic reviews. We considered a diagnosis of MPS to be based on the identification of trigger points in the taut band through palpation of sensitive nodules, local twitch response and specific patterns of referred pain associated with each trigger point. DATA COLLECTION AND ANALYSIS Two review authors independently screened identified studies, extracted data, assessed trial quality and analysed results using the Cochrane PaPaS Review Group criteria. MAIN RESULTS Four studies with a total of 233 participants, comparing BTXA with placebo, met the inclusion criteria. In one study with 145 participants, significant improvement rates of pain intensity scores and duration of daily pain were demonstrated when comparing BTXA with placebo. The three other studies showed that there was no statistically significant difference between BTXA and placebo in pain intensity. AUTHORS' CONCLUSIONS Since the first publication of this review, no new studies were found. There is inconclusive evidence to support the use of botulinum toxin in the treatment of MPS based on data from four studies with a total of 233 participants, which we considered were of sufficient quality to be included in this review. Meta-analyses were not possible due to the heterogeneity between studies. We suggest that in future studies the same methodology to assess pain, a standardised dose of treatment, follow-up of at least four months (to observe the maximum and minimum curve of the drug effect) and appropriate data presentation should be used. More high-quality RCTs of botulinum toxin for treating MPS need to be conducted before firm conclusions on its effectiveness and safety can be drawn.
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Affiliation(s)
- Adriana Soares
- Department of Medicine, Universidade Federal de São Paulo, Rua Grão Pará, 570 apt.1101 Bairro Santa Efigênia, Belo Horizonte, Minais Gerais, Brazil, 30150-341
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Matak I, Lacković Z. Botulinum toxin A, brain and pain. Prog Neurobiol 2014; 119-120:39-59. [PMID: 24915026 DOI: 10.1016/j.pneurobio.2014.06.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/25/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
Botulinum neurotoxin type A (BoNT/A) is one of the most potent toxins known and a potential biological threat. At the same time, it is among the most widely used therapeutic proteins used yearly by millions of people, especially for cosmetic purposes. Currently, its clinical use in certain types of pain is increasing, and its long-term duration of effects represents a special clinical value. Efficacy of BoNT/A in different types of pain has been found in numerous clinical trials and case reports, as well as in animal pain models. However, sites and mechanisms of BoNT/A actions involved in nociception are a matter of controversy. In analogy with well known neuroparalytic effects in peripheral cholinergic synapses, presently dominant opinion is that BoNT/A exerts pain reduction by inhibiting peripheral neurotransmitter/inflammatory mediator release from sensory nerves. On the other hand, growing number of behavioral and immunohistochemical studies demonstrated the requirement of axonal transport for BoNT/A's antinociceptive action. In addition, toxin's enzymatic activity in central sensory regions was clearly identified after its peripheral application. Apart from general pharmacology, this review summarizes the clinical and experimental evidence for BoNT/A antinociceptive activity and compares the data in favor of peripheral vs. central site and mechanism of action. Based on literature review and published results from our laboratory we propose that the hypothesis of peripheral site of BoNT/A action is not sufficient to explain the experimental data collected up to now.
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Affiliation(s)
- Ivica Matak
- Laboratory of Molecular Neuropharmacology, Department of Pharmacology and Croatian Brain Research Institute, University of Zagreb School of Medicine, Šalata 11, 10000 Zagreb, Croatia
| | - Zdravko Lacković
- Laboratory of Molecular Neuropharmacology, Department of Pharmacology and Croatian Brain Research Institute, University of Zagreb School of Medicine, Šalata 11, 10000 Zagreb, Croatia.
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Burstein R, Zhang X, Levy D, Aoki KR, Brin MF. Selective inhibition of meningeal nociceptors by botulinum neurotoxin type A: therapeutic implications for migraine and other pains. Cephalalgia 2014; 34:853-69. [PMID: 24694964 PMCID: PMC4167963 DOI: 10.1177/0333102414527648] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Meningeal and other trigeminal nociceptors are thought to play important roles in the initiation of migraine headache. Currently, the only approved peripherally administered chronic migraine prophylactic drug is onabotulinumtoxinA. The purpose of this study was to determine how botulinum neurotoxin type A (BoNT-A) affects naïve and sensitized meningeal nociceptors. Material and methods Using electrophysiological techniques, we identified 43 C- and 36 Aδ-meningeal nociceptors, and measured their spontaneous and evoked firing before and after BoNT-A administration to intracranial dura and extracranial suture-receptive fields. Results As a rule, BoNT-A inhibited C- but not Aδ-meningeal nociceptors. When applied to nonsensitized C-units, BoNT-A inhibited responses to mechanical stimulation of the dura with suprathreshold forces. When applied to sensitized units, BoNT-A reversed mechanical hypersensitivity. When applied before sensitization, BoNT-A prevented development of mechanical hypersensitivity. When applied extracranially to suture branches of intracranial meningeal nociceptors, BoNT-A inhibited the mechanical responsiveness of the suture branch but not dural axon. In contrast, BoNT-A did not inhibit C-unit responses to mechanical stimulation of the dura with threshold forces, or their spontaneous activity. Discussion The study provides evidence for the ability of BoNT-A to inhibit mechanical nociception in peripheral trigeminovascular neurons. These findings suggest that BoNT-A interferes with neuronal surface expression of high-threshold mechanosensitive ion channels linked preferentially to mechanical pain by preventing their fusion into the nerve terminal membrane.
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Affiliation(s)
- Rami Burstein
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - XiChun Zhang
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | - Dan Levy
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, MA, USA Harvard Medical School, Boston, MA, USA
| | | | - Mitchell F Brin
- Allergan Inc., Irvine, CA, USA University of California, Irvine, CA, USA
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de Abreu Venancio R, Guedes Pereira Alencar F, Zamperini C. Botulinum Toxin, Lidocaine, and Dry-Needling Injections in Patients with Myofascial Pain and Headaches. Cranio 2014; 27:46-53. [DOI: 10.1179/crn.2009.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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de Abreu Venâncio R, Guedes Pereira Alencar F, Zamperini C. Different Substances and Dry-Needling Injections in Patients with Myofascial Pain and Headaches. Cranio 2014; 26:96-103. [DOI: 10.1179/crn.2008.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Peloso PM, Khan M, Gross AR, Carlesso L, Santaguida L, Lowcock J, MacDermid JC, Walton D, Goldsmith CH, Langevin P, Shi Q. Pharmacological Interventions Including Medical Injections for Neck Pain: An Overview as Part of the ICON Project. Open Orthop J 2013; 7:473-93. [PMID: 24155805 PMCID: PMC3802125 DOI: 10.2174/1874325001307010473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/25/2013] [Accepted: 04/04/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To conduct an overview (review-of-reviews) on pharmacological interventions for neck pain. SEARCH STRATEGY Computerized databases and grey literature were searched from 2006 to 2012. SELECTION CRITERIA Systematic reviews of randomized controlled trials (RCT) in adults with acute to chronic neck pain reporting effects of pharmacological interventions including injections on pain, function/disability, global perceived effect, quality of life and patient satisfaction. DATA COLLECTION & ANALYSIS Two independent authors selected articles, assessed risk of bias and extracted data The GRADE tool was used to evaluate the body of evidence and an external panel provided critical review. MAIN RESULTS We found 26 reviews reporting on 47 RCTs. Most pharmacological interventions had low to very low quality methodologic evidence with three exceptions. For chronic neck pain, there was evidence of: a small immediate benefit for eperison hydrochloride (moderate GRADE, 1 trial, 157 participants);no short-term pain relieving benefit for botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis, 258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4 trial meta-analysis, 183 participants) including reduced pain, disability or global perceived effect; andno long-term benefit for medial branch block of facet joints with steroids (moderate GRADE; 1 trial, 120 participants) over placebo to reduce pain or disability; REVIEWERS' CONCLUSIONS While in general there is a lack of evidence for most pharmacological interventions, current evidence is against botulinum toxin-A for chronic neck pain or subacute/chronic whiplash; against medial branch block with steroids for chronic facet joint pain; but in favour of the muscle relaxant eperison hydrochloride for chronic neck pain.
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Carrasco AT, Wescoat L, Roman A. A retrospective review of Botulinum toxin type A compared with standard therapy in the treatment of lumbar myofascial back pain patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856903767650709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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