1
|
Borba DBDM, Fialho T, Oliveira RCGD, de Oliveira RCG, Valarelli FP, Pinzan-Vercelino CRM, Cotrin P, Freitas KMS. Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study. J Craniomaxillofac Surg 2024; 52:999-1005. [PMID: 38871616 DOI: 10.1016/j.jcms.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/09/2024] [Accepted: 06/08/2024] [Indexed: 06/15/2024] Open
Abstract
This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.
Collapse
Affiliation(s)
| | - Tiago Fialho
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Brazil; Department of Orthodontics, Bauru Dental School, University of São Paulo, Bauru, Brazil.
| | | | | | | | | | - Paula Cotrin
- Department of Orthodontics, Ingá University Center UNINGÁ, Maringá, Brazil
| | | |
Collapse
|
2
|
Schiellerup NS, Kobberø H, Andersen K, Poulsen CA, Poulsen MH. Evaluation of Botox treatment in patients with chronic scrotal pain: Protocol for a randomized double-blinded control trial. BJUI COMPASS 2024; 5:541-547. [PMID: 38873349 PMCID: PMC11168772 DOI: 10.1002/bco2.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/27/2023] [Accepted: 01/21/2024] [Indexed: 06/15/2024] Open
Abstract
Background Chronic scrotal pain is a common condition with a prevalence of 2.5-4.8% in male outpatients. Up to 40% of these patients report depressive symptoms and many feel isolated. Minimal invasive treatment is lacking, while spermatic cord injections of Botox® (BTX) have been proposed to offer long-term pain relief. Study Design This research protocol comprises a prospective multicentre, randomized, double-blinded clinical trial drawing patients from other urological departments in the region of Southern Denmark. End Points The primary end point will be reduction in pain evaluated by visual analogue score for pain at 3 months. Secondary end point will be length of effect of BTX injections along with changes in quality of life. Patients and Methods The study will include 50 patients for randomization to either spermatic cord block with 100 IE BTX or sterile saline. All patients will prior to randomization undergo physical examination and will be asked to fulfil multiple questionnaires regarding pain and impact in daily life, that is, (1) visual analogue score for pain, (2) quality of life (EQ-5D-5L), (3) Chronic Prostatitis Symptom Index (NIH-CPSI), (4) ICD-10 depression questionnaire (MDI), (5) Likert global assessment scale, and (6) International Index of Erectile Function questionnaire. Physical examination and fulfilment of the questionnaires will be repeated multiple times throughout the study period of 12 weeks. After this time point, patients will be unblinded, and the control arm will be given the opportunity of cross-over.
Collapse
Affiliation(s)
| | - Hanne Kobberø
- Department of UrologyOdense University HospitalOdenseDenmark
| | - Karin Andersen
- Department of UrologyOdense University HospitalOdenseDenmark
| | | | | |
Collapse
|
3
|
Bavikatte G, Francisco GE, Jost WH, Baricich A, Duarte E, Tang SFT, Schwartz M, Nelson M, Musacchio T, Esquenazi A. Pain, disability, and quality of life in participants after concurrent onabotulinumtoxinA treatment of upper and lower limb spasticity: Observational results from the ASPIRE study. PM R 2024. [PMID: 38813838 DOI: 10.1002/pmrj.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/23/2024] [Accepted: 03/25/2024] [Indexed: 05/31/2024]
Abstract
INTRODUCTION Upper and lower limb spasticity is commonly associated with central nervous system disorders including stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, and spinal cord injury, but little is known about the concurrent treatment of upper and lower limb spasticity with botulinum toxins. OBJECTIVE To evaluate onabotulinumtoxinA (onabotA) utilization and to determine if concurrent onabotA treatment of the upper and lower limbs has supported improvements in participants with spasticity. DESIGN Sub-analysis of a 2-year, international, prospective, observational registry (ASPIRE, NCT01930786). SETTING International clinic sites (54). PARTICIPANTS Adult spasticity participants across etiologies, who received ≥1 concurrent onabotA treatment of the upper and lower limbs during the study. INTERVENTION Participants were treated with onabotA at the clinician's discretion. OUTCOMES Baseline characteristics and outcomes of disability (Disability Assessment Scale [DAS]), pain (Numeric Pain Rating Scale [NPRS]), participant satisfaction, physician satisfaction, and quality of life (QoL; Spasticity Impact Assessment [SIA]) were evaluated. Adverse events were monitored throughout the study. RESULTS Of 744 participants enrolled, 730 received ≥1 dose of onabotA; 275 participants received treatment with onabotA in both upper and lower limbs during ≥1 session; 39.3% of participants were naïve to onabotA for spasticity. The mean (SD) total dose per treatment session ranged from 421.2 (195.3) to 499.6 (188.6) U. The most common baseline upper limb presentation was clenched fist (n = 194, 70.5%); lower limb was equinovarus foot (n = 219, 66.9%). High physician and participant satisfaction and improvements in pain, disability and QoL were reported after most treatments. Nine participants (3.3%) reported nine treatment-related adverse events; two participants (0.7%) reported three serious treatment-related severe adverse events. No new safety signals were identified. CONCLUSION More than a third of enrolled participants received at least one concurrent onabotA treatment of the upper and lower limbs, with reduced pain, disability, and improved QoL after treatment, consistent with the established safety profile of onabotA for the treatment of spasticity.
Collapse
Affiliation(s)
| | - Gerard E Francisco
- UT Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, Texas, USA
| | - Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | - Simon F T Tang
- Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Lotung Poh Ai Hospital, Luodong, Taiwan
| | | | | | | | - Alberto Esquenazi
- Moss Rehab Gait and Motion Analysis Laboratory, Elkins Park, Pennsylvania, USA
| |
Collapse
|
4
|
Álvarez SD, Velázquez Saornil J, Sánchez Milá Z, Jaén Crespo G, Campón Chekroun A, Barragán Casas JM, Frutos Llanes R, Rodríguez Sanz D. Effectiveness of Dry Needling and Ischemic Trigger Point Compression in the Gluteus Medius in Patients with Non-Specific Low Back Pain: A Randomized Short-Term Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12468. [PMID: 36231767 PMCID: PMC9564974 DOI: 10.3390/ijerph191912468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The presence of latent myofascial trigger points (MTrPs) in the gluteus medius is one of the possible causes of non-specific low back pain. Dry needling (DN) and ischemic compression (IC) techniques may be useful for the treatment of these MTrPs. METHODS For this study, 80 participants were randomly divided into two groups: the dry needling group, who received a single session of DN to the gluteus medius muscle plus hyperalgesia (n = 40), and the IC group, who received a single session of IC to the gluteus medius muscle plus hyperalgesia (n = 40). Pain intensity, the pressure pain threshold (PPT), range of motion (ROM), and quality of life were assessed at baseline, immediately after treatment, after 48 h, and one week after treatment. RESULTS Statistically significant differences were shown between the two groups immediately after the intervention, showing a decrease in PPT (p < 0.05) in the DN group and an increase in PPT in the IC group. These values increased more and were better maintained at 48 h and after one week of treatment in the DN group than in the IC group. Quality of life improved in both groups, with greater improvement in the DN group than in the IC group. CONCLUSIONS IC could be more advisable than DN with respect to UDP and pain intensity in the most hyperalgesic latent MTrPs of the gluteus medius muscle in subjects with non-specific low back pain, immediately after treatment. DN may be more effective than IC in terms of PPT, pain intensity, and quality of life in treating latent plus hyperalgesic gluteus medius muscle MTrPs in subjects with non-specific low back pain after 48 h and after one week of treatment.
Collapse
Affiliation(s)
| | | | | | - Gonzalo Jaén Crespo
- Department of Physiotherapy, Universidad Europea de Madrid, 28670 Madrid, Spain
| | | | | | - Raúl Frutos Llanes
- Department of Physiotherapy, Universidad Católica de Ávila, 05005 Ávila, Spain
| | - David Rodríguez Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| |
Collapse
|
5
|
Barreto RR, Veras PJL, de Oliveira Leite G, Vieira Neto AE, Zogheib LV, Sessle BJ, Campos AR. Botulinum toxin promotes orofacial antinociception by modulating TRPV1 and NMDA receptors in adult zebrafish. Toxicon 2022; 210:158-166. [DOI: 10.1016/j.toxicon.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/12/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
|
6
|
Non-invasive Intrauterine Administration of Botulinum Toxin A Enhances Endometrial Angiogenesis and Improves the Rates of Embryo Implantation. Reprod Sci 2021; 28:1671-1687. [PMID: 33650094 PMCID: PMC8144131 DOI: 10.1007/s43032-021-00496-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/08/2021] [Indexed: 10/26/2022]
Abstract
Endometrial angiogenesis plays crucial roles in determining the endometrial receptivity. Defects in endometrial receptivity often cause repeated implantation failure, which is one of the major unmet needs for infertility and contributes a major barrier to the assisted reproductive technology. Despite the numerous extensive research work, there are currently no effective evidence-based treatments to prevent or cure this condition. As a non-invasive treatment strategy, botulinum toxin A (BoTA) was administered into one side of mouse uterine horns, and saline was infused into the other side of horns for the control. Impact of BoTA was assessed in the endometrium at 3 or 8 days after infusion. We demonstrated that BoTA administration enhances the capacity of endothelial cell tube formation and sprouting. The intrauterine BoTA administration significantly induced endometrial angiogenesis displaying increased numbers of vessel formation and expression levels of related marker genes. Moreover, BoTA intrauterine application promoted the endometrial receptivity, and the rates of embryo implantation were improved with BoTA treatment with no morphologically retarded embryos. Intrauterine BoTA treatment has a beneficial effect on vascular reconstruction of functional endometrium prior to embryo implantation by increasing endometrial blood flow near the uterine cavity suggesting BoTA treatment as a potential therapeutic strategy for patients who are suffering from repeated implantation failure with the problems with endometrial receptivity.
Collapse
|
7
|
The role of intrasphincteric botulinum toxin injection in the management of functional biliary pain: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2020; 32:984-989. [PMID: 32453006 DOI: 10.1097/meg.0000000000001773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The management of postcholecystectomy functional biliary pain or Type III sphincter of Oddi dysfunction is challenging. The Evaluating Predictors and Interventions in Sphincter of Oddi Dysfunction study has demonstrated the lack of efficacy of endoscopic sphincterotomy in the management of Type III sphincter of Oddi dysfunction. OBJECTIVE AND METHODS Botulinum toxin injection to the sphincter of Oddi has been reported as being effective in uncontrolled studies. We sought to understand its pooled efficacy in controlling pancreaticobiliary pain in a systematic review and meta-analysis. RESULTS Our literature review yielded 10 studies (416 patients) and on random effects meta-analysis, the pooled efficacy of intrasphincteric botulinum toxin injection in alleviating symptoms of pancreaticobiliary was 49% (complete response) and 64% (partial response). One patient developed mild pancreatitis postprocedure and five patients needed postprocedure hospital admission for pain management. The effect of botulinum toxin injection was transient and in the majority of studies, and a positive response to botulinum toxin injection was followed by an endoscopic sphincterotomy. In one study, relapse of pain was managed by repeat botulinum toxin injections with success. CONCLUSION Intermittent botulinum toxin injection could be a potential option in the overall management strategy of patients with Type III sphincter of Oddi dysfunction, in conjunction with medical management with neuromodulatory medication.
Collapse
|
8
|
Significance of spine stability criteria on trunk muscle forces following unilateral muscle weakening: A comparison between kinematics-driven and stability-based kinematics-driven musculoskeletal models. Med Eng Phys 2019; 73:51-63. [PMID: 31378640 DOI: 10.1016/j.medengphy.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 06/25/2019] [Accepted: 07/17/2019] [Indexed: 12/30/2022]
Abstract
Two optimization-driven approaches were employed to develop kinematics-driven (KD) and stability-based kinematics-driven (SKD) musculoskeletal models of an adult thoracolumbar to ascertain the significance of spine stability in holding the upright-standing posture after muscular disuse atrophy. Both models were used to estimate muscle forces of the trunk with intact and unilaterally reduced longissimus thoracis pars thoracic (LGPT) and multifidus lumborum (MFL) muscles strength. A finite element model of the L5-S1 segment of the same kinematics was also developed to compare the joint stresses predicted by the KD and SKD models. Matching well with in vivo data, the SKD model predicted a 15% and 33% reduction in contralateral muscle forces to the 95% debilitated LGPT and MFL muscles, respectively. In contrast, the contralateral muscle force enhancement to the debilitated MFL muscle in the KD model was in contradiction with in vivo data, implying that the KD model is incapable of correctly predicting the muscular disorders. However, the similarity of both models' predictions of intradiscal pressures and intervertebral discs' stresses, which matched well with in vivo data, does indicate the feasibility of the KD model to investigate trunk muscle weakness effects on spinal loads, which could offer additional tools for research in ergonomics. Nonetheless, SKD models can be employed for assessment of contralateral muscle impotence in spinal neuromuscular disorders.
Collapse
|
9
|
Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects? Clin Oral Investig 2019; 23:3411-3421. [PMID: 31342244 DOI: 10.1007/s00784-019-03026-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 07/11/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objective of the study was to conduct a systematic review of literature assessing botulinum toxin type A (BoNT-A) safety and adverse effects in the treatment of myofascial pain (MFP) and trigeminal neuralgia (TN). MATERIALS AND METHODS The search for articles by two specific researchers involved the PubMed, EMBASE, Web of Science, and Scopus databases. Specific terms were used, and no publication time and language restrictions were applied. Clinical trials that investigated the effects of BoNT-A among participants with myofascial pain in masticatory muscles or trigeminal neuralgia were considered eligible for this systematic review. Data for each study were extracted and analyzed according to a PICO-like structured reading. RESULTS The search strategy provided 436 citations. After analysis, 16 citations were included, seven for MFP and nine for TN. In all studies, BoNT-A was well tolerated and improved pain. The most common adverse effects were temporary regional weakness, tenderness over the injection sites, and minor discomfort during chewing. Most studies reported a spontaneous resolution of adverse effect. CONCLUSIONS It can be concluded that BoNT-A treatment is well tolerated, since minor adverse effects were the most frequently reported; however, it is recommended that future studies aim to assess the safety and possible adverse effects of multiples applications or high doses of this treatment. CLINICAL RELEVANCE BoNT-A has been increasingly diffused in dentistry, being used for the management of masticatory myofascial pain and trigeminal neuralgia. Nonetheless, there is no consensus about its efficacy and adverse effects that could occur when this treatment is applied.
Collapse
|
10
|
De la Torre Canales G, Câmara-Souza MB, do Amaral CF, Garcia RCMR, Manfredini D. Is there enough evidence to use botulinum toxin injections for bruxism management? A systematic literature review. Clin Oral Investig 2017; 21:727-734. [DOI: 10.1007/s00784-017-2092-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/21/2017] [Indexed: 02/01/2023]
|
11
|
Bezerra MER, Rocha-Filho PAS. Headache Attributed to Craniocervical Dystonia - A Little Known Headache. Headache 2016; 57:336-343. [DOI: 10.1111/head.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/14/2016] [Indexed: 01/03/2023]
Affiliation(s)
| | - Pedro Augusto Sampaio Rocha-Filho
- Department of Neuropsychiatry; Universidade Federal de Pernambuco (UFPE), Recife, Brazil and Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
| |
Collapse
|
12
|
Wissel J, Ganapathy V, Ward AB, Borg J, Ertzgaard P, Herrmann C, Haggstrom A, Sakel M, Ma J, Dimitrova R, Fulford-Smith A, Gillard P. OnabotulinumtoxinA Improves Pain in Patients With Post-Stroke Spasticity: Findings From a Randomized, Double-Blind, Placebo-Controlled Trial. J Pain Symptom Manage 2016; 52:17-26. [PMID: 27037050 DOI: 10.1016/j.jpainsymman.2016.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 01/11/2016] [Accepted: 02/13/2016] [Indexed: 12/16/2022]
Abstract
CONTEXT Patients with post-stroke spasticity (PSS) commonly experience pain in affected limbs, which may impact quality of life. OBJECTIVES To assess onabotulinumtoxinA for pain in patients with PSS from the BOTOX(®) Economic Spasticity Trial, a multicenter, randomized, double-blind, placebo-controlled trial. METHODS Patients with PSS (N = 273) were randomized to 22- to 34-week double-blind treatment with onabotulinumtoxinA + standard care (SC) or placebo injection + SC and were eligible to receive open-label onabotulinumtoxinA up to 52 weeks. Assessments included change from baseline on the 11-point pain numeric rating scale, proportion of patients with baseline pain ≥4 achieving ≥30% and ≥50% improvement in pain, and pain interference with work at Week 12, end of double-blind treatment, and Week 52. RESULTS At baseline, most patients (74.3%) experienced pain and 47.4% had pain ≥4 (pain subgroup). Mean pain reduction from baseline at Week 12 was significantly greater with onabotulinumtoxinA + SC (-0.77, 95% CI -1.14 to -0.40) than placebo + SC (-0.13, 95% CI -0.51 to 0.24; P < 0.05). Higher proportions of patients in the pain subgroup achieved ≥30% and ≥50% reductions in pain at Week 12 with onabotulinumtoxinA + SC (53.7% and 37.0%, respectively) compared with placebo (28.8% and 18.6%, respectively; P < 0.05). Reductions in pain were sustained through Week 52. Compared with placebo + SC, onabotulinumtoxinA consistently reduced pain interference with work. CONCLUSION This is the first randomized, placebo-controlled trial demonstrating statistically significant and clinically meaningful reductions in pain and pain interference with work with onabotulinumtoxinA in patients with PSS.
Collapse
Affiliation(s)
- Jörg Wissel
- Neurological Rehabilitation, Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Vaidyanathan Ganapathy
- Health Economics & Outcomes Research, Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts, USA
| | - Anthony B Ward
- North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke on Trent, United Kingdom
| | - Jörgen Borg
- Department of Clinical Sciences, Karolinska Institute and Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Per Ertzgaard
- Department of Rehabilitation Medicine and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Christoph Herrmann
- Department of Neurological Rehabilitation and Early Rehabilitation, Asklepios-Kliniken Schildautal, Seesen, Germany
| | - Anders Haggstrom
- Department of Rehabilitation Medicine, Orebro University Hospital, Orebro, Sweden
| | - Mohamed Sakel
- East Kent University Hospital NHS, Canterbury, Kent, United Kingdom
| | - Julia Ma
- Allergan Plc, Irvine, California, USA
| | | | - Antony Fulford-Smith
- Allergan Holdings Ltd., Marlow International, The Parkway, Marlow, Buckinghamshire, United Kingdom
| | | |
Collapse
|
13
|
Charles PD, Manack Adams A, Davis T, Bradley K, Schwartz M, Brin MF, Patel AT. Neck Pain and Cervical Dystonia: Treatment Outcomes from CD PROBE (Cervical Dystonia Patient Registry for Observation of OnabotulinumtoxinA Efficacy). Pain Pract 2016; 16:1073-1082. [PMID: 26910788 DOI: 10.1111/papr.12408] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 09/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pain is a prevailing feature of cervical dystonia (CD), the most common form of focal dystonia. This analysis examined pain relief after onabotulinumtoxinA treatment in CD subjects with moderate/severe pain from the Cervical Dystonia Patient Registry for Observation of OnabotulinumtoxinA Efficacy (CD PROBE). METHODS CD PROBE was a prospective, multicenter, observational registry of CD subjects who were naïve to botulinum toxin (BoNT), new to physician, or had not received BoNT within ≥ 16 weeks if in a clinical trial. Subjects were eligible for 3 treatments, with variable session intervals. Descriptive and inferential statistics were utilized to evaluate the change in pain scores in the population with moderate/severe neck pain at baseline (Pain Numeric Rating Scale [PNRS] score 4 to 10). RESULTS Of 1046 enrolled, 733 (70.7%) had moderate/severe neck pain at baseline. Postinjection pain questionnaire responses 4 to 6 weeks after each of the 3 treatments revealed that a majority of subjects (67.1%, 72.4%, and 76.4%) reported pain relief; mean time to pain relief was 7.1, 7.4, and 7.6 days. All pain scales showed significant improvements from baseline to final visit (all P < 0.0001): PNRS, mean 6.6 to 3.8; CD Impact Profile-58 Pain and Discomfort subscale, mean 78.7 to 56.5; and Toronto Western Spasmodic Torticollis Rating Scale Pain subscale, mean 12.6 to 8.5. Multivariable regression models showed that initial pain score significantly contributed to the final pain score for all scales. CONCLUSION Results from this real-world clinical registry indicate that a majority of CD subjects with moderate/severe neck pain experience significant relief following onabotulinumtoxinA treatment.
Collapse
Affiliation(s)
- P David Charles
- Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | | | - Thomas Davis
- Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Kathryn Bradley
- Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Marc Schwartz
- MedNet Solutions, Inc., Minnetonka, Minnesota, U.S.A
| | - Mitchell F Brin
- Allergan, Inc., Irvine, California, U.S.A.,University of California, Irvine, California, U.S.A
| | - Atul T Patel
- Kansas City Bone and Joint Clinic, Overland Park, Kansas, U.S.A
| |
Collapse
|
14
|
Allegri M, Baron R, Hans G, Correa-Illanes G, Mayoral Rojals V, Mick G, Serpell M. A pharmacological treatment algorithm for localized neuropathic pain. Curr Med Res Opin 2016; 32:377-84. [PMID: 26641136 DOI: 10.1185/03007995.2015.1129321] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Neuropathic pain is caused by a lesion or disease affecting the somatosensory system and is difficult to manage, often proving refractory to existing treatments. In more than half of cases, it is localized and affects a specific, clearly circumscribed area of the body (localized neuropathic pain, or LNP). A recently developed screening tool enables patients with probable neuropathic pain/LNP to be identified quickly and easily. In view of the conflicting current treatment recommendations, an advisory board of pain specialists met in June 2015 to develop a complementary treatment guidance algorithm, for use in the primary care setting and by non-pain specialists. The starting point of the algorithm is a diagnosis of LNP and there was consensus that first-line treatment should be a topical analgesic agent, because the benefit/risk ratios are far better than for systemic agents. Topical application offers site-specific delivery, a lower total systemic dose and avoidance of first-pass metabolism, reducing the risk of adverse events and drug/drug interactions. The 5% lidocaine medicated plaster has most evidence supporting its use in LNP, producing effective analgesia and reducing the associated area of allodynia, but other topical agents include capsaicin, clonidine and botulinum toxin type A. Treatment should be commenced with the topical agent of choice, and the patient re-assessed after an appropriate period. Where the response is good the topical agent is continued, with a re-evaluation after 3-6 months. A systemic agent (e.g. gabapentin, pregabalin, duloxetine, venlafaxine) is added if there is only a partial response, or substituted if there is no response, and the patient re-assessed after a month. If there is poor or no response to the systemic agent the patient should be switched to an alternative one and, if this also proves ineffective, referred to a pain specialist.
Collapse
Affiliation(s)
- Massimo Allegri
- a a Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital , Parma , Italy
| | - Ralf Baron
- b b Division of Neurological Pain Research and Therapy, Department of Neurology , Christian-Albrechts-Universität zu Kiel , Kiel , Germany
| | - Guy Hans
- c c Multidisciplinary Pain Centre, Antwerp University Hospital , Edegum , Belgium
| | - Gerardo Correa-Illanes
- d d Rehabilitation Department , Hospital del Trabajador de Asociación Chilena de Seguridad , Santiago , Chile
| | - Victor Mayoral Rojals
- e e Anaesthesiology Department , Hospital Universitario de Bellvitge, 08907 El Hospitalet de Llobregat , Barcelona , Spain
| | - Gerard Mick
- f f Centre for Pain Evaluation and Treatment, University Neurological Hospital , Lyons , France
| | - Michael Serpell
- g g University Department of Anaesthesia , Pain Research Office, Gartnavel General Hospital , Glasgow , Scotland , UK
| |
Collapse
|
15
|
Orsini M, Leite MAA, Chung TM, Bocca W, de Souza JA, de Souza OG, Moreira RP, Bastos VH, Teixeira S, Oliveira AB, Moraes BDS, Matta AP, Jacinto LJ. Botulinum Neurotoxin Type A in Neurology: Update. Neurol Int 2015; 7:5886. [PMID: 26487928 PMCID: PMC4591494 DOI: 10.4081/ni.2015.5886] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022] Open
Abstract
This paper reviews the current and most neurological (central nervous system, CNS) uses of the botulinum neurotoxin type A. The effect of these toxins at neuromuscular junction lends themselves to neurological diseases of muscle overactivity, particularly abnormalities of muscle control. There are seven serotypes of the toxin, each with a specific activity at the molecular level. Currently, serotypes A (in two preparations) and B are available for clinical purpose, and they have proved to be safe and effective for the treatment of dystonia, spasticity, headache, and other CNS disorders in which muscle hyperactivity gives rise to symptoms. Although initially thought to inhibit acetylcholine release only at the neuromuscular junction, botulinum toxins are now recognized to inhibit acetylcholine release at autonomic cholinergic nerve terminals, as well as peripheral release of neuro-transmitters involved in pain regulation. Its effects are transient and nondestructive, and largely limited to the area in which it is administered. These effects are also graded according to the dose, allowing individualized treatment of patients and disorders. It may also prove to be useful in the control of autonomic dysfunction and sialorrhea. In over 20 years of use in humans, botulinum toxin has accumulated a considerable safety record, and in many cases represents relief for thousands of patients unaided by other therapy.
Collapse
Affiliation(s)
- Marco Orsini
- Centro Universitário Augusto Motta, Bonsucesso , Rio de Janeiro, Brasil ; Universidade Federal Fluminense, Departamento de Neurologia, Niterói , Rio de Janeiro, Brasil
| | | | - Tae Mo Chung
- Universidade de São Paulo - USP , São Paulo, Brasil
| | - Wladimir Bocca
- Universidade Federal de São Paulo - UNIFESP , São Paulo, Brasil
| | | | | | | | | | | | | | | | - André Palma Matta
- Universidade Federal Fluminense, Departamento de Neurologia, Niterói , Rio de Janeiro, Brasil
| | | |
Collapse
|
16
|
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]
|
17
|
Abstract
Raynaud phenomenon may be a primary disorder or associated with a variety of other autoimmune processes. Raynaud phenomenon produces digital vasospasm, which can lead to ischemia and ulceration. The treatment of Raynaud phenomenon has been difficult because multiple medical treatments have not provided uniform resolution of symptoms. Many patients have turned to surgery and sympathectomies for the treatment of unrelenting vasospasm. Botulinum toxin has been shown to be an effective alternative to surgery, with a single treatment being capable of resolving pain and healing ulcer. This article reviews the use of botulinum toxin for the treatment of Raynaud phenomenon.
Collapse
|
18
|
The Management of Intractable Pain with Adjuvant Pulsed Electromagnetic Field Therapy. Adv Skin Wound Care 2014; 27:205-9. [DOI: 10.1097/01.asw.0000445951.44967.ca] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
A closer look to botulinum neurotoxin type A-induced analgesia. Toxicon 2013; 71:134-9. [PMID: 23747735 DOI: 10.1016/j.toxicon.2013.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/10/2013] [Accepted: 05/14/2013] [Indexed: 11/20/2022]
Abstract
Chronic pain indicates a type of pain that lasts over time and is accompanied by diagnostic and therapeutic difficulties. It follows that treatment failures are common and patients roam from doctor to doctor in search of an effective care program. So there is an urgent need for long-acting and effective therapeutics to alleviate symptoms of the varied forms of chronic pain. During the past few years, a good success has been achieved with a derivative of a neurotoxin. It has been shown that administration of this toxin can block the release of neurotransmitters and pain mediators. Botulinum neurotoxin type A (BoNT/A) is well known as a treatment for neuromuscular conditions such as dystonia and spasticity. However, the clinical application for BoNT/A has continued to expand. Its analgesic effect has been used in clinical practice with satisfactory results. This review provides an introduction of a hypothesis for the mechanism by which BoNT/A eases chronic pain. It also summarizes the clinical therapeutic effects of BoNT/A in different types of chronic pain and its potential prospects.
Collapse
|
20
|
Climent JM, Kuan TS, Fenollosa P, Martin-del-Rosario F. Botulinum toxin for the treatment of myofascial pain syndromes involving the neck and back: a review from a clinical perspective. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2013; 2013:381459. [PMID: 23533477 PMCID: PMC3590763 DOI: 10.1155/2013/381459] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
Abstract
Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results. Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS. Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.
Collapse
Affiliation(s)
- José M. Climent
- Physical and Rehabilitation Medicine Department, Alicante University General Hospital, C/Pintor Baeza s/n, 03010 Alicante, Spain
| | - Ta-Shen Kuan
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | | | - Francisco Martin-del-Rosario
- Physical and Rehabilitation Medicine Department, Gran Canaria Insular Hospital, Avenida Marítima del Sur, 35006 Las Palmas de Gran Canaria, Spain
| |
Collapse
|
21
|
Jarrell J. Endometriosis and abdominal myofascial pain in adults and adolescents. Curr Pain Headache Rep 2012; 15:368-76. [PMID: 21755274 DOI: 10.1007/s11916-011-0218-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endometriosis and myofascial pain are common disorders with significant impact on quality of life. Increasingly, these conditions are being recognized as highly interconnected through processes that have been described for more than a century. This review is directed to this interconnection through a description of the relationships of endometriosis to proposed mechanisms of pain and chronic pain physiology; the clinical assessment of myofascial representations of this pain; and an approach to the management of these interconnected disorders.
Collapse
Affiliation(s)
- John Jarrell
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
22
|
Karadaş O, Oztürk B, Ulaş UH, Kütükçü Y, Odabaşı Z. The efficacy of botulinum toxin in patients with cervicogenic headache: a placebo-controlled clinical trial. Balkan Med J 2012; 29:184-7. [PMID: 25206992 DOI: 10.5152/balkanmedj.2012.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 12/12/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Botulinum toxin type-A (BoNTA) has been considered a treatment option for CH. The aim of this study was to assess the effectiveness of BoNTA treatment in patients with medically resistant CH. MATERIALS AND METHODS Forty patients with CH were included in the study. Patients in the BoNTA group (n=20) were administered 10 U of BoNTA bilaterally to the frontal muscles, 20 U to the temporal muscles, 15 U to the semispinalis capitis, 15 U to the splenius capitis, and 15 U to the trapezius muscles (total: 150 U). Patients in the placebo group (n=20) received 0.2 mL of saline administrated to the same sites. All participations were evaluated 6 and 12 weeks after treatment; side effects, the number of painful days, severity (by visual analogue scale, VAS) and frequency of pain were evaluated. RESULTS In the BoNTA group, the severity and frequency of pain 6 and 12 weeks post treatment were significantly lower than pre-treatment levels (p<0.05). At 12 weeks post treatment, the severity and frequency of pain in the BoNTA group were lower than in the placebo group (p<0.05). CONCLUSION The findings suggest that BoNTA was an effective treatment for CH.
Collapse
Affiliation(s)
- Omer Karadaş
- Department of Neurology, Erzincan Military Hospital, Erzincan, Turkey
| | - Bilgin Oztürk
- Department of Neurology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Umit Hıdır Ulaş
- Department of Neurology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Yaşar Kütükçü
- Department of Neurology, Gülhane Military Medical Academy, Ankara, Turkey
| | - Zeki Odabaşı
- Department of Neurology, Gülhane Military Medical Academy, Ankara, Turkey
| |
Collapse
|
23
|
Abstract
Pain represents a foremost feature of neurogenic thoracic outlet syndrome (NTOS). Similar to other persistent pain conditions, the physical discomfort associated with NTOS can cause severe and often debilitating symptoms. In fact, those suffering from the syndrome report a quality of life impacted as significantly as those with chronic heart failure. This evidence-based literature review focuses on the classification, etiology, clinical presentation, diagnostic measures, and surgical treatment of NTOS, with a focus on nonoperative therapies such as physical modalities, pharmacological therapies, and more contemporary minimally invasive intramuscular treatments with botulinum toxin.
Collapse
|
24
|
Christo PJ, McGreevy K. Erratum to: Updated Perspectives on Neurogenic Thoracic Outlet Syndrome. Curr Pain Headache Rep 2011. [DOI: 10.1007/s11916-011-0179-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
25
|
Sim WS. Application of botulinum toxin in pain management. Korean J Pain 2011; 24:1-6. [PMID: 21390172 PMCID: PMC3049971 DOI: 10.3344/kjp.2011.24.1.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 11/22/2022] Open
Abstract
Botulinum toxin has been used for the treatment of many clinical disorders by producing temporary skeletal muscle relaxation. In pain management, botulinum toxin has demonstrated an analgesic effect by reducing muscular hyperactivity, but recent studies suggest this neurotoxin could have direct analgesic mechanisms different from its neuromuscular actions. At the moment, botulinum toxin is widely investigated and used in many painful diseases such as myofascial syndrome, headaches, arthritis, and neuropathic pain. Further studies are needed to understand the exact analgesic mechanisms, efficacy and complications of botulinum toxin in chronic pain disorders.
Collapse
Affiliation(s)
- Woo Seog Sim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Langevin P, Lowcock J, Weber J, Nolan M, Gross AR, Peloso PM, Roberts J, Graham N, Goldsmith CH, Burnie SJ, Haines T. Botulinum toxin intramuscular injections for neck pain: a systematic review and metaanalysis. J Rheumatol 2010; 38:203-14. [PMID: 21123322 DOI: 10.3899/jrheum.100739] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effect of intramuscular botulinum toxin type A (BoNT-A) injections on pain, function/disability, global perceived effect, and quality of life (QOL) in adults with neck pain (NP). METHODS We searched Central, Medline, and Embase databases up to June 2010. A minimum of 2 authors independently selected articles, abstracted data, and assessed risk of bias and clinical applicability. We estimated standard mean differences (SMD) with 95% CI, relative risks (RR), and performed metaanalyses (SMD(p)) using a random-effects model for nonheterogeneous data. The approach of the Grading of Recommendations Assessment, Development, and Evaluation working group summarizes the quality of evidence. RESULTS We selected 14 trials. High-quality evidence suggested BoNT-A was no better than saline at 4 weeks [4 trials/183 participants; SMD(p) -0.21 (95% CI -0.50 to 0.07)] and 6 months for chronic NP. Moderate-quality evidence showed a similar effect for subacute/chronic whiplash-associated disorder (WAD) on pain [4 trials/122 participants; SMD(p) -0.21 (95% CI -0.57 to 0.15)], disability, and QOL. Very low-quality evidence indicated BoNT-A combined with exercise and analgesics was not significant for chronic NP reduction at 4 weeks [3 trials/114 participants; SMD(p) -0.08 (95% CI -0.45 to 0.29)] but was at 6 months [2 trials/43 participants; SMD(p) -0.66 (95% CI -1.29 to -0.04)]. CONCLUSION Current evidence does not confirm a clinically or statistically significant benefit of BoNT-A used alone on chronic NP in the short term or on subacute/chronic WAD pain, disability, and QOL. Larger trials, subgroups, and predictors of responses defined a priori (to facilitate selection of patients most likely to benefit) and factorial designs to explore BoNT as an adjunct treatment to physiotherapeutic exercise and analgesics are needed.
Collapse
Affiliation(s)
- Pierre Langevin
- Cliniques Physio Interactive, 3520 rue de l'Hêtrière, Local 202, St-Augustin-de-Desmaures, Québec G3A 0B4, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Wasserman D, Monheit G. Commentary: new treatment for a surgical wrinkle. Aesthetic Plast Surg 2010; 34:428-9. [PMID: 20533033 DOI: 10.1007/s00266-010-9531-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
|
28
|
Christo PJ, Christo DK, Carinci AJ, Freischlag JA. Single CT-guided chemodenervation of the anterior scalene muscle with botulinum toxin for neurogenic thoracic outlet syndrome. PAIN MEDICINE 2010; 11:504-11. [PMID: 20202146 DOI: 10.1111/j.1526-4637.2010.00814.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine pain relief in patients with neurogenic thoracic outlet syndrome (NTOS) after a single, low dose injection of botulinum toxin A (Botox) into the anterior scalene muscle (ASM) under computed tomographic (CT) guidance. DESIGN Prospective longitudinal study. SETTING Academic medical institution. PATIENTS Patients 18 years of age and older were evaluated for potential scalenectomy and first rib resection using the transaxillary approach at the study institution between 2005 and 2008. All patients had failed physical therapy. A total of 29 procedures on 27 participants were studied. INTERVENTIONS A single, 20-unit injection of Botox into the ASM under CT-guidance. OUTCOME MEASURES Short-form McGill Pain Questionnaire (SF-MPQ) prior to and at 1, 2, and 3 months post-Botox toxin injection. RESULTS There was a decline in pain during the 3 months subsequent to Botox injection as noted by the following components of the SF-MPQ: sensory (P = 0.02), total (P = 0.05), visual analog scale (VAS [P = 0.04]), and present pain intensity (PPI) score (P = 0.06). The proportion of patients reporting more intense pain scores did not return to the pre-intervention level at 3 months post-Botox injection. CONCLUSION Patients experienced substantial pain relief in months 1 and 2 following a single Botox injection into the ASM under CT guidance. Significant pain reduction was noted for 3 months after Botox injection with respect to both sensory and VAS scores, and the total and PPI scores approximated statistical significance. After 3 months, patients experienced a 29% decrease in the sensory component of their pain as well as an approximate 15% reduction in their VAS score. A single, CT-guided Botox injection into the ASM may offer an effective, minimally invasive treatment for NTOS.
Collapse
Affiliation(s)
- Paul J Christo
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|