An update on botulinum toxin a injections of trigger points for myofascial pain

Jon Y Zhou, Dajie Wang

Research output: Contribution to journalReview article

10 Citations (Scopus)

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.

Original languageEnglish (US)
Article number386
JournalCurrent Pain and Headache Reports
Volume18
Issue number1
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Myofascial Pain Syndromes
Trigger Points
Botulinum Toxins
Type A Botulinum Toxins
Injections
Clinical Trials
Chronic Pain
Referred Pain
Pain
Therapeutics
Placebo Effect
Muscle Relaxation
Activities of Daily Living
PubMed
Health Status
Acetylcholine
Analgesics
Randomized Controlled Trials

Keywords

  • Botulinumtoxin
  • Chronic pain
  • Myofascial pain syndrome
  • Trigger point

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

An update on botulinum toxin a injections of trigger points for myofascial pain. / Zhou, Jon Y; Wang, Dajie.

In: Current Pain and Headache Reports, Vol. 18, No. 1, 386, 2014.

Research output: Contribution to journalReview article

@article{0dddc161b48f4322bb17c74c1d9840b5,
title = "An update on botulinum toxin a injections of trigger points for myofascial pain",
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.",
keywords = "Botulinumtoxin, Chronic pain, Myofascial pain syndrome, Trigger point",
author = "Zhou, {Jon Y} and Dajie Wang",
year = "2014",
doi = "10.1007/s11916-013-0386-z",
language = "English (US)",
volume = "18",
journal = "Current Pain and Headache Reports",
issn = "1531-3433",
publisher = "Current Science, Inc.",
number = "1",

}

TY - JOUR

T1 - An update on botulinum toxin a injections of trigger points for myofascial pain

AU - Zhou, Jon Y

AU - Wang, Dajie

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Botulinumtoxin

KW - Chronic pain

KW - Myofascial pain syndrome

KW - Trigger point

UR - http://www.scopus.com/inward/record.url?scp=84889779255&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84889779255&partnerID=8YFLogxK

U2 - 10.1007/s11916-013-0386-z

DO - 10.1007/s11916-013-0386-z

M3 - Review article

C2 - 24338700

AN - SCOPUS:84889779255

VL - 18

JO - Current Pain and Headache Reports

JF - Current Pain and Headache Reports

SN - 1531-3433

IS - 1

M1 - 386

ER -