Skip to main content

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
Cancel
×
×
Home
  • Home
Chapter
  • Print publication year: 2009
  • Online publication date: July 2009

19 - Use of botulinum toxin in musculoskeletal pain and arthritis

Export citation
Summary

Introduction

Since the mid 1990s, botulinum toxins (BoNTs) have been proposed in the treatment of over 100 musculoskeletal conditions. Although initial reports from open-label studies, retrospective reviews, and case series have been encouraging, clinical evidence from large controlled trials is largely lacking, mixed, or negative in regard to the efficacy of botulinum toxins for neck and back pain (Cheshire et al., 1994; Brashear et al., 1999; Brin et al., 1999; Foster et al., 2001; Benzon et al., 2003; De Andres et al., 2003; Lang, 2003, 2004; Gobel et al., 2006; Jabbari et al., 2006; Jabbari, 2007). These differences reflect the complexities of pain syndromes, variations in dosing regimens and injection methodologies, and importance of individual muscles to regional kinematics and function.

The use of BoNT for treatment of myofascial pain (MP), arthritis, and other conditions that are beyond the Food and Drug Administration (FDA)-approved labeling should be considered investigational. Numerous studies have found BoNT type A (BoNT-A) and BoNT type B (BoNT-B) to be safe and well tolerated at doses used for the treatment of cervical dystonia, but side effects can be seen at the higher doses used for cervicothoracic and lumbosacral pain.

Precautions should be taken around breast implants, pacemakers, and other implanted devices. Care should be exercised in regard to the depth of any injection over the trunk so as to avoid pneumothorax.

Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Manual of Botulinum Toxin Therapy
  • Online ISBN: 9780511575761
  • Book DOI: https://doi.org/10.1017/CBO9780511575761
Please enter your name
Please enter a valid email address
Who would you like to send this to *

CAPTCHA *

Skip to the audio challenge
×
REFERENCES
Aoki, K. R. (2005). Review of a proposed mechanism for the antinociceptive action of botulinum toxin type A. Neurotoxicology, 26, 785–93.
Benzon, H. T., Katz, J. A., Benzon, H. A. & Iqbal, M. S. (2003). Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology, 98, 1442–8.
Borg-Stein, J. & Simons, D. G. (2002). Focused review: myofascial pain. Arch Phys Med Rehabil, 83, S40–7, S48–9.
Brashear, A., Lew, M. F., Dykstra, D. D., et al. (1999). Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-responsive cervical dystonia. Neurology, 53, 1439–46.
Brin, M. F., Lew, M. F., Adler, C. H., et al. (1999). Safety and efficacy of NeuroBloc (botulinum toxin type B) in type A-resistant cervical dystonia. Neurology, 53, 1431–8.
Calandre, E. P., Hidalgo, J., Garcia-Leiva, J. M. & Rico-Villademoros, F. (2006). Trigger point evaluation in migraine patients: an indication of peripheral sensitization linked to migraine predisposition?Eur J Neurol, 13, 244–9.
Calillet, R. (1977). Soft Tissue Pain and Disability. Philadelphia: FA Davis Co.
Carter, J. E. (1998). Surgical treatment for chronic pelvic pain. JSLS, 2, 129–39.
Cheshire, W. P., Abashian, S. W. & Mann, J. D. (1994). Botulinum toxin in the treatment of myofascial pain syndrome. Pain, 59, 65–9.
Darlow, L. A., Pesco, J. & Greenberg, M. S. (1987). The relationship of posture to myofascial pain dysfunction syndrome. J Am Dent Assoc, 114, 73–5.
Andres, J., Cerda-Olmedo, G., Valia, J. C., et al. (2003). Use of botulinum toxin in the treatment of chronic myofascial pain. Clin J Pain, 19, 269–75.
Dorsher, P. (2006). Trigger points and acupuncture points. Acupunct Med, 17, 21–5.
Durette, M. R., Rodriquez, A. A., Agre, J. C. & Silverman, J. L. (1991). Needle electromyographic evaluation of patients with myofascial or fibromyalgic pain. Am J Phys Med Rehabil, 70, 154–6.
Durham, P. L., Cady, R. & Cady, R. (2004). Regulation of calcitonin gene-related peptide secretion from trigeminal nerve cells by botulinum toxin type A: implications for migraine therapy. Headache, 44, 35–42; discussion 42–3.
Fernandez-de-las-Penas, C., Alonso-Blanco, C., Cuadrado, M. L. & Pareja, J. A. (2006). Forward head posture and neck mobility in chronic tension-type headache: a blinded, controlled study. Cephalalgia, 26, 314–19.
Ferrante, F. M., Bearn, L., Rothrock, R. & King, L. (2005). Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A. Anesthesiology, 103, 377–83.
Foster, L., Clapp, L., Erickson, M. & Jabbari, B. (2001). Botulinum toxin A and chronic low back pain: a randomized, double-blind study. Neurology, 56, 1290–3.
Frost, F. A., Jessen, B. & Siggaard-Andersen, J. (1980). A control, double-blind comparison of mepivacaine injection versus saline injection for myofascial pain. Lancet, 1, 499–500.
Gerwin, R. D., Shannon, S., Hong, C. Z., Hubbard, D. & Gevirtz, R. (1997). Interrater reliability in myofascial trigger point examination. Pain, 69, 65–73.
Gilio, F., Curra, A., Lorenzano, C., et al. (2000). Effects of botulinum toxin type A on intracortical inhibition in patients with dystonia. Ann Neurol, 48, 20–6.
Gioux, M. & Petit, J. (1993). Effects of immobilizing the cat peroneus longus muscle on the activity of its own spindles. J Appl Physiol, 75, 2629–35.
Gobel, H., Heinze, A., Reichel, G., Hefter, H. & Benecke, R. (2006). Efficacy and safety of a single botulinum type A toxin complex treatment (Dysport) for the relief of upper back myofascial pain syndrome: results from a randomized double-blind placebo-controlled multicentre study. Pain, 125, 82–8.
Graff-Radford, S. B. (2004). Myofascial pain: diagnosis and management. Curr Pain Headache Rep, 8, 463–7.
Greenfield, B., Catlin, P. A., Coats, P. W., et al. (1995). Posture in patients with shoulder overuse injuries and healthy individuals. J Orthop Sports Phys Ther, 21, 287–95.
Griegel-Morris, P., Larson, K., Mueller-Klaus, K. & Oatis, C. A. (1992). Incidence of common postural abnormalities in the cervical, shoulder, and thoracic regions and their association with pain in two age groups of healthy subjects. Phys Ther, 72, 425–31.
Haughie, L. J., Liebert, I. M. & Roach, K. E. (1995). Relationship of forward head posture and cervical backward bending to neck pain. J Man Manip Ther, 3, 91–7.
Hayton, M. J., Santini, A. J., Hughes, P. J., et al. (2005). Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am, 87, 503–7.
Hong, C. Z. & Simons, D. G. (1998). Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Arch Phys Med Rehabil, 79, 863–72.
Jabbari, B. (2007). Treatment of chronic low back pain with botulinum neurotoxins. Curr Pain Headache Rep, 11, 352–8.
Jabbari, B., Ney, J., Sichani, A., et al. (2006). Treatment of refractory, chronic low back pain with botulinum neurotoxin A: an open-label, pilot study. Pain Med, 7, 260–4.
Kern, U., Martin, C., Scheicher, S. & Muller, H. (2004a). Does botulinum toxin A make prosthesis use easier for amputees?J Rehabil Med, 36, 238–9.
Kern, U., Martin, C., Scheicher, S. & Muller, H. (2004b). Effects of botulinum toxin type B on stump pain and involuntary movements of the stump. Am J Phys Med Rehabil, 83, 396–9.
Kern, U., Martin, C., Scheicher, S. & Muller, H. (2004c). [Long-term treatment of phantom- and stump pain with Botulinum toxin type A over 12 months. A first clinical observation]. Nervenarzt, 75, 336–40.
Lang, A. M. (2000). A pilot study of botulinum toxin type A (BOTOX), administered using a novel injection technique, for the treatment of myofascial pain. Am J Pain Manage, 10, 108–12.
Lang, A. M. (2002). Botulinum toxin therapy for myofascial pain disorders. Curr Pain Headache Rep, 6, 355–60.
Lang, A. M. (2003). Botulinum toxin type A therapy in chronic pain disorders. Arch Phys Med Rehabil, 84, S69–73; quiz S74–5.
Lang, A. M. (2004). Botulinum toxin type B in piriformis syndrome. Am J Phys Med Rehabil, 83, 198–202.
Mahowald, M. L., Singh, J. A. & Dykstra, D. (2006). Long term effects of intra-articular botulinum toxin A for refractory joint pain. Neurotox Res, 9, 179–88.
Maier, A., Eldred, E. & Edgerton, V. R. (1972). The effects on spindles of muscle atrophy and hypertrophy. Exp Neurol, 37, 100–23.
McPartland, J. M. (2004). Travell trigger points–molecular and osteopathic perspectives. J Am Osteopath Assoc, 104, 244–9.
Mennell, J. M. (1992). The Musculoskeletal System: Differential Diagnosis from Symptoms and Physical Signs. Gaithersburg, Maryland: Aspen Publishers, Inc.
Porta, M. (2000). A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain, 85, 101–5.
Simons, D. G. (2004). Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol, 14, 95–107.
Simons, D. G., Travell, J. G. & Simons, L. (1999). Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, Vol. 1. Upper Half of Body 2nd edn., Baltimore: Lippincott Williams & Wilkins.
Singh, J., Mahowald, M. & Dykstra, D. (2004a). Intra-articular botulinum A toxin for chronic shoulder pain in the elderly. J Invest Med, 52, S380.
Singh, J., Mahowald, M. & Dykstra, D. (2004b). Report on intraarticular botulinum toxin type A for refractory joint pain. J Pain, 5, S60.
Welch, M. J., Purkiss, J. R. & Foster, K. A. (2000). Sensitivity of embryonic rat dorsal root ganglia neurons to Clostridium botulinum neurotoxins. Toxicon, 38, 245–58.
Wheeler, A. H., Goolkasian, P. & Gretz, S. S. (1998). A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine, 23, 1662–6; discussion 1667.
Williams, R. (1980). Sensitivity changes shown by spindle receptors in chronically immobilized skeletal muscle. J Physiol, 306, 26P–7P.
Wong, S. M., Hui, A. C., Tong, P. Y., et al. (2005). Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med, 143, 793–7.
Cancel
Confirm
×