A critical appraisal of the evidence for botulinum toxin type a in the treatment for cervico-thoracic myofascial pain syndrome

Mehul J. Desai, Tatyana Shkolnikova, Andrew Nava, Danielle Inwald

Research output: Contribution to journalReview article

Abstract

Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence-based medicine to the treatment for cervico-thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al.'s as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.

Original languageEnglish (US)
Pages (from-to)185-195
Number of pages11
JournalPain Practice
Volume14
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Myofascial Pain Syndromes
Botulinum Toxins
Chest Pain
Trigger Points
Myalgia
Pain
Injections
Evidence-Based Medicine
PubMed
MEDLINE
Therapeutics
Databases

Keywords

  • Botulinum toxin
  • Myofascial pain syndrome
  • Myofascial trigger points
  • Neck pain
  • Nociceptors
  • Review

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

A critical appraisal of the evidence for botulinum toxin type a in the treatment for cervico-thoracic myofascial pain syndrome. / Desai, Mehul J.; Shkolnikova, Tatyana; Nava, Andrew; Inwald, Danielle.

In: Pain Practice, Vol. 14, No. 2, 01.01.2014, p. 185-195.

Research output: Contribution to journalReview article

Desai, Mehul J. ; Shkolnikova, Tatyana ; Nava, Andrew ; Inwald, Danielle. / A critical appraisal of the evidence for botulinum toxin type a in the treatment for cervico-thoracic myofascial pain syndrome. In: Pain Practice. 2014 ; Vol. 14, No. 2. pp. 185-195.
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