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Botox for trigger points, update

PainSci » bibliography » Zhou et al 2014
Tags: muscle pain, injections, medications, spasms, muscle, pain problems, medicine, treatment, self-treatment

Four pages on PainSci cite Zhou 2014: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Chronic Tension Headaches3. Trigger Points on Trial4. The evidence on Botox for muscle knots blew my mind once upon a time

PainSci commentary on Zhou 2014: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Previous reviews of Botox injection (Ho 2007, Jackson 2012, Gerwin) for myofascial pain have been disappointingly negative or inconclusive. This review (albeit in a much more obscure journal) is somewhat more optimistic … but only a little. Zhou and Wang believe that “there are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS.” But they emphasize that it’s not conclusive, and that we need (among other improvements) more studies “minimizing placebo effect” … which is exactly how promising results tend to evaporate in follow-up studies.

Just two years earlier, in 2012, Gerwin was more critical of the state of the evidence: “few studies have been designed to avoid many of the pitfalls associated with a trial of botulinum toxin treatment of trigger points.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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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This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:

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