title: Treatment of chronic low back pain with successive injections of botulinum toxin a over 6 months: a prospective trial of 60 patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effects of two successive neurotoxin treatments for chronic low back pain using multiple pain rating scales in an open-label, prospective study.
  
  
  METHODS
  Adult patients with chronic low back pain received multiple paraspinal muscle injections with a maximum dosing of 500 units of botulinum A toxin per session. Those with a beneficial clinical response received a second treatment at 4 months. Pain was assessed by visual analog scale (VAS), modified low back pain questionnaire (OLBPQ), and a clinical low back pain questionnaire (CLBPQ) at baseline, 3 weeks, 2 months, 4 months, and 6 months after the first treatment.
  
  
  RESULTS
  Eighteen women and 42 men, ages 21 to 79 years (mean 46.6 years), with low back pain of a mean duration of 9.1 years were included. Significant improvement in back and radicular pain occurred at 3 weeks in 60% and at 2 months in 58% of the cohort. Beneficial clinical response to the first injection predicted response to reinjection in 94%. A significant minority of patients had a sustained beneficial effect from the first injection at 4 (16.6%) and 6 months (8.3%). Two patients had a transient flu-like reaction after the initial treatment.
  
  
  CONCLUSIONS
  Botulinum toxin A improves refractory chronic low back pain with a low incidence of side effects. The beneficial clinical response is sustained with a second treatment.
authors.affiliation: Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. John.Ney@na.amedd.army.mil
authors.forename: John P
authors.initials: JP
authors.lastname: Ney
authors.forename: Marc
authors.initials: M
authors.lastname: Difazio
authors.forename: Afsoun
authors.initials: A
authors.lastname: Sichani
authors.forename: William
authors.initials: W
authors.lastname: Monacci
authors.forename: Leslie
authors.initials: L
authors.lastname: Foster
authors.forename: Bahman
authors.initials: B
authors.lastname: Jabbari
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A