title: Low back ache treatment with botulinum neurotoxin type A. Local experience in Kuwait.
abstract: OBJECTIVE
  To investigate the efficacy, safety and tolerability of paraspinal administration of botulinum neurotoxin type A (BoNT-A) in patients with chronic low back ache (LBA).
  
  
  METHODS
  Eight patients with chronic LBA were injected with BoNT-A at three sites on either side of lumbar paraspinal muscles. The patients rated their pain intensity using a visual analogue scale (VAS) from 0 to 10, and our physiotherapist assessed the paraspinal muscle spasm using a functional scale (FS) from 0 to 5. The improvement in both VAS and FS 30, 60 and 90 days after BoNT-A from baseline was analyzed separately using paired t test. The correlation between the muscle spasm (FS) and pain relief (VAS) was analyzed using the Spearman's rank correlation coefficient test. The level of statistical significance was p < 0.05.
  
  
  RESULTS
  Five (63%) patients showed a remarkable recovery in VAS and FS, whereas 2 (25%) patients showed improvement only in FS. Statistically significant improvement was achieved in VAS and FS independently 30 days (p < 0.02 and p < 0.02, respectively), 60 days (p < 0.01 and p < 0.001, respectively) and 90 days (p < 0.02 and p < 0.001, respectively) after treatment. Pain relief started early and it was independent of relief of muscle spasm 30 days after treatment (r = 0.685; p > 0.05).
  
  
  CONCLUSIONS
  With this limited study, we have demonstrated that the paraspinal injection of BoNT-A is effective in relieving chronic LBA without producing side effects. The injection is an easy procedure, well tolerated and did not require anesthesia or imaging technique.
authors.affiliation: Department of Neurology, Ibn Sina Hospital, Kuwait, Kuwait. nagarajanusharani@hotmail.com
authors.forename: Venkatesan
authors.initials: V
authors.lastname: Nagarajan
authors.forename: Asmahan
authors.initials: A
authors.lastname: Al-Shubaili
authors.forename: Yasser M
authors.initials: YM
authors.lastname: Ayad
authors.forename: John
authors.initials: J
authors.lastname: Alexander
authors.forename: Khadijah
authors.initials: K
authors.lastname: Al-Ramezi
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D017116:Low Back Pain / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D016059:Range of Motion, Articular; D013035:Spasm / Q000188:drug therapy; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A