title: A critical appraisal of the evidence for botulinum toxin type A in the treatment for cervico-thoracic myofascial pain syndrome.
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.
authors.affiliation: The George Washington University Spine & Pain Center, Washington, District of Columbia, U.S.A.
authors.forename: Mehul J
authors.initials: MJ
authors.lastname: Desai
authors.forename: Tatyana
authors.initials: T
authors.lastname: Shkolnikova
authors.forename: Andrew
authors.initials: A
authors.lastname: Nava
authors.forename: Danielle
authors.initials: D
authors.lastname: Inwald
mesh_terms: D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D002574:Cervical Vertebrae; D019317:Evidence-Based Medicine; D006801:Humans; D009209:Myofascial Pain Syndromes / Q000188:drug therapy*; D019547:Neck Pain / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013904:Thoracic Vertebrae
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin; myofascial pain syndrome; myofascial trigger points; neck pain; nociceptors; review