Open AccessTREATMENT WITH BOTULINUM TOXIN TYPE B (MYOBLOC) INJECTIONS IN THREE PATIENTS WITH MYOFASCIAL PAIN
Author(s) -
Mary Johansen,
William C. Satterfield,
Wallace B. Baze,
Tamara Lee Gradert,
Samuel J. Hassenbusch
Publication year - 2002
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1046/j.1526-4637.2002.202439.x
Subject(s) - myofascial pain , medicine , botulinum toxin , myofascial pain syndrome , anesthesia , physical therapy , alternative medicine , pathology
Srinivas Nalamachu, MD Mid‐America Physiatrists PA Overland Park, KS Botulinum toxin type B (BoNT‐B; Myobloc) is an antigenically distinct botulinum toxin serotype that is effective for managing patients with cervical dystonia. Studies show that BoNT‐B significantly reduces the pain associated with this disorder. The mechanism by which it provides pain relief may be related to chemodenervation as well as other potential theoretical mechanisms. We report the results of three patients (2 female; 1 male) with myofascial pain who were treated with BoNT‐B injections. Patients were between 30–40 years of age and have failed treatment with oral anti‐inflammatories and muscle relaxants, and have not had good results with physical therapy or conventional modalities, such as ultrasound and TENS. Pain was measured on a VAS scale pre‐ and post‐ injection. Patients were injected with a 5000‐U dose of BoNT‐B into an average of 5 muscles with an equal dose of 1000 U into each injection site. Muscles injected include cervical paraspinals, trapezii, supraspinatus, and infrapsinatus. Prior to injection, patients were 8/10, 8/10, and 10/10 in pain severity. Results of treatment with BoNT‐B in our three patients with myofascial pain were very good. At the 1‐week and 1‐month follow‐up, patients reported significant improvements in pain severity: 2/10, 2/10, and 3/10, respectively. They also reported a decreased need in the medications that they were taking for pain control. One patient has returned for re‐injection and to date has received a total of 2 injections, supporting a positive and continuous response to treatment. Overall, BoNT‐B was very well‐tolerated. One patient reported flu‐like symptoms 12 hours after the first injection that lasted for 24 hours, but this event did not recur with further injections. The two other patients have reported no side effects. Based on our findings, further studies of BoNT‐B in the treatment of myofascial pain are warranted.