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Low‐Dose Botulinum Toxin Type A for the Treatment of Refractory Piriformis Syndrome
Author(s) -
Yoon Se Jin,
Ho Jin,
Kang Ho Yeong,
Lee Sang Ho,
Kim Kyung Im,
Shin Wan Gyoon,
Oh Jung Mi
Publication year - 2007
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.27.5.657
Subject(s) - medicine , quality of life (healthcare) , botulinum toxin , refractory (planetary science) , prospective cohort study , lidocaine , sf 36 , piriformis syndrome , physical therapy , anesthesia , sciatic nerve , health related quality of life , physics , nursing , disease , astrobiology
Study Objectives . To evaluate the efficacy of a single, low‐dose injection of botulinum toxin type A in relieving pain in Korean patients with piriformis syndrome resistant to conventional therapy, and to assess the drug's influence on these patients' quality of life. Design . Prospective, single‐site, open‐label trial. Setting . Rehabilitation medicine clinic in Seoul, Korea. Patients . Twenty‐nine patients with a confirmed diagnosis of chronic piriformis syndrome and 82 age‐ and sex‐matched healthy subjects were enrolled from April 1, 2003–February 28, 2004. Intervention . In 20 of the patients, botulinum toxin type A 150 U was injected using computed tomographic guidance into the affected unilateral piriformis muscle. The other nine patients served as active controls and received an injection of dexamethasone 5 mg and 1% lidocaine. The healthy subjects did not receive any injection. Measurements and Main Results . The patients' pain at baseline and at 4, 8, and 12 weeks after treatment was rated by using a numeric rating scale. Health‐related quality of life was assessed by using the validated Korean version of the Medical Outcomes Study 36‐Item Short Form Health Survey (SF‐36) at baseline and at 4 weeks of treatment. Healthy subjects also completed the SF‐36 at baseline. Pain intensity scores were significantly lower at 4, 8, and 12 weeks after treatment than at baseline (p<0.0001). Baseline scores from the SF‐36 subscales, including those for physical functioning (p<0.0001), role physical (p<0.0001), bodily pain (p<0.0001), general health (p<0.0001), vitality (p<0.0001), and social functioning (p<0.002), were significantly lower in the patients than in the healthy subjects. Four weeks after treatment, physical functioning (p=0.003), role physical (p=0.021), bodily pain (p=0.016), general health (p=0.013), vitality (p=0.031) and social functioning (p=0.035) improved significantly from baseline in the patients. However, at 4 weeks, patients in the active control group were withdrawn from the study because their pain did not improve, and continuation without further medical care was considered unethical. Conclusion . A low dose of botulinum toxin type A relieved pain and improved quality of life in patients with refractory piriformis syndrome.