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An Update on Botulinum Toxin A Injections of Trigger Points for Myofascial Pain

  • Anesthetic Techniques in Pain Management (D Wang, Section Editor)
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Abstract

Myofascial pain syndrome (MPS) is a common chronic pain condition that is characterized by distinct “trigger points.” Despite current treatments with physical therapy, analgesics, anti-depressants and trigger-point injections, myofascial pain remains a challenging chronic pain condition in clinical practice. Botulinum toxin A (BTX-A) can cause prolonged muscle relaxation through inhibition of acetylcholine release. It may offer some advantages over the current treatments for MPS by providing a longer sustained period of pain relief. Despite numerous clinical trials, the efficacy of BTX-A in alleviating MPS is not well-established due to mixed results from recent clinical trials. Active trigger points are associated with referred pain and greatly impact many aspects of activities of daily living, mood, and health status. This review is designed to analyze the clinical trials regarding the efficacy of BTX-A injection of active trigger points as a treatment for MPS. The literature referenced was obtained via a computer search with Google Scholar, Pubmed, Medline and EMbase. Our search terms included “Botulinum toxin,” “myofascial pain,” “trigger points,” “myofascial trigger points,” “chronic pain.” Additional references were retrieved from the reference list of the reports found via this search. Studies were considered eligible for inclusion if they were double-blinded, randomized, controlled trials evaluating the efficacy of BTX-A injections into trigger points for pain reduction, and if the trigger point selection in the trial included referred pain and/or local twitch response. Open-label studies, case reports, and other non-randomized studies were excluded. Eight trials were found according to the above criteria and are summarized in Table 1. There are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS. However, further clinical trials with considerations of minimizing placebo effect, repeated dosing, adequate coverage of trigger points, and using ultrasound confirmation and guidance are required to provide conclusive evidence for BTX-A in the treatment of myofascial pain.

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Conflict of Interest

Dr. Jon Y. Zhou and Dr. Dajie Wang reported no potential conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Anesthesiology, Thomas Jefferson University Hospital, 111. S 11th Street, Suite 8290 Gibbon, Philadelphia, PA, USA

    Jon Y. Zhou

  2. Department of Anesthesiology, Jefferson Medical College, 834 Chestnut Street, Suite T-150, Philadelphia, PA, USA

    Dajie Wang

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  1. Jon Y. Zhou
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  2. Dajie Wang
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Correspondence to Jon Y. Zhou.

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This article is part of the Topical Collection on Anesthetic Techniques in Pain Management

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Zhou, J.Y., Wang, D. An Update on Botulinum Toxin A Injections of Trigger Points for Myofascial Pain. Curr Pain Headache Rep 18, 386 (2014). https://doi.org/10.1007/s11916-013-0386-z

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  • DOI: https://doi.org/10.1007/s11916-013-0386-z

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