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AAN: Tough-To-Treat Myofascial Pain Responds To Botulinium Toxin Type A By Jill Stein Special to DG News PHILADELPHIA, PA -- May 10, 2001 -- Nearly three-quarters of patients with refractory myofascial pain syndrome experience good to excellent pain relief with Botox (botulinium toxin type A) injections, according to data presented at the 53rd Annual Meeting of the American Academy of Neurology. While botulinium toxin type A has proven effective in a variety of conditions associated with muscle spasm, the literature on its use in refractory myofascial pain syndrome (MPS) has been limited. MPS is a common chronic regional pain syndrome defined by the presence of trigger points and referred pain remote from the involved area. Mike A. Royal, MD, and colleagues at the University of Oklahoma College of Medicine in Tulsa, Oklahoma tested botulinium toxin type A in 104 patients 18 to 85 years of age who had MPS that was refractory to conservative measures including medications, trigger point injections, and various psychological techniques. Body regions injected were cervical, thoracic, lumbar, piriformis, gluteal and the extremities. Injections were performed as standard trigger point injections using botulinium toxin type A 20 to 40 units in 1-4 mL per trigger point. The diluent was bupivicaine 0.5%, typically 5 to 10cc per 100 units. The patient dose per injection session was 100 to 300 units, which was determined by the number of involved muscles and spasm severity. Patient responses to injection were defined as no relief (less than 30 percent symptom reduction), fair (30 to 40 percent reduction), good (50 to 69 percent reduction) and excellent (at least 70 percent reduction). Of the 187 injections in 104 patients in whom records were available for review, 135 (72.2 percent) injections resulted in good (16.6 percent) to excellent (55.6 percent) pain relief, lasting an average of 2.7 to 3.8 months. Nearly one in five patients (19.2 percent) who had an excellent response had at least a six-month duration of relief. Treatment was well tolerated with only a handful of patients having mild and very transient reactions. Related Link: Botox (botulinium toxin type A). E-mail this page to a friend or colleague! To print, use this version