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Treatment of Chronic Low Back Pain by Local Injection of Botulinum Toxin A



Treatment of Chronic Low Back Pain by Local Injection of Botulinum Toxin A



Anesthesiology Abstracts of Scientific Papers Annual Meeting (2000): Abstract No 771



Introduction. Since the initial use of Botulinum Toxin A (BTA) in the treatment of strabismus 20 years ago, is has also been used to treat spasticity, cervical dystonia, spasmodic dystonia, writer's cramp, and tremor.1-3 However, use of BTA in the treatment of fibromyalgia, myofascial pain and chronic low back pain is still controversial. In order to clarify the effects of BTA on the low back pain secondary to myoneural syndrome and lumbar radiculitis, we studied its use in a group of chronic pain patients at LSU Health Sciences Center from 1998 to the present. Material and Methods. With IRB approval and following informed consent, nineteen patients diagnosed with myoneural syndrome and/or lumbar radiculitis were enrolled in this study and followed for 6-12 months. Data were collected using the following methods: Visual Analogue Scale (0-10), McGill-Melzack Pain Questionnaire, Oswestry Disability Questionnaire, Roland-Morris Disability Scale, and a muscle spasm score (0-4). Patients provided these data upon referral and then again either 1 month after treatment (BTA group) or within 1-12 months of referral (control group). An assessment of the range of the patient's range of motion was also done. Scales that use physical measures to quantify the effects of pain have certain criteria similar to those of self-reported scales. There were 10 patients in the control (non-treated) group. In the BTA group, 9 patients were treated with local injections of Botulinum Toxin A (BTX-A, Allergan Pharmaceuticals, Porton Products Pharmaceuticals, Ltd). Results. Comparison of the two sets of data for the control group demonstrated that, during the period between questionnaires, the natural progression of untreated chronic low back pain was generally to become worse. However, the patients treated with BTA showed an overall improvement (Table 1). Conclusions. Although the number of cases in this study is limited, it appears that the beneficial effect of BTA in the relaxation of muscle spasm associated with chronic low back pain leads to pain relief. Further investigation should be encouraged.

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