Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A
Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A
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DOI：
10.1097/00000542-200508000-00021
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发表时间：
2005-08-01
期刊：
影响因子：
8.8
通讯作者：
King, L
中科院分区：
文献类型：
--
作者：
Ferrante, FM;Bearn, L;King, L
背景：肌筋膜疼痛缓解的传统策略提供短暂的，不完全的，可变的或不可预测的结果。肉毒杆菌毒素本身是一种镇痛药，但也可以引起持续的肌肉松弛，从而可能提供更大的救济比传统therapy.Methods：本研究的目标是确定是否直接注射A型肉毒杆菌毒素（BONT-A）到触发点是有效的颈胸肌筋膜疼痛，如果是这样，以确定是否存在的剂量反应关系。132例颈椎或肩部肌筋膜疼痛或两者兼有且有活动性触发点的患者入组了一项为期12周的随机、双盲、安慰剂对照试验。在所有药物的2周洗脱期后，患者被注射生理盐水或10、25或50 U BoNT-A至多达5个活性触发点。每个实验组的最大剂量分别为0、50、125和250 U/例患者。患者随后接受肌筋膜松解物理治疗和阿米替林，布洛芬和丙氧苯-对乙酰氨基酚萘磺酸盐。在第1、2、4、6、8和12周进行随访访视。结果指标包括视觉模拟疼痛评分、压力测痛法测量的痛阈以及丙氧苯-对乙酰氨基酚萘磺酸盐的急救剂量使用。结果：安慰剂组和BoNT-A组在视觉模拟疼痛评分、压力测痛法和急救药物方面没有显着差异。结论：将BoNT-A直接注射到触发点并不能改善颈胸肌筋膜疼痛。与其他注射方法相比，直接注射BoNT-A的触发点的作用进行了讨论，在缓解疼痛的潜在起源。
Background: Traditional strategies for myofascial pain relief provide transient, incomplete, variable, or unpredictable outcomes. Botulinum toxin is itself an analgesic but can also cause sustained muscular relaxation, thereby possibly affording even greater relief than traditional therapies.Methods: The study goal was to determine whether direct injection of botulinum toxin type A (BoNT-A) into trigger points was efficacious for cervicothoracic myofascial pain, and if so, to determine the presence or absence of a dose-response relation. One hundred thirty-two patients with cervical or shoulder myofascial pain or both and active trigger points were enrolled in a 12-week, randomized, double-blind, placebo-controlled trial. After a 2-week washout period for all medications, patients were injected with either saline or 10, 25, or 50 U BoNT-A into up to five active trigger points. The maximum doses in each experimental group were 0, 50, 125, and 250 U per patient, respectively. Patients subsequently received myofascial release physical therapy and amitriptyline, ibuprofen, and propoxyphene-acetaminophen napsylate. Follow-up visits occurred at 1, 2, 4, 6, 8, and 12 weeks. Outcome measures included visual analog pain scores, pain threshold as measured by pressure algometry, and rescue dose use of propoxyphene-acetaminophen napsylate.Results: No significant differences occurred between placebo and BoNT-A groups with respect to visual analog pain scores, pressure algometry, and rescue medication.Conclusions: Injection of BoNT-A directly into trigger points did not improve cervicothoracic myofascial pain. The role of direct injection of trigger points with BoNT-A is discussed in comparison to other injection methodologies in the potential genesis of pain relief.