Rev. Soc. Esp. Dolor. 2021; 28(2): 100-110 / DOI: 10.20986/resed.2021.3902/2021
Diana Carolina Nájera, John Carlos Pérez, Agustín Mendiola
ABSTRACT
Botulinum toxin injections have been used in pain treatment associated with pathologies such as focal dystonia, spasticity, headaches and myofascial pain. However, results from botulinum toxin trials in myofascial pain syndrome (MPS) are contradictory.
The objective of this paper is to analyze the evidence of botulinum toxin type A (BTA) efficacy compared to placebo in myofascial pain management. Literature search was performed in PubMed, Web of Science (WoS), Scielo and Scopus, using the following key words: myofascial pain, trigger point, botulinum toxin and botox. Eleven clinical trials comparing BTA versus normal saline solution (NSS) met the inclusion criteria. Although most of the clinical trials analyzed cannot demonstrate a BTA superiority, it would not be correct to conclude that botulinum toxin is not indicated in miofascial pain treatment due to the great heterogeneous patient selection, variability in BTA doses, different trigger points (TP) injections techniques, variability in trials duration, and absence of cost-effective analysis.
More specific clinical trials are required using homogeneous samples to provide conclusive evidence for BTA in the MPS treatment.
RESUMEN
Las infiltraciones con toxina botulínica han sido utilizadas en el tratamiento del dolor asociado a múltiples patologías, como distonías focales, espasticidad, cefaleas y dolor miofascial. Sin embargo, los resultados de los diferentes estudios realizados con toxina botulínica en el síndrome de dolor miofascial (SDM) son contradictorios. El objetivo de la presente revisión es analizar la evidencia de la eficacia de la toxina botulínica tipo A (TBA) frente a placebo en la disminución del dolor crónico de origen miofascial.
Se realizó una búsqueda bibliográfica en PubMed, Web of Science (WoS), Scielo y Scopus, utilizando las siguientes palabras clave: dolor miofascial, punto gatillo, toxina botulínica y bótox. Los estudios que cumplieron los criterios inclusión fueron once ensayos clínicos que comparaban la TBA frente a solución salina normal (SSN).
Aunque en la mayoría de los ensayos clínicos analizados no podemos evidenciar un beneficio de la TBA frente a SSN, no sería acertado concluir que la toxina botulínica no está indicada en el tratamiento de dolor asociado al SDM, dado que existe una selección de pacientes muy heterogénea, hay una gran variabilidad en la dosis de toxina botulínica, se usan diferentes técnicas de infiltración de los puntos gatillo (PG), la duración de los estudios es variable y no hay estudios que realicen un análisis costo-efectivo.
Se necesitan ensayos clínicos más específicos, con muestras más homogéneas, que nos permitan sacar conclusiones acerca del papel de la TBA en el tratamiento del SDM.
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Bibliografía
1. Nicol AL, Wu II, Ferrante FM. Botulinum toxin type a injections for cervical and shoulder girdle myofascial pain using an enriched protocol design. Anesth Analg. 2014;118(6):1326-35. DOI: 10.1213/ANE.0000000000000192.
2. Ho KY, Tan KH. Botulinum toxin A for myofascial trigger point injection: A qualitative systematic review. Eur J Pain. 2007;11(5);519-27. DOI: 10.1016/j.ejpain.2006.09.002.
3. Avendaño-Coy J, Gómez-Soriano J, Valencia M, Estrada J, Leal F, Ruiz-Campa R. Botulinum toxin type a and myofascial pain syndrome: A retrospective study of 301 patients. J Back Musculoskelet Rehabil. 2014;27(4):485-92. DOI: 10.3233/BMR-140470.
4. Raj PP. Botulinum toxin therapy in pain management. Anesthesiol Clin North Am. 2003;21(4):715-31. DOI: 10.1016/S0889-8537(03)00082-8.
5. Gerwin R. Botulinum toxin treatment of myofascial pain: A critical review of the literature. Curr Pain Headache Rep. 2012;16(5):413-22. DOI: 10.1007/s11916-012-0287-6.
6. Hallett M. Mechanism of action of botulinum neurotoxin: Unexpected consequences. Toxicon. 2018;147:73-6. DOI: 10.1016/j.toxicon.2017.08.011.
7. Safarpour Y, Jabbari B. Botulinum toxin treatment of pain syndromes –an evidence based review. Toxicon. 2018;147:120-8. DOI: 10.1016/j.toxicon.2018.01.017.
8. Reilich P, Fheodoroff K, Kern U, Mense S, Seddigh S, Wissel J, et al. Consensus statement: Botulinum toxin in myofacial pain. J Neurol. 2004;251(Suppl. 1):36-8. DOI: 10.1007/s00415-004-1109-5.
9. Seo HG, Bang MS, Chung SG, Jung SH, Lee SU. Effect of electrical stimulation on botulinum toxin a therapy in patients with chronic myofascial pain syndrome: A 16-week randomized double-blinded study. Arch Phys Med Rehabil. 2013;94(3):412-8. DOI: 10.1016/j.apmr.2012.09.034.
10. Roldan CJ, Osuagwu U, Cardenas-Turanzas M, Huh BK. Normal Saline Trigger Point Injections vs Conventional Active Drug Mix for Myofascial Pain Syndromes. Am J Emerg Med. 2020;38(2):311-6. DOI: 10.1016/j.ajem.2019.158410.
11. Velázquez Rivera I, Muñoz Vico M, Velázquez Clavarana L, García Velasco P, Zénner del Castillo A, Ruiz Olivares J, et al. Comparación de resultados obtenidos en el tratamiento del dolor miofascial de la cintura pélvica con toxina botulínica sola y asociada con lidocaína. Rev Soc Esp Dolor. 2014;21(5):242-53. DOI: 10.4321/S1134-80462014000500003. DOI: 10.4321/S1134-80462014000500003.
12. Graboski CL, Shaun Gray D, Burnham RS. Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: A randomised double blind crossover study. Pain. 2005;118(1-2):170-5. DOI: 10.1016/j.pain.2005.08.012.
13. Porta M. A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of myofascial pain syndrome and pain from chronic muscle spasm. Pain. 2000;85(1-2):101-5. DOI: 10.1016/S0304-3959(99)00264-X.
14. Castro M, Cánovas L, García-Rojo B, Morillas P, Martínez-Salgado J, Gómez-Pombo A, et al. Tratamiento del síndrome de dolor Miofascial con toxina botulínica tipo A. Rev la Soc Esp del Dolor. 2006;13(2):96-102.
15. Kim DY, Kim JM. Safety and efficacy of prabotulinumtoxina (Nabota®) injection for cervical and shoulder girdle myofascial pain syndrome: A pilot study. Toxins (Basel). 2018;10(9):355. DOI: 10.3390/toxins10090355.
16. Torres Huerta JC, Hernández Santos JR, Ortiz Ramírez EM, Tenopala Villegas S. Toxina botulínica tipo A para el manejo del dolor en pacientes con síndrome de dolor miofascial crónico. Rev la Soc Esp del Dolor. 2010;17(1):22-7. DOI: 10.1016/S1134-8046(10)70004-5.
17. Carrasco AT, Wescoat L, Roman A. A retrospective review of Botulinum toxin type A compared with standard therapy in the treatment of lumbar myofascial back pain patients. Pain Clinic. 2003;15:205-11. DOI: 10.1163/156856903767650709.
18. Wheeler AH, Goolkasian P. Open label assessment of botulinum toxin A for pain treatment in a private outpatient setting. J Musculoskelet Pain. 2001;9(1):67-82. DOI: 10.1300/J094v09n01_08.
19. Lang AM. A preliminary comparison of the efficacy and tolerability of botulinum toxin serotypes A and B in the treatment of myofascial pain syndrome: A retrospective, open-label chart review. Clin Ther. 2003;25(8):2268-78. DOI: 10.1016/S0149-2918(03)80218-7.
20. Cartagena-Sevilla J, García-Fernández MR, Vicente-Villena JP. Analgesic Effect of Botulinum Toxin A in Myofascial Pain Syndrome Patients Previously Treated with Local Infiltration of Anesthetic and Steroids. J Pain Palliat Care Pharmacother. 2016;30(4):269-75. DOI: 10.1080/15360288.2016.1231742.
21. Jerosch J, Söhling M. Open-label, multicenter, randomized study investigating the efficacy and safety of botulinum toxin type A in the treatment of myofascial pain syndrome in the neck and shoulder girdle. J Musculoskelet Pain. 2012;20(2):95-9. DOI: 10.3109/10582452.2012.674309.
22. De Andrés J, Cerda-Olmedo G, Valía JC, Monsalve V, Lopez-Alarcón, Minguez A. Use of botulinum toxin in the treatment of chronic myofascial pain. Clin J Pain. 2003;19(4):269-75. DOI: 10.1097/00002508-200307000-00011.
23. Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayık Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int. 2005;25(8):604-11. DOI: 10.1007/s00296-004-0485-6.
24. Ojala T, Arokoski JPA, Partanen J. The effect of small doses of botulinum toxin A on neck-shoulder myofascial pain syndrome: A double-blind, randomized, and controlled crossover trial. Clin J Pain. 2006;22(1):90-6. DOI: 10.1097/01.ajp.0000151871.51406.c3.
25. Wheeler AH, Goolkasian P, Gretz SS. Botulinum toxin A for the treatment of chronic neck pain. Pain. 2001;94(3):255-60. DOI: 10.1016/S0304-3959(01)00358-X.
26. Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic Use of Botulinum Toxin Type A in Treating Neck and Upper-Back Pain of Myofascial Origin: A Pilot Study. Arch Phys Med Rehabil. 2008;89(1):75-80. DOI: 10.1016/j.apmr.2007.08.133.
27. Göbel H, Heinze A, Reichel G, Hefter H, Benecke R. Efficacy and safety of a single botulinum type A toxin complex treatment (Dysport®) for the relief of upper back myofascial pain syndrome: Results from a randomized double-blind placebo-controlled multicentre study. Pain. 2006;125(1-2):82-8. DOI: 10.1016/j.pain.2006.05.001.
28. Ferrante FM, Bearn L, Rothrock R, King L. Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A. Anesthesiology. 2005;103(2):377-83. DOI: 10.1097/00000542-200508000-00021.
29. Qerama E, Fuglsang-Frederiksen A, Kasch H, Bach FW, Jensen TS. A double-blind, controlled study of botulinum toxin A in chronic myofascial pain. Neurology. 2006;67(2):241-5. DOI: 10.1212/01.wnl.0000224731.06168.df.
30. Benecke R, Heinze A, Reichel G, Hefter H, Göbel H. Botulinum type A toxin complex for the relief of upper back myofascial pain syndrome: How do fixed-location injections compare with trigger point-focused injections? Pain Med. 2011;12(11):1607-14. DOI: 10.1111/j.1526-4637.2011.01163.x.
31. De Andrés J, Adsuara VM, Palmisani S, Villanueva V, López-Alarcón MD. A double-blind, controlled, randomized trial to evaluate the efficacy of botulinum toxin for the treatment of lumbar myofascial pain in humans. Reg Anesth Pain Med. 2010;35(3):255-60. DOI: 10.1097/AAP.0b013e3181d23241.
32. Kwanchuay P, Petchnumsin T, Yiemsiri P, Ma NP, Hathaiareerug C. Efficacy and Safety of Single Botulinum Toxin Type A (Botox®) Injection for Relief of Upper Trapezius Myofascial Trigger Point: A Randomized, Double-Blind, Placebo-Controlled Study. J Med Assoc Thai. 2015;98(12):1231-6..
33. Fenollosa P, De Barutell C, Figueroa J, Míguez A, Nieto C. Toxina botulínica A (Dysport®) asociada a rehabilitación, en pacientes con dolor miofascial cervical o dorsal primario: Un estudio piloto multicéntrico aleatorizado. Rehabilitacion. 2011;45(2):139-47. DOI: 10.1016/j.rh.2011.03.015.
34. Reilich P, Schoser BGH. Accuracy of botulinum toxin injections in myofascial pain. Response to Gobel et al. Pain 2006;125:82-8. Pain. 2007;130(3):299. DOI: 10.1016/j.pain.2007.04.020.
35. Göbel H, Heinze A, Reichel G, Hefter H, Benecke R. Efficacy and safety of a single botulinum type A toxin complex treatment (Dysport®) for the relief of upper back myofascial pain syndrome: Results from a randomised double-blind placebo-controlled multicentre study. Pain 2006;125(1-2):82-8. DOI: 10.1016/j.pain.2006.05.001.
36. Hsieh RL, Lee WC. Are the Effects of Botulinum Toxin Injection on Myofascial Trigger Points Placebo Effects or Needling Effects? Arch Physical Med Rehab. 2008;89(4):792-3. DOI: 10.1016/j.apmr.2008.02.004.