Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


The Effectiveness of Botulinum Toxin Type-A and Prilocaine Injections in Myofascial Pain Syndrome.

Zeki Kiralp,  Mehmet, Ozdemir,  Baki, Cakar,  Engin, Durmus,  Oguz, Tekin,  Levent, Dincer,  Umit

Objective:

The objective of this study was to compare the effectiveness of botulinum toxin-A (Btx-A) and prilocaine injections in the treatment of myofascial pain syndrome (MAS).

Methods:

Forty-six eligible patients who had diagnosed as MAS were recruited and were randomized into two treatment groups namely Btx group (n=23) and prilocaine group (n=23). The injections were made to most painful maximum three trigger points of the patients. 10 IU of Btx-A in Btx group and 2ml prilocaine in the prilocaine group were injected to each points. All of the patients were trained about the stretching exercises and instructed to do at home regularly. Clinical assessment parameters were visual analog scale (VAS) for pain during function, pain score (PS) during digital pressure, short form-36 (SF-36) for quality of life and Beck depression inventory (BDI) for general well-being. The assessments were performed at baseline and at 2nd and 6th weeks after the injections.

Results:

There were no statistical differences between the groups at baseline. The study was finished with 38 patients (19 patients in each group). Both of the groups' VAS, PS, BDI scores at 2nd and 6th weeks and all of the subscale scores of SF-36 at 6th week improved according to baseline. In inter-group comparison it was seen that the VAS score at 2nd and 6th weeks and PS at 6th week improved statistically better in Btx group than prilocaine group (p<0.05). In addition, all of the subscale scores of SF-36 except physical functioning were statistically better in Btx-A group (p<0.05) at 2nd and 6th weeks.

Table 1. The intra-group and inter-group comparisons of the treatment effects of Btx-A and prilocaine

 Baseline2nd week6th week
 mean ± SDp**mean ± SDp**mean ± SDp**
VAS      
Prilocaine8.95 ± 1.130.164.26 ± 1.410.0123.74 ± 1.660.001
  %  -52 -58 
  p*  <0.0001 <0.0001 
   0.16 0.012 
Btx-A8.37 ± 1.38 3.21 ± 1.03 2 ± 0.88 
  %  -62 -76 
  p*  <0.0001 <0.0001 
PS      
Prilocaine2.89 ± 0.32 1.68 ± 0.58 1.42 ± 0.61 
  %  -42 -51 
  p*  <0.0001 <0.0001 
  0.11 0.16 0.01
Btx-A2.68 ± 0.48 1.42 ± 0.51 1 ± 0.33 
  %  -47 -63 
  p*  <0.0001 <0.0001 
*: p score of intra-group changes according to baseline**: p score of inter-group changes%: the percentage of change according to baseline

Conclusions:

Both Btx-A and prilocaine injections combined with appropriate exercise program were beneficial treatment choices in MAS management. It was also seen that Btx-A injections have better effects especially in regard to pain and health quality in short to medium term. It was noticeable that there was no difference between the groups at 2nd week in regard to PS, but Btx group's PS scores were statistically better at 6th week control. This might be interpreted as the progressive cumulative effect of Btx-A.

These outcomes were the preliminary results of an ongoing follow-up study. Further studies are needed for the clarification of the long term effects of Btx-A injections in MAS management.

To cite this abstract, please use the following information:
Zeki Kiralp, Mehmet, Ozdemir, Baki, Cakar, Engin, Durmus, Oguz, Tekin, Levent, Dincer, Umit; The Effectiveness of Botulinum Toxin Type-A and Prilocaine Injections in Myofascial Pain Syndrome. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :114
DOI: 10.1002/art.27883

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