Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
권호 표지

Botulinum Toxin type A injection Versus Lidocaine Injection for Myofascial Pain Involving upper Trapezius

승모근 근막동통에 대한 보툴리눔 독소와 리도카인 주사의 치료효과 비교

  • Ahn, Sung-Woo (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Park, Eun-Hee (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, College of Dentistry, Dankook University)
  • 안성우 (단국대학교 치과대학 구강내과학교실) ;
  • 박은희 (단국대학교 치과대학 구강내과학교실) ;
  • 김미은 (단국대학교 치과대학 구강내과학교실)
  • Published : 2005.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of this double-blind study was to evaluate clinical effects of botulinum toxin type A (BTX-A) injection on myofascial pain syndrome (MPS) involving upper trapezius and compare with those of lidocaine injection. 21 patients presenting with active TrP1 and/or TrP2 in the upper trapezius over 6 months were selected for this study. The subjects were randomly divided into two groups; one group injected with BTX-A (15 unit of $Botox^{(R)}$ / 0.3 ml per trigger point (TrP)) and the other group injected with 0.5% lidocaine (0.3 ml /TrP). The clinical effects were evaluated by VAS and PPT at baseline, 2, 4, 6 and 8 weeks after treatment. BTX-A group showed persistent decrease of VAS values and increase of PPT values following treatment. While there was no significant difference in VAS values between BTX-A and lidocaine groups (p=0.347), there was significant difference in PPT values after treatment between two groups (p=0.000). The subjects received BTX-A showed noticeable improvement in PPT values after treatment, suggesting more reliable effect of BTX-A injection compared with lidocaine injection. The results of this study support that the direct injection of BTX-A to a TrP is an effective and safe treatment for MPS involving upper trapezius.

근막동통(myofascial pain syndrome, MPS)은 근막발통점에 의해 야기되는 지각, 운동 및 자율신경계의 증상으로 발통점이 자극되면 이환부에 동통을 발생할 뿐 아니라 연관통, 연관압통, 운동신경장애, 자율신경반응을 야기할 수 있다. 본 연구는 근막동통의 다양한 치료법 중에서 botulinum toxin type A(BTX-A)의 주사의 효과를 국소마취제인 lidocaine의 주사효과와 비교하였다. 상부 승모근에 6개월 이상 활동성 발통점을 가진 21명의 환자를 선정한 다음, 무작위로 두 군으로 나누어 한 군(BTX-A 주사군, n=12)에는 발통점에 BTX-A(15 unit of $Botox^{(R)}$ / 0.3 ml per trigger point (TrP))를 주사하고 다른 군(lidocaine 주사군, n=9)에는 0.5% lidocaine (0.3 ml /TrP)를 주사하였다. 두 군 모두 주사는 1 회만 시행하였으며 운동요법이나 물리치료 및 약물치료는 시행하지 않았다. 주사 후 동통의 변화를 관찰하기 위하여 주사 전 및 주사 후 2 주, 4 주, 6 주, 8 주에 주관적 동통척도인 VAS와 압력통각역치(PPT)를 측정하였으며 실험은 이중맹검으로 시행되었다. 실험결과, BTX-A 주사군은 주사 후 8 주의 시간이 경과되는 동안 VAS가 지속적으로 감소하였으며 PPT는 지속적으로 증가하였으나 lidocaine 주사군에서는 VAS의 감소만이 관찰되었다. 즉, 주관적인 동통척도에 있어서는 BTX-A 주사군과 lidocaine 주사군 사이에 유의한 통계학적 차이가 나타나지 않고(p=0.347), 두 군 모두 시간경과에 따라 동통이 감소하는 양상을 보여주었다. 그러나 PPT의 경우에는 BTX-A 주사군에서만 감소하여 두 군 사이에 유의한 통계학적 차이가 관찰되었다(p=0.000). 본 연구의 결과에 따르면 상부승모근 발통점에 대한 BTX-A 주사는 효과적이고 신뢰할 만한 치료법이라고 생각된다.

Keywords

References

  1. Simons DG, Travell JG, Simons LS. Travell and Simon's Myofascial pain and dysfunction, The trigger point manual, Vol.1 Upper Half of Body (2nd ed). Baltimore, Lippincott Williams & Wilkins, 1999
  2. Mense S, Simons DG, Ressell IJ. Muscle pain. Understanding its nature, diagnosis, and treatment. Philadelphia, Lippincott Williams & Wilkins, 2001
  3. Kamanli A, Kaya A, Ardicoglu O, Ozgocmen S, Zengin FO, Bayik Y. Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int 2004;15(Epub ahead of print)
  4. Han SC, Harrision P. Myofascial pain syndrome and trigger point management. Reg Anesth 1997;22:89-101 https://doi.org/10.1016/S1098-7339(06)80062-3
  5. Sellin LC. The action of botulinum toxin at the neuromuscular junction. Med Biol 1981;59:11-20
  6. Ahnert-Hilger G, Bigalke H. Molecular spects of tetanus and botulinum neurotoxin poisoning. Prog Neurobiol 1995;46:83-96 https://doi.org/10.1016/0301-0082(95)00003-E
  7. 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;85:101-105 https://doi.org/10.1016/S0304-3959(99)00264-X
  8. Reilich P, Fheodoroff K, Kern U, Mense S, Seddigh S, Wissel J, Pongratz D. Consensus statement: botulinum toxin in myofascial pain. J Neurol 2004;251(Suppl 1):136-138
  9. Wheeler AH, Goolkasian P, Gretz SS. A randomized, double-blind, prospective pilot study of botulinum toxin for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine 1998;23:1662-1667 https://doi.org/10.1097/00007632-199808010-00009
  10. Wheeler AH, Goolkasian P, Gretz SS. Botulinum toxin A for the treatment of chronic neck pain. Pain 2001;94:255-260 https://doi.org/10.1016/S0304-3959(01)00358-X
  11. Mense S : Neurobiological basis for the use of botulinum toxin in pain therapy. J Neurol 2004;251(suppl 1):1/1-1/7 https://doi.org/10.1007/s00415-004-0321-7
  12. Alo KM, Yland MJ, Kramer DL, Charnov JH, Redko V. Botulinum toxin in the treatment of myofascial pain. The Pain Clinic 1997;10:107-116
  13. Cheshire WP, Abashian SW, Mann JD. Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994;59:65-69 https://doi.org/10.1016/0304-3959(94)90048-5
  14. Kuan TS, Chen JT, Chen SM, Chien CH, Hong CZ. Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 2002;81:512-520 https://doi.org/10.1097/00002060-200207000-00008
  15. De Andres J, Cerda-Olmedo G, Valia JC, Monsalve V, Lopez-Alarcon MD, Minguez A . Use of botulinum toxin in the treatment of chronic myofascial pain. Clin J Pain 2004;19: 269-275 https://doi.org/10.1097/00002508-200307000-00011