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Botulinum Toxin Injections for Chronic Low Back Pain

Intramuscular injections of botulinum toxin A have been used successfully for a variety of conditions characterized by muscle spasm or dystonia. In this trial, researchers in Washington, DC, sought to determine whether botulinum toxin A also might be effective for patients with chronic low back pain, which can be associated with paraspinal muscle spasm.

Thirty-one patients, all of whom had had low back pain for at least 6 months (mean duration, 7 years) and unilateral predominance of pain, were enrolled. They were randomized to receive either botulinum toxin or saline placebo injected at 5 lumbar paravertebral sites. At 8 weeks, the proportion of patients with at least 50 percent improvement in pain (as measured on a visual analogue scale) was significantly greater in the botulinum group than in the placebo group (60 percent vs. 12.5 percent, P=0.009). Botulinum recipients also showed significantly greater improvement on a function scale for tasks of daily living. No side effects from botulinum toxin were noted. However, at 6-month follow-up, 6 of 10 botulinum responders noted that the benefit from the injections had subsided.

Comment: The authors believe that this is the first double-blind trial showing botulinum toxin A to be effective in chronic low back pain. The difference between groups was highly significant despite the small sample size, but the benefit was relatively short-lived. This study should be repeated in other settings; in addition, it would be useful to determine whether repeat injections are worthwhile.

— AS Brett

Published in Journal Watch General Medicine June 1, 2001

Citation(s):

Foster L et al. Botulinum toxin A and chronic low back pain: A randomized, double-blind study. Neurology 2001 May 56 1290-1293.

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