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Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome.

Abstract：

STUDY OBJECTIVES:To evaluate the efficacy of a single, low-dose injection of botulinum toxin type A in relieving pain in Korean patients with piriformis syndrome resistant to conventional therapy, and to assess the drug's influence on these patients' quality of life. DESIGN:Prospective, single-site, open-label trial. SETTING:Rehabilitation medicine clinic in Seoul, Korea. PATIENTS:Twenty-nine patients with a confirmed diagnosis of chronic piriformis syndrome and 82 age- and sex-matched healthy subjects were enrolled from April 1, 2003-February 28, 2004. Intervention. In 20 of the patients, botulinum toxin type A 150 U was injected using computed tomographic guidance into the affected unilateral piriformis muscle. The other nine patients served as active controls and received an injection of dexamethasone 5 mg and 1% lidocaine. The healthy subjects did not receive any injection. MEASUREMENTS AND MAIN RESULTS:The patients' pain at baseline and at 4, 8, and 12 weeks after treatment was rated by using a numeric rating scale. Health-related quality of life was assessed by using the validated Korean version of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) at baseline and at 4 weeks of treatment. Healthy subjects also completed the SF-36 at baseline. Pain intensity scores were significantly lower at 4, 8, and 12 weeks after treatment than at baseline (p<0.0001). Baseline scores from the SF-36 subscales, including those for physical functioning (p<0.0001), role physical (p<0.0001), bodily pain (p<0.0001), general health (p<0.0001), vitality (p<0.0001), and social functioning (p<0.002), were significantly lower in the patients than in the healthy subjects. Four weeks after treatment, physical functioning (p=0.003), role physical (p=0.021), bodily pain (p=0.016), general health (p=0.013), vitality (p=0.031) and social functioning (p=0.035) improved significantly from baseline in the patients. However, at 4 weeks, patients in the active control group were withdrawn from the study because their pain did not improve, and continuation without further medical care was considered unethical. CONCLUSION:A low dose of botulinum toxin type A relieved pain and improved quality of life in patients with refractory piriformis syndrome.

journal_name

Pharmacotherapy

journal_title

Pharmacotherapy

authors

Yoon SJ,Ho J,Kang HY,Lee SH,Kim KI,Shin WG,Oh JM

doi

10.1592/phco.27.5.657

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

657-65

issue

eissn

0277-0008

issn

1875-9114

journal_volume

pub_type

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Low-dose botulinum toxin type A for the treatment of refractory piriformis syndrome.