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Botulinum toxin injections for low-back pain and sciatica.

Abstract

BACKGROUND

Adequate relief from low-back pain (LBP) is not always possible. Emerging evidence suggests a role for botulinum neurotoxin (BoNT) injections in treating pain disorders. Proponents of BoNT suggest its properties can decrease muscle spasms, ischemia and inflammatory markers, thereby reducing pain.

OBJECTIVES

To determine the effects of botulinum toxin injections in adults with LBP.

SEARCH STRATEGY

We searched CENTRAL (The Cochrane Library 2009, issue 3) and MEDLINE, EMBASE, and CINAHL to August 2009; screened references from included studies; consulted with content experts and Allergan. We included published and unpublished randomised controlled trials without language restrictions

SELECTION CRITERIA

We included randomised trials that evaluated BoNT serotypes versus other treatments in patients with non-specific LBP of any duration.

DATA COLLECTION AND ANALYSIS

Two review authors selected the studies, assessed the risk of bias using the Cochrane Back Review Group criteria, and extracted the data using standardized forms. We performed a qualitative analysis due to lack of data.

MAIN RESULTS

We excluded evidence from nineteen studies due to non-randomisation, incomplete or unpublished data. We included three randomised trials (N =123 patients). Only one study included patients with chronic non-specific LBP; the other two examined unique subpopulations. Only one of the three trials had a low risk of bias and demonstrated that BoNT injections reduced pain at three and eight weeks and improved function at eight weeks better than saline injections. The second trial showed that BoNT injections were better than injections of corticosteroid plus lidocaine or placebo in patients with sciatica attributed to piriformis syndrome. The third trial concluded that BoNT injections were better than traditional acupuncture in patients with third lumbar transverse process syndrome. Both studies with high risk of bias had several key limitations. Heterogeneity of the studies prevented meta-analysis. There is low quality evidence that BoNT injections improved pain, function, or both better than saline injections and very low quality evidence that they were better than acupuncture or steroid injections.

AUTHORS' CONCLUSIONS

We identified three studies that investigated the merits of BoNT for LBP, but only one had a low risk of bias and evaluated patients with non-specific LBP (N = 31). Further research is very likely to have an important impact on the estimate of effect and our confidence in it. Future trials should standardize patient populations, treatment protocols and comparison groups, enlist more participants and include long-term outcomes, cost-benefit analysis and clinical relevance of findings.

Authors+Show Affiliations

Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

21249702

Citation

Waseem, Zeeshan, et al. "Botulinum Toxin Injections for Low-back Pain and Sciatica." The Cochrane Database of Systematic Reviews, 2011, p. CD008257.
Waseem Z, Boulias C, Gordon A, et al. Botulinum toxin injections for low-back pain and sciatica. Cochrane Database Syst Rev. 2011.
Waseem, Z., Boulias, C., Gordon, A., Ismail, F., Sheean, G., & Furlan, A. D. (2011). Botulinum toxin injections for low-back pain and sciatica. The Cochrane Database of Systematic Reviews, (1), CD008257. https://doi.org/10.1002/14651858.CD008257.pub2
Waseem Z, et al. Botulinum Toxin Injections for Low-back Pain and Sciatica. Cochrane Database Syst Rev. 2011 Jan 19;(1)CD008257. PubMed PMID: 21249702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Botulinum toxin injections for low-back pain and sciatica. AU - Waseem,Zeeshan, AU - Boulias,Chris, AU - Gordon,Allan, AU - Ismail,Farooq, AU - Sheean,Geoffrey, AU - Furlan,Andrea D, Y1 - 2011/01/19/ PY - 2011/1/21/entrez PY - 2011/1/21/pubmed PY - 2011/3/1/medline SP - CD008257 EP - CD008257 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 1 N2 - BACKGROUND: Adequate relief from low-back pain (LBP) is not always possible. Emerging evidence suggests a role for botulinum neurotoxin (BoNT) injections in treating pain disorders. Proponents of BoNT suggest its properties can decrease muscle spasms, ischemia and inflammatory markers, thereby reducing pain. OBJECTIVES: To determine the effects of botulinum toxin injections in adults with LBP. SEARCH STRATEGY: We searched CENTRAL (The Cochrane Library 2009, issue 3) and MEDLINE, EMBASE, and CINAHL to August 2009; screened references from included studies; consulted with content experts and Allergan. We included published and unpublished randomised controlled trials without language restrictions SELECTION CRITERIA: We included randomised trials that evaluated BoNT serotypes versus other treatments in patients with non-specific LBP of any duration. DATA COLLECTION AND ANALYSIS: Two review authors selected the studies, assessed the risk of bias using the Cochrane Back Review Group criteria, and extracted the data using standardized forms. We performed a qualitative analysis due to lack of data. MAIN RESULTS: We excluded evidence from nineteen studies due to non-randomisation, incomplete or unpublished data. We included three randomised trials (N =123 patients). Only one study included patients with chronic non-specific LBP; the other two examined unique subpopulations. Only one of the three trials had a low risk of bias and demonstrated that BoNT injections reduced pain at three and eight weeks and improved function at eight weeks better than saline injections. The second trial showed that BoNT injections were better than injections of corticosteroid plus lidocaine or placebo in patients with sciatica attributed to piriformis syndrome. The third trial concluded that BoNT injections were better than traditional acupuncture in patients with third lumbar transverse process syndrome. Both studies with high risk of bias had several key limitations. Heterogeneity of the studies prevented meta-analysis. There is low quality evidence that BoNT injections improved pain, function, or both better than saline injections and very low quality evidence that they were better than acupuncture or steroid injections. AUTHORS' CONCLUSIONS: We identified three studies that investigated the merits of BoNT for LBP, but only one had a low risk of bias and evaluated patients with non-specific LBP (N = 31). Further research is very likely to have an important impact on the estimate of effect and our confidence in it. Future trials should standardize patient populations, treatment protocols and comparison groups, enlist more participants and include long-term outcomes, cost-benefit analysis and clinical relevance of findings. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/21249702/Botulinum_toxin_injections_for_low_back_pain_and_sciatica_ L2 - https://doi.org/10.1002/14651858.CD008257.pub2 DB - PRIME DP - Unbound Medicine ER -