A COMPARATIVE STUDY OF LIDOCAINE, BOTULINUM TOXIN TYPE A INJECTION AND DRY NEEDLING IN THE TREATMENT OF MYOFASCIAL PAIN SYNDROME

Background: Miyofascial pain syndrome (MPS) is one of the most common cause of chronic musculoskeletal pain and is defined as a muscular pain disorder that involves regional pain which is referred to by trigger points (TrP) within the myofascial structures local or distant from the experienced pain.Objectives: This prospective single-blind study proposed to compare TrP injection with Botulinum Toxin type A (BTX-A) to dry needling and lidocaine injection in MPS.Methods: Eighty seven trigger points (cervical and/or periscapular regions) in 23 female and 6 male patients with MPS (with a disease duration more 6 months) were treated. The patients were randomly assigned into three groups: Lidocaine injection group (LIG) (n:9, 32 TrP), dry needling group (DNG) (n:10, 33 TrP) and BTX-A injected group (BTIG) (n:10, 22 TrP).Outcome Measures: Clinical assessment including cervical range of motion (ROM), TrP pain pressure threshold (PPT) measurement, pain scores (PS), Visual analog scale-pain (VAS-pain), fatigue, work disability scores were evaluated at entry and at the end of fourth week. Additionally depression and anxiety was evaluated by Hamilton Depression and Anxiety Rating Scales and quality of life was assessed using Nottingham Health Profile (NHP). The subjects were also asked for the side effects.Injection procedure: 0.5% of lidocaine 1 ml to each TrP in LIG, 10-20 IU BTX-A to each TrP in BTIG, dry needling to each TrP in DNG was administered and followed by stretching of involved muscle groups. Patients instructed to continue their home exercise programmes.Results: PPT and PS were significantly improved in three groups. PPT values were significantly increased in LIG group compared to DNG and PS were significantly decreased in comparison to both BTIG and DNG. All over VAS scores were significantly decreased in LIG and BTIG, and not significantly changed in DNG. VAS-fatigue scores were significantly improved in LIG group compared to DNG, whereas no significant change was found between LIG vs BTIG or BTIG vs DNG. Disturbance during the injection procedure was lowest in LIG. Quality of life scores assessed by NHP were significantly improved in both LIG and BTIG, but not in DNG. Depression and anxiety scores were significantly improved only in BTIG group.Conclusion: Injection is a more practical and rapid treatment of choice in MPS. Lidocain injection seems to be more prominent since this technique has less disturbance during the procedure than dry needling and more cost effective than BTX-A injection. On the other hand BTX-A is an expensive and not easily available drug and could be selectively used in patients with MPS who were resistant to the conventional treatments.Citation: , volume , supplement , year 2003, page Session: Psychology, measurements and management of pain