Botulinum Toxin A Treatment in Unilateral Painful Paravertebral Muscle Spasm: Case Report

Boylu, Ece; Aşir, Alparslan; Domaç, Füsun Mayda; Saraçoğlu, Mehmet
March 2009
Journal of Neurological Sciences;2009, Vol. 26 Issue 1, p92
Academic Journal
Botulinum toxin A (BTX-A) has been used in the treatment of chronic pain since effective pain relief was experienced by sufferers of spasticity and dystonia. In our study we aim to discuss the effectiveness of BTX-A in the treatment of the chronic pain that was refractory to traditional therapeutic options. Our patient had developed disciitis after the operation of lumbar disc herniation (L4-L5) and resultant muscle spasm had been observed 20 days after the operation. He complained of severe back pain with a Visual Analog Scale score of 100 millimeter and Oswestry Low Back Pain Questionnaire score of 50. Intravenous antibiotherapy, analgesics and anti-inflammatory medication, and hyperbaric oxygen treatment were applied, and upon persistence of the complaints BTX-A treatment was planned for univertebral muscle spasm and resultant pain. A total of 140 units of BTX-A (Botox) accompanied by EMG was injected due to the muscle spasm severity, between thoracal 1 and lumbar 5 vertebras where paravertebral muscle spasm was observed. The patient was visited at 1,2,3,4 weeks and at 2, 4, and 6 months. Pain disappeared at the end of the second week while the paravertebral muscle spasm improved at the end of the third week. Patient's complaints did not recur and he was noted to maintain his daily activities. The reduction of pain before the disappearance of the muscle spasm suggests that BTX-A is effective in the treatment of chronic pain refractory to the other therapeutic options.


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