Johns Hopkins University, 7830 Old Georgetown Road, Bethesda, MD 20814, USA.
Curr Pain Headache Rep. 2012 Oct;16(5):413-22. doi: 10.1007/s11916-012-0287-6.
This is a review of literature relevant to the treatment of myofascial pain syndrome by botulinum injections. The objective is to critically review the studies to see if they are appropriately designed, conducted, and interpreted to provide guidance in the management of myofascial pain. The intent is to better understand the mixed results that these studies have provided. A search was made utilizing PubMed for literature relevant to the use of botulinum toxin in the treatment of myofascial pain. All identifiable series were reviewed, including open label, single-blinded and double-blinded studies, randomized and controlled, or not. In general, small case series of only a few patients were not included unless they made a relevant point and there were no available randomized studies or larger studies. Single case reports were not included. This is not a meta-analysis. The studies were evaluated according to their design and the selection of outcome measurements, and the interpretation of results. The studies were individually critiqued, and an overall assessment and commentary was made of the studies in the field as a whole. Problems that were common to the studies were robust placebo responders, incomplete treatment of a regional myofascial pain syndrome, inappropriate or confounding control populations or treatments, and inappropriate time periods for assessment of outcomes, or misinterpretation of the time-frame of action of botulinum toxin. The studies of the effect of botulinum toxin treatment of myofascial trigger points have had mixed results. However, few studies have been designed to avoid many of the pitfalls associated with a trial of botulinum toxin treatment of trigger points. Better-designed studies may give results that can be used to guide practice based on reliable evidence. At the present time, one must conclude that the available evidence is insufficient to guide clinical practice.
这是一篇关于肉毒杆菌注射治疗肌筋膜疼痛综合征的文献综述。目的是批判性地回顾这些研究，以确定它们是否经过精心设计、实施和解释，从而为肌筋膜疼痛的管理提供指导。目的是更好地理解这些研究提供的结果为何喜忧参半。利用 PubMed 搜索了与肉毒毒素治疗肌筋膜疼痛相关的文献。综述了所有可识别的系列研究，包括开放标签、单盲和双盲研究、随机和对照研究，或非对照研究。一般来说，只有少数患者的小病例系列研究，如果没有随机研究或更大规模的研究，且没有提供相关观点，则不包括在内。也没有纳入单病例报告。这不是一项荟萃分析。根据设计和选择的结果测量方法以及结果的解释对研究进行了评估。对研究进行了逐个评论，并对整个领域的研究进行了全面评估和评论。研究中存在的共同问题包括：强大的安慰剂反应者、区域性肌筋膜疼痛综合征治疗不完整、不合适或混杂的对照人群或治疗方法、以及对结果评估的时间段不当，或对肉毒毒素作用时间框架的误解。肉毒毒素治疗肌筋膜触发点的效果研究结果喜忧参半。然而，很少有研究旨在避免与肉毒毒素治疗触发点相关的试验相关的许多陷阱。更好设计的研究可能会提供结果，可以基于可靠的证据来指导实践。目前，人们必须得出结论，现有证据不足以指导临床实践。
