A double-blind, controlled study of botulinum toxin A in chronic myofascial pain

Abstract

I read with interest the article by Qerama et al. on botulinum toxin A and myofascial pain syndrome.1 As a neurologist, I have been treating patients for 15 years with botulinum toxin A (Btx), many of whom fulfill the inclusionary criteria for this study (i.e., chronic shoulder and arm pain of greater than 6 months duration). Given the somewhat complex nature of the innervation and musculature of the shoulder and upper extremity, I wonder why a single trigger point located in the infraspinatus muscle was chosen. Furthermore, why would there be any expectation that a single injection of botulinum toxin would be of any benefit in this group of patients? For these reasons, it was not surprising that there were not favorable outcomes in this small study. It should also be …