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Effect of electrical stimulation on Botulinum Toxin A therapy in patients with chronic myofascial pain syndrome: a 16-week randomized double-blinded study
Seo HG, Bang MS, Chung SG, Jung SH, Lee S-U
Archives of Physical Medicine and Rehabilitation 2013 Mar;94(3):412-418
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: Yes; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To evaluate the effect of different intensities of electrical stimulation on Botulinum Toxin A (BTX-A) injection at trigger points (TrPs) in patients with chronic myofascial pain syndrome (MPS) DESIGN: Double-blind randomized trial. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: The participants (n = 76) were patients with chronic MPS on the neck and shoulder regions. INTERVENTIONS: Patients were randomly assigned to 1 of 2 intervention groups: BTX-A injection followed by electrical stimulation which induces visible muscle contraction (MOTOR group) and electrical stimulation with intensity just above the sensory threshold (SENSORY group). Electrical stimulation was administered for 30 minutes a day for three consecutive days after injection. MAIN OUTCOME MEASURES: The primary outcome was the visual analogue scale (VAS) for pain. Secondary outcomes included the neck pain and disability scale (NPAD), global assessment of improvement scale (GAS), and pressure pain threshold (PPT). RESULTS: The VAS scores decreased significantly at 4, 8, 12, and 16 weeks from the baseline in both groups. Significant changes in the NPAD score over time were noted only in the SENSORY group at 8, 12, and 16 weeks. The SENSORY group showed lower VAS and NPAD scores at 16 weeks (p = 0.043 and p = 0.041, respectively), and higher treatment success rates at 12 and 16 weeks (p = 0.039 and p = 0.024, respectively) than the MOTOR group. These was no significant result in the GAS and PPT. CONCLUSIONS: Short-term electrical stimulation may affect reduction in pain after BTX-A injection at TrPs in patients with chronic MPS on the neck and shoulder regions. Based on the results, it seems that sensory electrical stimulation was superior to motor electrical stimulation as an adjuvant therapy of BTX-A injection in the patients with chronic MPS. Further studies are warranted to investigate the method facilitating the effect of BTX-A on MPS.

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