Efficacy of ultrasound-guided infiltration with levobupivacaine and triamcinolone for myofascial pain syndrome of the quadratus lumborum: a retrospective observational study

Abstract Introduction and objectives: Myofascial Pain Syndrome (MPS) of the Quadratus Lumborum muscle (QL) is a frequent cause of chronic low back pain. With this study, we aimed to assess the efficacy of ultrasound-guided infiltration with 0.25% levobupivacaine and 40 mg triamcinolone for MPS of the QL. Methods: Observational and retrospective study of participants submitted to ultrasound-guided infiltration of the QL muscle from January 1, 2015 to June 31, 2019. Pain intensity was assessed using the five-point pain Numeric Rating Scale (NRS): pre-intervention, at 72 hours, 1 month, 3 months and 6 months post-intervention. Additional data collected were demographic characteristics, opioid consumption, and adverse effects. Results: We assessed 90 participants with mean age of 55.2 years. Sixty-eight percent of participants were female. Compared to the pre-intervention assessment, there was an improvement in pain at 72 hours (Mean Difference [MD = 3.085]; 95% CI: 2.200-3.970, p < 0.05), at the 1st month (MD = 2.644; 95% CI: 1.667-3.621, p < 0.05), at the 3rdmonth (MD = 2.017; 95% CI: 0.202-2.729, p < 0.05) and at the 6th month (MD = 1.339; 95% CI 0.378-2.300, p < 0.05), post-intervention. No statistically significant differences in opioid consumption were observed. No adverse effects associated with the technique were reported. Conclusions: Ultrasound-guided infiltration of the QL muscle is a safe and effective procedure for the treatment of pain in the QL MPS within 6 months post-intervention.

Toxina botulínica tipo A nas DTM musculares: há eficácia? / Botulinum toxin type A in muscle TMD: There's effectiveness?

Os objetivos dessa revisão da literatura foram verificar a eficácia da toxina botulínica tipo A (BTX-A) na diminuição da dor em indivíduos com DTM e identificar os parâmetros ideais para o local, número de aplicações, dosagens e tempo de duração. Foram selecionados 19 artigos das bases de dados do Google Acadêmico e PubMed, que incluíram 14 artigos de pesquisa clínica e 5 de revisão sistemática. Foi possível concluir a respeito da toxina botulínica que os músculos indicados para a aplicação são principalmente os masseteres e os temporais, podendo ser aplicado também nos músculos pterigoideos, lateral e medial, digástrico e platisma. Os locais de escolha são os que apresentam maior volume e sensibilidade à palpação (pontos-gatilho) ou maior atividade eletromiográfica em repouso. As dosagens variam de um total de 10U a 400U de BTX-A por indivíduo, sendo distribuídas pelos músculos indicados. A BTX-A, em geral, é aplicada em dose única, porem alguns autores preconizam uma segunda aplicação se a primeira não fez o efeito esperado. O efeito da toxina botulínica sobre os músculos e a dor, em geral, tem duração variada, sendo relatado desde 3 a 4 semanas até 3 a 5 meses. A maioria dos estudos observou à eficácia da BTX-A na diminuição da dor de indivíduos com DTM. Porém é necessário que mais estudos clínicos randomizados, duplo cegos, multicêntricos e controlados sejam realizados para que a eficácia da BTX-A seja comprovada e para que um protocolo de atendimento seja realizado.(AU)

The objectives of this literature review were to verify the efficacy of botulinum toxin type A (BTX-A) in reducing pain of TMD patients and to identify the optimal parameters for the location, number of applications, dosages and duration. We selected 19 articles from Google Scholar and PubMed databases that included 14 articles of clinical research and 5 systematic reviews. It was concluded about BTX-A that the muscles appropriate to the application are mostly masseter and temporal and can also be applied in the pterygoid muscle lateral and medial, digastric and platysma. The choices of locations are those who have higher volume and sensitivity to palpation (trigger points) or higher EMG activity at rest. Dosages vary from a total of 10U to 400U of BTX-A by individual, being distributed by the indicated muscles. BTX-A in general is applied in a single dose, but some authors recommend a second application if the first did not make the expected effect. The effect of BTX-A on muscle and pain in general has varying duration, being reported from 3 to 4 weeks for 3 to 5 months. Most studies have noted at the effectiveness of BTX-A in patient pain reduction DTM. However more randomized, double-blind, multicenter, controlled clinical trials needs to be carried out so that the effectiveness of BTX-A could be confirmed and a management protocol, stabilished.(AU)