Información de la revista
Vol. 2. Núm. 4.
Páginas 173-182 (Julio - Agosto 2006)
Vol. 2. Núm. 4.
Páginas 173-182 (Julio - Agosto 2006)
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Revisión sistemática: ¿es recomendable el empleo de toxina botulínica como tratamiento del dolor en el síndrome miofascial?
Systematic review: can botulinum toxin be recommended as treatment for pain in myofascial syndrome?
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Claudia Alejandra Peredaa,
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Correspondencia: Dra. C.A. Pereda. Reumatología. Clínica Mediterráneo. Nueva Musa, s/n. 04007 Almería. España.
, Jacqueline Usón Jaegerb, Loreto Carmonac
a Reumatología. Clínica Mediterráneo. Almería. España
b Reumatología. Hospital de Móstoles. Madrid. España
c Unidad de Investigación. Fundación Española de Reumatología. Madrid. España.
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Estadísticas

El dolor miofascial tiene un posible componente de contractura muscular.

Objetivos

Dado que la toxina botulínica ha resultado beneficiosa en enfermedades asociadas a hipertonía, se quiso evaluar la eficacia de la toxina botulínica en la reducción del dolor en el síndrome miofascial (SM).

Métodos

Se realizó una revisión sistemática con búsqueda en Medline, EMBASE y Cochrane Library Plus de todos los ensayos clínicos de toxina botulínica en dolor regional. Además, se efectuó una búsqueda manual entre los resúmenes de los congresos del ACR y EULAR de los últimos 3 años. Los estudios seleccionados fueron revisados y analizados de forma independiente por 2 revisoras.

Resultados

Ocho estudios cumplían los criterios de inclusión, y la calidad etodológica general fue baja. Toxina botulínica se comparó frente a solución salina fisiológica en 6 tudios, frente a esteroides en 2 y frente a lidocaína y aguja seca en 1 (brazo de 1 estudio). La población estudiada incluía cervicalgia (n=3), lumbalgia (n=2), síndrome piriforme (n=2), untos gatillo varios (n=1) y voluntarios sanos a los que se provocaba dolor (n=1). Toxina botulínica mostró una cierta ventaja sobre placebo y corticoides. Un metaanálisis de los 3 estudios con medidas de eficacia agrupables dio como resultado una diferencia media ponderada en una escala visual analógica de dolor de 0-10 de −2,72 (intervalo de confianza del 95%, −3,86 a −1,58). Sin embargo, toxina botulínica no mostró superioridad frente a lidocaína (p>0,016).

Conclusiones

La evidencia en esta revisión no permite confirmar la efectividad de toxina botulínica A o B en el tratamiento del SM. Son necesarios estudios rigurosos, de mayor calidad y a largo plazo dado el alto coste de la toxina botulínica.

Palabras clave:
Toxina botulínica
Síndrome miofascial
Revisión sistemática
Metaanálisis

Myofascial pain syndrome (MPS) may have an intrinsic muscle spasm component.

Aim

Since botulinum toxin has been successfully used to reduce hypertonicity in several neurological disorders, we analyzed the efficacy of botulinum toxin A or B in reducing pain in MPS.

Methods

We performed a systematic review through an electronic search in MEDLINE, EMBASE, and Cochrane Library Plus. All clinical trials of botulinum toxin and regional pain were selected. In addition, the abstracts of the ACR and EULAR meetings in the previous 3 years were searched manually. The studies identified were reviewed and analyzed by 2 independent reviewers.

Results

Eight studies met the inclusion criteria. The methodological quality was generally low. Botulinum toxin was compared to saline solution (6 studies), to steroids (2 studies), and to lidocaine and dry needle (1 study arm). The population studied included persons with neck pain (n=3), low back pain (n=2), piriformis syndrome (n=2), several trigger points (n=1), and healthy volunteers in whom pain was provoked (n=1). Botulinum toxin showed a certain advantage over saline solution and steroids in pain control. A meta-analysis of the 3 studies with efficacy measures that could be combined showed a weighted mean difference in pain on a 0-10 visual analogue scale of -2.72 (95% CI: −3.86; −1.58). However, botulinum toxin showed no advantage over lidocaine (p>0.016).

Conclusions

Currently, there is insufficient evidence to confirm the real efficacy of botulinum toxin A and B in the treatment of MPS. Given the high cost of botulinum toxin, long-term high quality studies are required.

Key words:
Botulinum toxin
Myofascial syndrome
Systematic review
Meta-analysis
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Financiación: Fundación Española de Reumatología.

Copyright © 2006. Elsevier España S.L. Barcelona
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