Muscle pain can be divided into two types, articular and non-articular pain. Articular pain involves inflammation of joints such as Rheumatoid
Arthritis or Osteoarthritis. Nonarticular pain consists of disorders involving the soft tissues. This group consists of low back pain, myofascial pain caused by trigger points, and fibromyalgia characterized by tender points. There are many treatments for muscle pain from physical therapy, massage, medications, acupuncture, surgery, and Botulinum Toxin injections. This section will discuss the advantages of using Botulinum Toxin in the treatment of soft tissue disorders.
Patients receiving larger doses of Botulinum Toxin A (200-300 units) for chronic musculoskeletal pain at tender point sites from L1-S2 have shown a greater than 50% pain relief starting at 3 weeks and lasting 3-4 months. For Chronic myofascial pain involving the piriformis, iliopsoas or scalenus anterior muscles, 80-150 units of Botox plus bupivicaine has significantly improved responses vs. steroid control studies. In the Royal 2001 study, patients with Piriformis Syndrome reported 50% improvement of pain and 71% improvement from Failed Back Surgery. Adverse effects consisted of some muscle weakness and mild flu-like symptoms.