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Chapter 29 - Use of botulinum neurotoxin in the treatment of low-back pain

Published online by Cambridge University Press:  05 February 2014

By
José De Andrés  and
Gustavo Fabregat
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett  and
Christopher Zachary
José De Andrés
Affiliation:
Department of Surgical Specialties, Valencia School of Medicine and Anesthesia Department of Anesthesiology, Critical Care and Pain Management, Valencia University General Hospital, Valencia, Spain
Gustavo Fabregat
Affiliation:
Department of Surgical Specialties, Valencia School of Medicine and Department of Anesthesiology, Critical Care and Pain Management, Valencia University General Hospital,Valencia, Spain
Daniel Truong
Affiliation:
The Parkinson’s and Movement Disorders Institute, Fountain Valley, California
Dirk Dressler
Affiliation:
Department of Neurology, Hannover University Medical School
Mark Hallett
Affiliation:
George Washington University School of Medicine and Health Sciences, Washington, DC
Christopher Zachary
Affiliation:
Department of Dermatology, University of California, Irvine
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Summary

Introduction

Chronic low-back pain is one of the leading causes of physician office visits and work absenteeism in developed countries. It is estimated that from 49% to 70% of the adult population will suffer at least one episode of low-back pain over their lifetime (Koes et al., 2006).

Although the etiopathogenesis of non-specific low-back pain is unknown, multiple factors may be involved in pain occurrence. Involvement of the muscles directly or indirectly stabilizing the lumbar spine may play a significant role in the occurrence and maintenance of low-back pain syndromes (Porterfield and DeRosa, 1998).

This chapter reviews the pathophysiology, diagnosis and treatment with botulinum neurotoxin (BoNT) of myofascial pain of muscles involved in lumbosciatic conditions (quadratus lumborum, iliopsoas and paravertebral) (Table 29.1). The piriformis muscle is reviewed in the next chapter.

Quadratus lumborum muscle

Dysfunction of the quadratus lumborum muscle is considered the most common cause of low-back pain by many authors (Travell and Simmons, 1983). Its impairment may be severely disabling as it plays an important stabilizing role in the spine, and makes the load of standing body weight intolerable.

Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 247 - 258
Publisher: Cambridge University Press
Print publication year: 2014

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References

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