Authors: Ignacio Velázquez Rivera, Lourdes Velázquez Clavarana, Pilar García Velasco, José Ruiz Olivares.
Background: One of the main alternatives to treat myofascial pain syndrome (MPS) is botulinum toxin A (BTA), which acts in the synaptic membrane at the neuromuscular junction, inhibiting the release of acetylcholine, producing muscle relaxation and pain relief, although in many cases its effect is not evident until several days have elapsed.
Aim: To test whether we could get a shortening in the reduction of VAS time and a life quality improvement adding local anesthetics (LA) to BT-A dose.
Methods: The study design was prospective, controlled, longitudinal and randomized in which we have assessed the evolution of 20 patients randomly divided into two groups. The first group was given IncobotulinumtoxinA (IncoBT-A, T group). The second group was treated with IncoBT-A and an additional dose of 2% lidocaine (TL group). Both groups had previously responded positively to a test with lidocaine 2% infiltration of the affected muscle.
Results: There was statistically significant difference between groups TL and IncoBT-A in the VAS assessment on the third day, just as in the Lattinen Index. No significant differences in the other reviews were stated. There was a significant difference in VAS reduction and Lattinen Index improvement at the beginning and end of the study in both groups.
Conclusion: IncoBT-A presents an alternative to the management of this condition when conservative therapy has failed. Local anesthetics cause a predictable, short and reversible muscle relaxation caused by blocking nerve conduction in nerve endings, while BT-A acts on the neuronal endings of the motor plate, preventing the release of acetylcholine. Their actions are carried out in different places and with different characteristics. The action of local anesthetics is almost instantaneous and short lasting, while the BT-A action is delayed and long lasting, so both can be complementary and agonists in their final effect.
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