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Biotech / Medical : Elan Corporation, plc (ELN) -- Ignore unavailable to you. Want to Upgrade?

To: Icebrg who wrote (3108)	8/22/2002 6:32:02 AM
From: Icebrg	Read Replies (1) \| Respond to of 10345

BOTULINUM TOXIN TYPE B INJECTION FOR A PATIENT WITH MYOFASCIAL PAIN Howard Smith, Joseph Audette, Ranjan Dey, Sajid Khan, Zahid Bajwa Beth Israel Deaconess Medical Center Boston, MA Botulinum toxin type B (BoNT-B; Myobloc) has been proven safe and effective for managing patients with cervical dystonia. The basis for the effectiveness of botulinum toxin in dystonic conditions is related to its ability to produce a localized paralysis in injected muscles. This mechanism as well as other potential theoretical mechanisms may be responsible for its effectiveness in providing significant and prolonged pain relief in these patients. We treated a 38-year old female with myofascial pain with BoNT-B. The patient presented with chronic upper back/neck, bilateral shoulder pain, and occasional mild frontal headaches that has been ongoing for the past 12 years. The pain was reported to worsen with activities but was better with rest. Physical examination findings include: 7/10 for pain severity; trigger points in the neck and upper back; mild decrease in range of motion (ROM) in the neck; full ROM elsewhere. Past and present interventions include physical therapy/TENS, diazepam, nortriptyline, baclofen, Tylenol with codeine, tramadol, and motrin. We initiated the patient on BoNT-B injections, 5000 U divided equally over five sites (1000 U/0.2 cc). Efficacy was determined by patient's assessment of pain and ROM. Overall, the results of treatment with BoNT-B in our patient with myofascial pain were very good. At the 3-month follow-up, the pain was decreased to 2/10 and patient had full ROM. The patient experienced no complications, reported no adverse effects, and was overall very satisfied with the treatment. It is conceivable that BoNT-B may be useful for the treatment of myofascial pain; further studies are warranted. The mechanisms of action of muscle paralysis as well as analgesia for BoNT-B will be discussed and illustrated. A review of the literature will be presented along with other clinical situations in which BoNT-B may be worthwhile investigating. Support of Elan Pharmaceuticals is gratefully acknowledged. docguide.com