Low back ache treatment with botulinum neurotoxin type A - Local experience in Kuwait

Objective: To investigate the efficacy, safety and tolerability of paraspinal administration of botulinum neurotoxin type A (BoNT-A) in patients with chronic low back ache (LBA). Subjects and Methods: Eight patients with chronic LBA were injected with BoNT-A at three sites on either side of lumbar paraspinal muscles. The patients rated their pain intensity using a visual analogue scale (VAS) from 0 to 10, and our physiotherapist assessed the paraspinal muscle spasm using a functional scale (FS) from 0 to 5. The improvement in both VAS and FS 30, 60 and 90 days after BoNT-A from baseline was analyzed separately using paired t test. The correlation between the muscle spasm (FS) and pain relief (VAS) was analyzed using the Spearman's rank correlation coefficient test. The level of statistical significance was p<0.05. Results: Five (63%) patients showed a remarkable recovery in VAS and FS, whereas 2 (25%) patients showed improvement only in FS. Statistically significant improvement was achieved in VAS and FS independently 30 days (p<0.02 and p<0.02, respectively), 60 days (p <0.01 and p<0.001, respectively) and 90 days (p<0.02 and p<0.001, respectively) after treatment. Pain relief started early and it was independent of relief of muscle spasm 30 days after treatment (r=0.685; p>0.05). Conclusion: With this limited study, we have demonstrated that the paraspinal injection of BoNT-A is effective in relieving chronic LBA without producing side effects. The injection is an easy procedure, well tolerated and did not require anesthesia or imaging technique. Copyright (C) 2007 S. Karger AG, Basel.