Botox treatment for low back pain and sciatica caused by Piriformis Syndrome

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ASA: Botox (Botulinum Toxin A) Effective Treatment for Low Back Pain and

Sciatica Caused by Piriformis Syndrome

By Emma Hitt

Special to DG News

ORLANDO, FL -- October 16, 2002 -- Botulinum toxin A (BotoxT, Allergan Inc.)

injection to the piriformis muscle appears to be an effective treatment for low

back pain and sciatica caused by piriformis syndrome.

Piriformis syndrome is a primary or contributory cause of sciatica and low back

pain, according to Dr. Serosh Saleemi, from the department of anaesthesia at

Louisiana State University Health Sciences Center, in Shreveport, United States,

and colleagues.

Botox acts presynaptically by inhibiting the release of acetylcholine, leading

to functional denervation of the muscle for up to 6 months.

Presenting their findings here October 15 at the 55th Annual Meeting of the

American Society of Anesthesiologists (ASA), Dr. Saleemi's team conducted a

retrospective review of 50 patients who underwent Botox injections in the

intrapiriformis muscle.

Criteria used to diagnose piriformis muscle syndrome included gluteal pain,

muscle spasms or pull in leg muscles, positive Beatty's Maneuver, and L5 or S1

sensory nerve root hypoaesthesia of A-delta fibers on the affected side. A

standardised preparation of 100 Units of Botox in 5 cc of preservative-free 0.9

N saline was injected into the piriformis muscle under fluoroscopic guidance.

All patients reported a reduction in pain score after six to eight weeks of

follow-up, the researchers reported.

Average visual analog scale (VAS) score for pain was nearly 8.87 prior to

treatment and 4.5 points after treatment (p<0.01). Average McGill score, which

was measured in 27 patients, was 40.6 before and 21.5 after the injection

(p<0.01). Oswestry score, also in 27 changed from 25.9 to 11.7 (p<0.01) and

Roland- score decreased from 16.0 to 20.6 (p<0.01).

" We propose that Botox injection to the piriformis muscle is an effective

treatment for low back pain and sciatica caused by piriformis syndrome, " the

authors concluded.

" Piriformis syndrome is quite common and an important cause of low back pain, "

Dr. Saleemi told Doctor's Guide. He claims that, when diagnosed correctly,

piriformis syndrome improves in more than 90 percent of cases when treated with

Botox.

" This treatment lasts for at least three months, and when administered with the

fluoroscopic technique, it is very easy to administer, " she said.

The research was funded by Allergan Inc., the manufacturers of Botox.

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