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Botulinum Toxin Treatment for Nocturnal Calf Cramps in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial

Authors
 Sang Jun Park  ;  Kyung Bong Yoon  ;  Duck Mi Yoon  ;  Shin Hyung Kim 
Citation
 ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, Vol.98(5) : 957-963, 2017 
Journal Title
 ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION 
ISSN
 0003-9993 
Issue Date
2017
MeSH
Aged ; Amines/therapeutic use ; Analgesics/therapeutic use ; Botulinum Toxins, Type A/therapeutic use* ; Cyclohexanecarboxylic Acids/therapeutic use ; Female ; Humans ; Lumbar Vertebrae* ; Male ; Middle Aged ; Neuromuscular Agents/therapeutic use* ; Pain Management ; Patient Acuity ; Prospective Studies ; Sleep-Wake Transition Disorders/drug therapy* ; Sleep-Wake Transition Disorders/etiology* ; Spinal Stenosis/complications* ; gamma-Aminobutyric Acid/therapeutic use
Keywords
Botulinum toxins ; Muscle cramp ; Rehabilitation ; Spinal stenosis
Abstract
OBJECTIVES: To evaluate the clinical effectiveness of botulinum toxin (BTX) injection into the gastrocnemius muscles in patients with lumbar spinal stenosis (LSS) who have frequent nocturnal calf cramps (NCCs). DESIGN: Prospective, randomized clinical trial. SETTING: Outpatient department for interventional pain management. PARTICIPANTS: Patients (N=50) with LSS who have NCCs at least once per week were enrolled. INTERVENTION: Patients were randomly allocated to receive either conservative treatments plus gabapentin (group GPN) or BTX injection (group BTX). MAIN OUTCOME MEASURES: We assessed back/leg pain intensity, the frequency and severity of NCCs, insomnia severity, and functional disability at baseline and after 2 weeks, 1 month, and 3 months. Additionally, Patient Global Impression of Change was assessed. RESULTS: Forty-five patients completed all assessments (group GPN, n=21; group BTX, n=24). Compared with group GPN, leg pain intensity, cramp frequency, and cramp severity were significantly decreased in group BTX at all follow-up visits (all, P<.01). Also, insomnia significantly improved in group BTX at the 2-week (P=.018) and 1-month follow-up (P=.037). Functional disability significantly improved in group BTX at 2 weeks' follow-up (P=.041). At the 3-month follow-up, patients in group BTX reported a higher impression of improvement for NCC symptoms than did those in group GPN (P<.001). A mean dose of 642.8mg of gabapentin was given daily in group GPN, but 7 patients (33.3%) reported systemic side effects. There were no serious complications related to BTX use. CONCLUSIONS: BTX treatment appears to be effective and safe for NCCs in symptomatic LSS patients receiving conservative care.
Full Text
http://www.sciencedirect.com/science/article/pii/S0003999317300825
DOI
10.1016/j.apmr.2017.01.017
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Park, Sang Jun(박상준) ORCID logo https://orcid.org/0000-0002-2496-7764
Yoon, Kyoung Bong(윤경봉) ORCID logo https://orcid.org/0000-0002-4167-1375
Yoon, Duck Mi(윤덕미)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/154640
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