Musculoskeletal & Myofascial Pain


No national or international guidelines available.

Botulinum toxin for myofascial pain syndromes in adults.

Soares A, Andriolo RB, Atallah ÁN, da Silva EMK, da Silva EMK. Cochrane Database of Systematic Reviews 2012, Issue 4.


Myofascial pain syndrome (MPS) is a regional muscular pain syndrome characterised by the presence of trigger points (painful points) in one or more muscles. The pain can be at the trigger point site or it can be felt away from it when the muscle is pressed, which is called referred pain. Botulinum toxin is a potent chemical that blocks the communication between nerves and muscles and inhibits muscle contractions where the trigger points are located, which may result in pain relief in the area it is injected. The purpose of this review is to assess how effective botulinum toxin is at reducing pain in patients with MPS. We identified four studies with 233 participants, comparing botulinum toxin A with placebo (control group). There is inconclusive evidence to support the use of botulinum toxin in the treatment of MPS. More high-quality randomised controlled trials of botulinum toxin for treating MPS need to be conducted before firm conclusions on its effectiveness and safety can be drawn.


No national or international guidelines available. 

Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults.

Karjalainen KA,Malmivaara A, van TulderMW, Roine R, JauhiainenM,HurriH, Koes BW. Cochrane Database of Systematic Reviews 1999, Issue 3.


Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasingly recognised chronic musculoskeletal disorder. The main purpose of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and wide spread musculoskeletal pain among working age adults. Patients included in the controlled trials in this review ranged in age from 18-65 years. Seven studies, with 1050 patients were included. The effectiveness of multidisciplinary rehabilitation was graded limited, showing no quantifiable benefit for both fibromyalgia and widespread musculoskeletal pain.

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