Evidence based medicine in the use of botulinum toxin for back pain

Summary Two randomized, prospective studies, one double blind and one open label, longterm evaluated efficacy and safety of Botulinum toxin A (Allergan-Inc) in 31 and 75 patients with chronic low back pain. Both studies used a novel technique imploying 5 level (L1 to L5) injections (40–50 units/level) of BoNT-A into erector spinae muscles. Significant ( p < 0.05) improvement of pain intensity, frequency and activities of daily living was noted in 60% and 53% of the patients, respectively. The second study also depicted safety with repeated injections over 14 months of follow up. Botulinum toxin-A should be considered for treatment of low back pain when other modes of treatment fail to improve pain.