Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis.
| Title: | Efficacy of Botulinum Toxin, Local Anesthetics, and Corticosteroids in Patients With Piriformis Syndrome: A Systematic Review and Meta-analysis. |
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| Authors: | Hilal FM; Saudi Board of Anesthesia SPA, Ministry of Health King Fahad General Hospital, Jeddah, Kingdome of Saudi Arabia.; Bashawyah A; Anesthesiology Department, College of Medicine and King Abdulaziz University Hospital, Jeddah, Kingdome of Saudi Arabia.; Allam AE; Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University, Egypt; Morphological Madrid Research Center (MoMaRC), Madrid, Spain.; Lam KHS; The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong; Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong.; El Oumri AA; Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda , Immuno-Hematology and Cellular Therapy Laboratory, Mohammed First University of Oujda, Morocco.; Galluccio F; Morphological Madrid Research Center (MoMaRC), Madrid, Spain; Rheumatology, Medical-Geriatric Department, University Hospital AOU Careggi, Florence, Italy.; AlKharabsheh A; King Abdullah University Hospital, Jordan University of Science and Technology, Jordan.; Kaye AD; LSU Health Science Center, New Orleans.; Salti A; Consultant Anesthesia and Interventional Pain Medicine, Cleveland Clinic, Abu Dhabi, United Arab Emirates; Clinical Associate Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States.; Varrassi G; Paolo Procacci Fdn, Roma, Italy. |
| Source: | Pain physician [Pain Physician] 2022 Aug; Vol. 25 (5), pp. 325-337. |
| Publication Type: | Journal Article; Meta-Analysis; Systematic Review; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: American Society of Interventional Pain Physicians Country of Publication: United States NLM ID: 100954394 Publication Model: Print Cited Medium: Internet ISSN: 2150-1149 (Electronic) Linking ISSN: 15333159 NLM ISO Abbreviation: Pain Physician Subsets: MEDLINE |
| Imprint Name(s): | Publication: Paducah, Ky. : American Society of Interventional Pain Physicians; Original Publication: Paducah, Ky. : Association of Pain Management Anesthesiologists |
| MeSH Terms: | Botulinum Toxins*/therapeutic use ; Piriformis Muscle Syndrome*/drug therapy; Adrenal Cortex Hormones/therapeutic use ; Anesthetics, Local/therapeutic use ; Humans ; Retrospective Studies |
| Abstract: | Background: Piriformis syndrome (PS) is a painful condition caused by entrapment of the sciatic nerve within the piriformis muscle. PS is typically unilateral and mainly occurs related to entrapment of the sciatic nerve. Treatments include physiotherapy, analgesics, anti-inflammatory drugs, behavioral modifications, injection therapy with local anesthetics (LAs) and steroids, epidural injection, botulinum toxin (BT) injection, and surgery.; Objectives: To investigate the efficacy of BT, LA, and corticosteroid (CS) injections in relieving pain in patients affected by PS.; Study Design: This systematic review and meta-analysis was conducted according to the "Cochrane Handbook for Systematic Reviews of Interventions" and the "Preferred Reporting Items for Systematic Reviews and Metaanalyses (PRISMA)" guidelines.; Methods: A systematic search was conducted through PubMed, Cochrane, Web of Science, and Scopus through April 2021 for studies investigating the efficacy of BT, LA, or CS injection in improving pain in patients with PS. After screening retrieved studies, data were extracted from included studies and pooled. Overall results were reported as standardized mean difference (SMD) and 95% confidence interval (CI). Analysis was performed using RevMan software version 5.4.; Results: Sixteen studies were included in this systematic review, and 12 of them were included in the quantitative synthesis. The pain scores decreased significantly after treatment with BT (SMD = -2.00; 95% CI [-2.84, -1.16], P < 0.001), LA and CS (SMD = -4.34; 95% CI [-5.77, 2.90], P < 0.001), LA (SMD = -3.73; 95% CI [-6.47, -0.99], P = 0.008), CS (SMD = -2.78; 95% CI [-3.56, -2.00], P < 0.001), and placebo injection (SMD = -0.04; 95% CI [-0.07, -0.01], P = 0.002). BT injection was less effective than LA and CS together (P = 0.006), more effective than placebo (P = 0.001), and similar to LA (P = 0.24) and CS (P = 0.18), when injected alone.; Limitations: A wide variety of study designs were utilized to obtain the largest sample size available. Many of the included studies lack randomization, and some are retrospective in nature. These limitations may introduce bias into the analyzed data and affect the results. Many studies had a low sample size and are of moderate quality, limiting the generalizability of the results. Also, we could not conduct a direct meta-analysis due to the lack of sufficient double-arm studies comparing different types of injection therapies.; Conclusions: In patients with PS, satisfactory pain improvement can be obtained by BT, LA plus CS, LA, or CS injection therapy. Injection of LA plus CS showed the best efficacy. |
| Contributed Indexing: | Keywords: corticosteroids; local anesthetics; meta-analysis; piriformis syndrome; systematic review; Botulinum toxin |
| Substance Nomenclature: | 0 (Adrenal Cortex Hormones); 0 (Anesthetics, Local); EC 3.4.24.69 (Botulinum Toxins) |
| Entry Date(s): | Date Created: 20220728 Date Completed: 20220801 Latest Revision: 20250728 |
| Update Code: | 20260130 |
| PMID: | 35901473 |
| Database: | MEDLINE |
Journal Article; Meta-Analysis; Systematic Review; Research Support, Non-U.S. Gov't