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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin

Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
Classification of Skeletal Muscle Relaxants01:28

Classification of Skeletal Muscle Relaxants

Skeletal muscle relaxants are a group of drugs that can reduce muscle stiffness and induce temporary paralysis to relieve pain. These agents can act centrally to reduce muscle tone or spasms in painful conditions such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or spinal injuries; they are called antispasmodics or spasmolytics.
Peripherally acting skeletal muscle relaxants interfere with the neurotransmission at the neuromuscular end plate to induce paralysis during...
Centrally Acting Muscle Relaxants: Therapeutic Uses01:24

Centrally Acting Muscle Relaxants: Therapeutic Uses

Centrally acting muscle relaxants reduce muscle tone and tension by interfering with the postsynaptic reflexes in the central nervous system.
Centrally acting drugs are classified into spasmolytic and antispasmodic drugs. Spasmolytic drugs such as baclofen, diazepam, and tizanidine inhibit spinal motor neurons and decrease muscle tone. Spasmolytic drugs are administered for severe and chronic spasms due to multiple sclerosis, cerebral palsy, stroke, and spinal cord and muscle injuries. However,...
Peripherally and Centrally Acting Muscle Relaxants: A Comparison01:09

Peripherally and Centrally Acting Muscle Relaxants: A Comparison

Skeletal muscle relaxants can target the central nervous system [CNS] to reduce muscle tension or act directly at the neuromuscular junction to induce temporary paralysis. These two classes of muscle relaxants are called centrally acting muscle relaxants and peripherally acting muscle relaxants. They differ in their action, mechanism, administration route, and clinical uses.
Centrally acting muscle relaxants can be further divided into spasmolytic and antispasmodic drugs. Spasmolytic drugs,...

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Related Experiment Video

Updated: Jun 5, 2026

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation
04:42

Treating Low Back Pain in Failed Back Surgery Patients with Multicolumn-lead Spinal Cord Stimulation

Published on: June 26, 2018

Botulinum toxin injections for low-back pain and sciatica.

Zeeshan Waseem1, Chris Boulias, Allan Gordon

  • 1Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada.

The Cochrane Database of Systematic Reviews
|January 21, 2011
PubMed
Summary
This summary is machine-generated.

Botulinum neurotoxin (BoNT) injections show potential for low-back pain (LBP) relief. One low-bias trial found BoNT improved pain and function versus saline, but more research is needed.

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Area of Science:

  • Neurology
  • Pain Management
  • Musculoskeletal Disorders

Background:

  • Low-back pain (LBP) often lacks adequate relief.
  • Botulinum neurotoxin (BoNT) injections are emerging as a potential treatment for pain disorders.
  • BoNT may reduce pain by decreasing muscle spasms, ischemia, and inflammatory markers.

Purpose of the Study:

  • To evaluate the efficacy of botulinum toxin injections in adults suffering from low-back pain.

Main Methods:

  • Searched multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL) up to August 2009.
  • Included randomized controlled trials (RCTs) of BoNT for non-specific LBP, regardless of duration.
  • Conducted a qualitative analysis due to limited data; assessed risk of bias.

Main Results:

  • Included three RCTs (N=123); only one had a low risk of bias and focused on non-specific LBP.
  • The low-bias trial showed BoNT injections reduced pain and improved function compared to saline at 8 weeks.
  • Other trials, with high risk of bias, suggested BoNT efficacy for sciatica and lumbar transverse process syndrome, but evidence quality was low to very low.

Conclusions:

  • Limited high-quality evidence supports BoNT for LBP; only one study met low risk of bias criteria.
  • Further research is essential, requiring standardized protocols, larger sample sizes, and long-term outcome assessments.
  • Future trials should address cost-benefit and clinical relevance for LBP patients.