Análisis de la efectividad de la toxina botulínica en pacientes con dolor miofascial atendidos en el servicio de consulta externa de Cuidados Paliativos del Hospital SOLCA – Guayaquil año 2024 - 2025.

Abstract

INTRODUCTION: Myofascial pain is highly prevalent in the care of cancer patients, where muscle tension and trigger points predominate. Trigger points appear when a muscle remains in a state of irritability due to pressure, stretching, or contracture, causing significant suffering and increasing opioid consumption. OBJECTIVE: To evaluate the effectiveness of botulinum toxin in the treatment of myofascial pain in patients treated in the outpatient palliative care service. METHODOLOGY: An observational, descriptive, retrospective, and cross-sectional study was conducted in the outpatient palliative care service between January 2024 and December 2025. Cancer patients who received botulinum toxin infiltration for refractory myofascial pain were included. Sociodemographic, clinical, and pharmacological data were collected through a review of medical records. RESULTS: Seventy patients with myofascial pain who received botulinum toxin injections were analyzed. The gender distribution was 61% female and 39% male; the mean age was 61 years. Approximately 49% of this group presented with disease progression, while 23% had stable disease. The most frequent location of myofascial pain was the lumbar region (43%) and trapezius muscle (23%), with less frequent locations being the intercostal and cervical regions. The Shapiro-Wilk test for normality (p < 0.001) indicated that the data did not follow a normal distribution; therefore, the Wilcoxon signed-rank test was used, showing a reduction in pain as measured by the VAS before and after treatment (Z = -6.893; p < 0.001). The most frequently used medication was tapentadol (27%), followed by buprenorphine (20%). Spearman's rank correlation showed a positive correlation between the reduction in medication use after botulinum toxin injection and the duration of the toxin's effect (r = 0.297, p = 0.012). During the follow-up period, 96% of patients did not require re-injection. CONCLUSIONS: This study determined that botulinum toxin produces a significant reduction in pain intensity, decreases opioid consumption, and facilitates a favorable duration of analgesic effect, with a low incidence of adverse effects. It is concluded that botulinum toxin can be a safe and effective alternative in the management of myofascial pain in patients receiving care in oncology palliative care units.