Botulinum Toxin Injection for Pain in Muscle Spasm and Visceromotor Disorders: A Meta-Analytic Study
Paula Ruth L. Siongco, Mary Camille E. Rosales, Raymond L. Rosales
Sep 2017 DOI 10.35460/2546-1621.2017-0054 Access
Background Apart from the popular use of botulinum neurotoxin type A (BoNT/A) for neuro-rehabilitation and cosmetic purposes, its analgesic potential has been highlighted in various studies. Although BoNT/A is effective, there is a paucity of literature explicating its effectiveness on muscle-based and visceromotor pain.
Objective This meta-analysis determined the effectiveness of botulinum type A (BoNT-A) in treating muscle-based (nociceptive) and visceromotor pain.
Data Sources Studies were searched at PubMed, ScienceDirect, EBSCO Host, and Google Scholar. Unpublished literature was also searched through ProQuest Dissertations & Theses Database and ClinicalTrials.gov.
Review Methods Randomized controlled trials (RCTs) and experimental studies on the effect of botulinum toxin on muscle-based pain were included. An abstraction form was independently accomplished by two reviewers. The standardized mean difference was used as the effect measure using the random-effects model and computed with RevMan 5.3.
Results A total of 17 RCTs were included and analyzed. The standardized mean difference was –0.40 (95%CI: –0.67, –0.13), statistically favoring the BoNT-A group (z=2.94, p = 0.003). Findings also showed a signifi cantly (X2=66.56, p<0.00001) large heterogeneity I2=74%; T2=0.21). Subgroup analyses according to dose concentration and length of follow-up visits showed lower pain scores in the BoNT-A group with a dose less than 300 units (z=2.49, p = 0.01) and a follow-up period greater than 12 weeks (z=2.31, p = 0.02).
Conclusion BoNT-A injections are effective in treating muscle-based (nociceptive) and visceromotor pain disorders.
Keywords: Botulinum neurotoxin, BoNT-A, pain, muscle-based pain, visceromotor pain.
- Münchau, A., Bhatia, K.P. (2000). Uses of botulinum toxin injection in medicine today. British Medical Journal, 321: 161 – 5.
- Jankovic, J. (2004). Botulinum toxin in clinical practice. J NeurolNeurosurg Psychiatry, 75: 951 – 957. doi: 10.1136/jnnp.2003.034702
- Matak, I., Lacković, Z. (2014). Botulinum toxin A, brain and pain. Progress in Neurobiology. 39 – 59. doi: 10.1016/j.pneurobio.2014.06.001
- Winner, P. Botulinum toxins in the treatment of migraine and tension-type headaches. Phys. Med. Rehabil. Clin. N. Am. 14, 885–899 (2003).
- Deepai, S., Thomson, A., (2008). Women’s Health 4 (2), 173 -181. Botulinum toxin for pelvic pain in women. doi: 10.2217/17455057.4.2.173
- Akiyama, Y., Nomiya, A, Niimi, A., Yamada, Y., Fujimura, T., Nakagawa, T., Fukuhara, H., Kume, H., Igawa, Y., and Homma, Y. (2015). Botulinum toxin type A injection for refractory interstitial cystitis: A randomized comparative study and predictors of treatment response. International Journal of Urology, 22 (9), 835 – 841. doi: 10.1111/iju.12833.
- Guarda-Nardini, L., Stecco, A., Stecco, C., Masiero, S., and Manfredini, D. (2012). Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio, 30 (2), 95–102.
- Kasyan, G. and Pushkar D. (2012). Randomized controlled trial for efficacy of botulinum toxin type a in treatment of patients suffering bladder pain syndrome/interstitial cystitis with Hunners’ lesions: Preliminary results. Journal of Urology, 187 (4): E335–E336
- Kuo, H.C. and Chancellor, M.B. (2009). Comparison of intravesicalbotulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome. BJU International, 104 (5), 657 – 661. doi: 10.1111/j.1464-410X.2009.08495.x
- Kuo, H.C., Jiang, Y.H., Tsai, Y.C., and Kuo, Y.C. (2015). Intravesicalbotulinum toxin-A injections reduce bladder pain of interstitial cystitis/bladder pain syndrome refractory to conventional treatment – A prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial. Neurourology and Urodynamics, 35 (5), 609 – 614. doi: 10.1002/nau.22760
- Kwanchuay, P., Petchnumsin, T., Yiemsiri, P., Pasuk, N., Srikanok, W., and Hathaiareerug, C. (2015). Efficacy and safety of single botulinum toxin type a (Botox®) injection for relief of upper trapezius myofascial trigger point: a randomized, double-blind, placebo-controlled study. Journal of the Medical Association of Thailand, 98 (12), 1231 – 1236.
- Lim, J.Y., Koh, J.H., and Paik, N.J. (2008). Intramuscular botulinum toxin-A reduces hemiplegic shoulder pain: a randomized, double-blind, comparative study versus intraarticular triamcinolone acetonide. Stroke, 39 (1), 126 – 131.
- Marco, E., Duarte, E., Vila, J., Tejero, M., Guillen, A., Boza, R., Escalada, F., and Espadaler, J.M. (2007). Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial. Journal of Rehabilitation Medicine, 39 (6), 440 – 447.
- Nixdorf, D.R., Heo, G., and Major, P.W. (2002). Randomized controlled trial of botulinum toxin A for chronic myogenousorofacial pain. Pain, 99 (3), 465–73.
- Rosales, R.L. et al. Botulinum toxin injection for hypertonicity of the upper extremity within 12 weeks after a stroke: a randomized controlled trial. Neural Rehabilitation and Neural Repair 26 (7), 812 – 821 (2012).doi:10.1177/1545968311430824.
- Shaw, L., Rodgers, H., Price, C., van Wijck, F., Shackley, P., Steen, N., Barnes, M., Ford, G., and Graham, L. (2010). BoTULS: a multicentre randomized controlled trial to evaluate the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A. Health Technology Assessment, 14 (26), 1 – 158. DOI: 10.3310/hta14260.
- Singh, J.A. and Fitzgeral, P.M. Botulinum toxin for shoulder pain. Cochrane Database of Systematic Reviews (2010).doi: 10.1002/14651858.CD008271.pub2
- Yelnik, A.P., Colle, F.M., Bonan, I.V., and Vicaut, E. (2007). Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A. Journal of Neurology, Neurosurgery, and Psychiatry, 78 (8), 845 – 848.
- Wheeler, A. and Smith, H.S. (2013). Botulinum toxins: Mechanisms of action, antinociception and clinical applications. Toxicology, 306, 124 – 146. http://dx.doi.org/10.1016/j.tox.2013.02.006.
- Brin, M. F. et al. Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Mov. Disord. 2, 237–254 (1987).
- Binder, W. J. et al. Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study. Otolaryngol. Head Neck Surg. 123, 669–676 (2000).
- Dressler, D. (2013). Botulinum toxin therapy: its use for neurological disorders of the autonomic nervous system. Journal of Neurology, 701-713. doi: 10.1007/s00415-012-6615-2
- El-enen, M.A., Abou-Farha, M., El-Abd, A., El-Tatawy, H., Tawfik, A., El-Abd, S., Rashed, M., and El-sharaby, M. (2015). Intraprostatic injection of botulinum toxin-A in patients with refractory chronic pelvic pain syndrome: the transurethral vs. transrectal approach. Arab Journal of Urology, 13, 94 – 99.
- El-Khawand, D., Wehbe, S., Whitmore, S. (2013). Botulinum toxin for conditions of the female pelvis. IntUrogynecol J, (24), 1073 – 1081. doi: 10.1007/s00192-012-2035-1
- Lim, E.C.H., Seet, R. C. (2010). Use of botulinum toxin in the neurology clinic. Nature Reviews. Neurology.doi: 10.1038/nrneurol.2010.149
- Mahowald, M. L., Singh, J. A. & Dykstra, D. Long term effects of intra-articular botulinum toxin A for refractory joint pain. Neurotox. Res. 9, 179–188 (2006).
- Piovesan, E. J. et al. An open study of botulinum-A toxin treatment of trigeminal neuralgia. Neurology 65, 1306–1308 (2005).
- Popoff, M.R. and Bouvet, P. (2013). Genetic characteristics of toxigenic Clostridia and toxin gene evolution. Toxicon, 75, 63 – 89.
- Qerama, E. et al. A double-blind, controlled study of botulinum toxin A in chronic myofascial pain. Neurology 67, 241–245 (2006).
- Shackleton, T., Ram, S., Black, M., Ryder, J., Clark, G.T., and Enciso, R. (2016). The efficacy of botulinum toxin for the treatment of trigeminal and postherpetic neuralgia: a systematic review with meta-analyses. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 122 (1), 61 – 71. http://dx.doi.org/10.1016/j.oooo.2016.03.003.
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