Botulinum Toxin Injection for Pain in Muscle Spasm and Visceromotor Disorders: A Meta-Analytic Study


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 Unpublished literature was also searched through ProQuest Dissertations & Theses Database and

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.

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