Botulinum toxin for shoulder pain

Singh, Jasvinder A; Fitzgerald, Patrick M

doi:10.1002/14651858.cd008271.pub2

Cited by 24 publications

(17 citation statements)

References 63 publications

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“…Likewise, our data in patients with spasticity concurs with previous studies that reported prevalence of pain in stroke to be 19-75%, 26 – 28 53% in MS, 29 64.9% in SCI 30 and 70% in brain injured patients 31 . The Cochrane Collaboration Systematic Review 32 reported a decrease in shoulder pain after injection of BoNTA; but in contrast, our study provides data on the prevalence of pain at any site in the body (not limited to shoulder pain) in patients experiencing spasticity due to various etiologies. Thus, our study results provide unique data to help understand patient perception of pain within the context of the experience of spasticity.…”

Section: Discussionsupporting

confidence: 91%

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

Shaikh

Phadke

Ismail

et al. 2015

Can. J. Neurol. Sci.

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Objective: To assess the prevalence of pain in adults with spasticity and to assess the association between the subjective experience of pain and spasticity. Design: Cross-sectional study. Setting: outpatient spasticity management clinic of a rehabilitation centre. Patients: Patients with upper motor neuron lesions and spasticity (n = 131) were recruited. Methods: We assessed pain intensity and location, relationship between spasticity and pain perception, and perception of pain relief from botulinum toxin type-A (BoNTA) injections. Main outcome measures: Pain perception rated on a 10-point numerical rating scale and pain quality. Results: 65% of the patients with spasticity reported presence of pain and 60% described it as an aching pain. More patients reported pain with movement (34%) compared to rest (21%). There was a statistically poor correlation between the severity of pain and spasticity (r = 0.16; p > 0.05). Most patients (80%) believed that their pain was related to spasticity and 62% reported that BoNTA injections decreased their pain. Conclusions: The high incidence of pain noted within our sample suggests that physicians may have to consider pain management as part of spasticity treatment. Participants reported that their pain was related to their spasticity, and that it decreased after BoNTA treatment. Further study is needed to explore the relationships between objective measures of spasticity and pain.RÉSUMÉ: Relation entre la toxine botulique, la spasticité et la douleur : une enquête sur la perception des patients. Objectif: Le but de l'étude était de déterminer la prévalence de la douleur chez des adultes souffrant de spasticité et d'étudier l'association entre l'expérience subjective de la douleur et la spasticité. Devis de l'étude: Il s'agit d'une étude transversale. Contexte: Cette étude a été réalisée auprès de patients fréquentant une clinique dédiée au traitement de la spasticité dans un centre de réadaptation. Patients: Des patients atteints de lésions du neurone moteur supérieur et de spasticité ont été recrutés (n = 131). Méthode: Nous avons évalué l'intensité et la localisation de la douleur, la relation entre la spasticité et la perception de la douleur ainsi que la perception du soulagement de la douleur suite à des injections de toxine botulique de type A (BoNTA). Principaux critères d'évaluation: Les critères utilisés étaient la perception de la douleur évaluée sur une échelle numérique de 10 points et la qualité de la douleur. Résultats: Soixante-cinq pour cent des patients présentant de la spasticité ont rapporté la présence de douleur et 60% l'ont décrite comme une douleur sourde. Plus de patients ont rapporté de la douleur au mouvement (34%) qu'au repos (21%). La corrélation entre la sévérité de la douleur et la spasticité était faible au point de vue statistique (r = 0,16 ; p > 0,05). La plupart des patients (80%) croyaient que leur douleur était reliée à la spasticité et 62% rapportaient que les injections de BoNTA diminuaient la douleur. Conclusions: L'incidence ...

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Section: Discussionsupporting

confidence: 91%

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

Shaikh

Phadke

Ismail

et al. 2015

Can. J. Neurol. Sci.

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“…An understanding of the early clinical signs of patients at risk of developing HSP associated with spasticity warrants further exploration as early intervention may reduce or prevent the complications associated with HSP. (20) Difficult to isolate muscles for injection 27.9 (19) Lack of evidence 25.0 (17) Other treatment options are more effective 16.2 (11) Uncertain of muscle anatomy 10.3 (7) Unable to access required equipment 5.9 (4) Difficulty in obtaining funding for toxin or service 5.9 (4) Need for imaging when injecting subscapularis 4.4 (3) Delays with referrals 2.9 (2) Concerns regarding safety 1.5 (1)…”

Section: Resultsmentioning

confidence: 99%

“…A Cochrane review [20] and a meta-analysis [21] reviewed BoNT-A injections for HSP and both found the evidence favoured the intervention. However, the few studies they reviewed were limited by low powered randomised controlled trials and a high potential for bias.…”

Section: Introductionmentioning

confidence: 99%

A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK

Holmes

Connell

2017

Disability and Rehabilitation

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Current UK practice of Botulinum Toxin type A injections for hemiplegic shoulder pain associated with spasticity is highly variable. There are large gaps between current practice and available evidence with regards to muscle selection and doses used. A number of areas for further investigation have been identified to progress current understanding of this intervention. Implications for rehabilitation There are wide variations in practice for this complex intervention and clinicians should consider that their individual decision-making could be based on their own beliefs rather than available evidence. Pectoralis major is most commonly injected to treat hemiplegic shoulder pain, but further evaluation is required to address whether it is the most effective. Clinicians most often use a limitation of shoulder abduction and external rotation, flexor patterning of the upper limb, and pain on passive movement to identify when hemiplegic shoulder pain is due to spasticity over other causes. Further research is needed to identify which patients are most likely to benefit from this intervention and at what stage post-stroke its use is most optimal.

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“…In a Cochrane report that focused on BTX-A for shoulder pain, the authors included six RCTs comparing BTX with a placebo or active treatment. Five RCTs in participants with post-stroke shoulder pain indicated that, compared with placebo, a single intramuscular injection of BTX-A significantly reduced pain at three to six months postinjection, but not at one month [ 80 ]. Another systematic review included nine RCTs of BTX injections in patients with shoulder pain.…”

Section: Clinical Studies Of Btx For Central Neuropathic Painmentioning

confidence: 99%

Botulinum Toxin for Central Neuropathic Pain

Park

Chung

2018

Toxins

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Botulinum toxin (BTX) is widely used to treat muscle spasticity by acting on motor neurons. Recently, studies of the effects of BTX on sensory nerves have been reported and several studies have been conducted to evaluate its effects on peripheral and central neuropathic pain. Central neuropathic pain includes spinal cord injury-related neuropathic pain, post-stroke shoulder pain, multiple sclerosis-related pain, and complex regional pain syndrome. This article reviews the mechanism of central neuropathic pain and assesses the effect of BTX on central neuropathic pain.

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Botulinum toxin for shoulder pain

Cited by 24 publications

References 63 publications

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception

A survey of the current practice of intramuscular Botulinum toxin injections for hemiplegic shoulder pain in the UK

Botulinum Toxin for Central Neuropathic Pain

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