Effects of Botulinum Toxin Type B on Stump Pain and Involuntary Movements of the Stump

Abstract

Patients who had previously undergone amputation of the arm (n = 2) or leg (n = 2) were treated with botulinum toxin type B injections at several trigger points of their stump musculature. We administered a total dose of 2500 IU of botulinum toxin type B (Neurobloc, Elan Pharma, Munich, Germany) to the arm amputation stumps, 5000 IU for one amputation of the lower leg, and 2500 IU to the other lower leg amputation of a patient with a very low baseline body weight. Two patients reported that the injection was very painful. All patients experienced a reduction in stump pain, which lasted for many weeks. Other reports included a reduction in the frequency of pain attacks, cessation of "balloon feelings," improvement in stump allodynia, and decreased occurrence of involuntary stump movements. In addition, quality of sleep at night significantly improved in one patient. Botulinum toxin type B can therefore be regarded as a new treatment option for possible improvements in the rehabilitation of amputees.

Clinical Effectiveness of Botulinum Toxin Type B in the Treatment of Subacromial Bursitis or Shoulder Impingement Syndrome

“…12,13,45 BT type B is thought to have good affinity for the autonomic nervous system, which might be probable contributors to pain relief. 17 BT type B injection to the back muscles lead to a reduction of pain and muscle spasms in patients with back pain, 13 and BT type B injected into amputation stumps showed that pain relief of the patient's symptoms lasted for approximately 3 months.…”

“…17 BT type B injection to the back muscles lead to a reduction of pain and muscle spasms in patients with back pain, 13 and BT type B injected into amputation stumps showed that pain relief of the patient's symptoms lasted for approximately 3 months. 45 Notably, due to the higher affinity for autonomic fibers, BT type B may give rise to anticholinergic side effects such as dryness of mouth, conjunctival irritation, and voiding difficulties. 17 However, in our study no patients in the BT group reported any anticholinergic side effects related to BT-B characteristics such as high affinity for the autonomic system and only transient local discomfort around injection area was reported.…”

Surgical and Morphological Factors that Affect Internal Mechanical Loads in Soft Tissues of the Transtibial Residuum

“…The clinical relevance of this finding is administration of botulinum toxin type B (Botox) injections directly to spastic muscles in the residuum to prevent involuntary muscle flap contractions and related pain. 16 Based on our present findings that stiffer muscle tissue is more susceptible to DTI and PU, Botox injections might theoretically also protect from DTI and PU.…”

Botulinum Toxin Type B in the Treatment of Residual Limb Hyperhidrosis for Lower Limb Amputees

“…43 Although, so far, mainly BTX-A was used for phantom pain therapy (intramuscular injections into the amputation stump 44Y46 ), we were also able to induce a positive effect on stump pain, the frequency of pain attacks, and stump allodynia by applying intramuscular BTX-B. 26 Therefore, it did not come entirely as a surprise that eight of the nine patients in our present study described an alleviation of stump pain after 3 mos (on average, statistically significant for the entire group) despite having received intracutaneous treatment. Some patients, on the other hand, reported a possible relationship between a transient increase in stump pain (even 30 days later) and the injection.…”