scholarly journals Intramuscular Botulinum Toxin in Complex Regional Pain Syndrome: Case Series and Literature Review

2011 ◽  
Vol 5;14 (5;9) ◽  
pp. 419-424
Author(s):  
Robert Schwartzman
Keyword(s):  
Botulinum Toxin ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Pain Syndrome ◽  
Control Group ◽  
Institutional Review

Background: Pain associated with Complex Regional Pain Syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. Objectives: To assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment. Study Design: Retrospective chart review. Setting: Outpatient clinic. Methods: Thirty-seven patients with spasm/dystonia in the neck and/or upper limb girdle muscles. Intervention: EMG-guided injection of Botulinum toxin - A (BtxA), 10-20 units per muscle. Total dose used was 100 units in each patient. Local pain score was measured on an 11-point Likert scale, 4 weeks after BtxA injections. Results: Mean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). 97% of patients had significant pain relief. One patient had transient neck drop after the injections. Limitations: This is a retrospective study. It lacks a control group and so the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks. Conclusions: Intramuscular injection of botulinum toxin in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS. The incidence of complications was low (2.7%) Institutional Review: This study was approved by the Institutional Review Board of the Drexel College of Medicine. Key words: Complex regional pain syndrome, botulinum toxin, spasm, dystonia

scholarly journals Intramuscular Botulinum Toxin A (BtxA) in Complex Regional Pain Syndrome

2011 ◽  
Vol 3;14 (3;5) ◽  
pp. 311-316
Author(s):  
Robert Schwartzman
Keyword(s):  
Botulinum Toxin ◽  
Pain Score ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Botulinum Toxin A ◽  
Case Series ◽  
Pain Syndrome ◽  
Control Group ◽  
Retrospective Case ◽  
Toxin A

Background: Pain associated with complex regional pain syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. Objectives: To assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment. Study Design: Retrospective chart review. Setting: Outpatient clinic. Methods: Patients: 37 patients with spasm/dystonia in the neck and/or upper limb girdle muscles. Intervention: Electromyography-guided injection of botulinum toxin A (BtxA), 10-20 U per muscle. Total dose used was 100 U in each patient. Measurement: Local pain score on an 11 point Likert scale, 4 weeks after BtxA injections. Results: Mean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). Ninetyseven percent of the patients had significant pain relief. One patient had transient neck drop after the injections. Limitations: This is a retrospective study; it lacks a control group and therefore the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks. Conclusion(s): Intramuscular injection of botulinum toxin A in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS in this retrospective case series. The incidence of complications was low (2.7%) Key words: Complex regional pain syndrome, botulinum toxin, spasm, dystonia

scholarly journals Effect of Additional Rehabilitation After Botulinum Toxin-A on Upper Limb Activity in Chronic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (2) ◽  
pp. 556-562
Author(s):  
Natasha A. Lannin ◽  
Louise Ada ◽  
Coralie English ◽  
Julie Ratcliffe ◽  
Steven G. Faux ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Upper Limb ◽  
Goal Attainment ◽  
Botulinum Toxin A ◽  
Chronic Stroke ◽  
Mean Difference ◽  
Control Group ◽  
Toxin A ◽  
Upper Limb Rehabilitation ◽  
Experimental Group

Background and Purpose— The aim of this trial was to determine the effect of additional upper limb rehabilitation following botulinum toxin-A for upper limb activity in chronic stroke. Methods— We conducted a multicenter phase III randomized trial with concealed allocation, blinded measurement, and intention-to-treat analysis. One hundred forty stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke >3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scaling) and upper limb activity (Box and Block Test) at 3 months (end of intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. Results— In terms of goal attainment, the experimental group scored the same (mean difference, 2 T-score [95% CI, −2 to 7]) as the control group on the Goal Attainment Scale. In terms of upper limb activity, by 3 months the experimental group moved blocks at the same speed (mean difference, 0.00 blocks/s [95% CI, −0.02 to 0.01]) as the control group on the Box and Block Test. There were no differences between groups on any secondary outcome except strength, in favor of the experimental group (mean difference, 1.4 kg [95% CI, 0.2–2.7]). Conclusions— Findings suggest that additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not effective. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: ACTRN12615000616572.

scholarly journals Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex Regional Pain Syndrome: A Randomized Trial

2021 ◽  
Author(s):  
Yongjae Yoo ◽  
Chang-Soon Lee ◽  
Jungsoo Kim ◽  
Dongwon Jo ◽  
Jee Youn Moon
Keyword(s):  
Botulinum Toxin ◽  
Complex Regional Pain Syndrome ◽  
Sympathetic Ganglion ◽  
Botulinum Toxin Type A ◽  
Pain Syndrome ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Control Group ◽  
Ganglion Block ◽  
Relative Temperature

Background The present study was designed to test the hypothesis that botulinum toxin would prolong the duration of a lumbar sympathetic block measured through a sustained increase in skin temperature. The authors performed a randomized, double-blind, controlled trial to investigate the clinical outcome of botulinum toxin type A for lumbar sympathetic ganglion block in patients with complex regional pain syndrome. Methods Lumbar sympathetic ganglion block was conducted in patients with lower-extremity complex regional pain syndrome using 75 IU of botulinum toxin type A (botulinum toxin group) and local anesthetic (control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as the pain intensity changes. Results A total of 48 participants (N = 24/group) were randomly assigned. The change in relative temperature increase was higher in the botulinum toxin group than in the control group (1.0°C ± 1.3 vs. 0.1°C ± 0.8, respectively; difference: 0.9°C [95% CI, 0.3 to 1.5]; P = 0.006), which was maintained at 3 months (1.1°C ± 0.8 vs. –0.2°C ± 1.2, respectively; P = 0.009). Moreover, pain intensity was greatly reduced in the botulinum toxin group compared with the control group at 1 month (–2.2 ± 1.0 vs. –1.0 ± 1.6, respectively; P = 0.003) and 3 months (–2.0 ± 1.0 vs. –0.6 ± 1.6, respectively; P = 0.003). There were no severe adverse events pertinent to botulinum toxin injection. Conclusions In patients with complex regional pain syndrome, lumbar sympathetic ganglion block using botulinum toxin type A increased the temperature of the affected foot for 3 months and also reduced the pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Efficacy of botulinum toxin for treating cramps in peripheral neuropathy

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Tejas Mehta ◽  
Richard Sommers ◽  
Raghav Govindarajan
Keyword(s):  
Botulinum Toxin ◽  
Peripheral Neuropathy ◽  
Pain Score ◽  
Chart Review ◽  
Botulinum Toxin A ◽  
Retrospective Chart Review ◽  
Wilcoxon Test ◽  
Safe Procedure

Abstract Introduction: Muscle cramps are a common occurrence in patients with peripheral neuropathy and are known to cause significant distress and decrease the quality of life. Although several drug formulations have been used in the management of cramps, there is significant variability in terms of efficacy and tolerability in patients with peripheral neuropathy. This study aims to assess the efficacy of botulinum toxin A in the management of lower limb cramps in patients with peripheral neuropathy.   Methods: This retrospective chart review included a total of ten patients with peripheral neuropathy with cramps. Relevant data such as age, gender, race, pain score and cause of peripheral neuropathy were documented. Statistical analyses to compare the variables was done using the Wilcoxon Test. The pain score before the administration, at 3-month, 6 month and 9 months follow up were compared.   Results All patients enrolled in the study showed improvement of pain assessed by visual pain analog scale. An improvement of 1.60 (95%CI, p<0.05), 2.70 (95%CI, p<0.05) and 3.50 (95%CI, p=0.05) was noted between test scores from before administration of botulinum toxin to 3-month, 6 months and 9 months follow up with a range of 6, 4 and 4 respectively.   Conclusion: Local BTX-A infiltration is a likely efficacious and safe procedure for improving pain associated with cramps in patients with peripheral neuropathy.

scholarly journals Peripheral Nerve Stimulation of the Brachial Plexus for Chronic Refractory CRPS Pain of the Upper Limb: Description of a New Technique and Case Series

Pain Medicine ◽  
2020 ◽  
Vol 21 (Supplement_1) ◽  
pp. S18-S26
Author(s):  
Thiago Nouer Frederico ◽  
Tiago da Silva Freitas
Keyword(s):  
Neuropathic Pain ◽  
Conservative Treatment ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Upper Limb ◽  
Case Series ◽  
Pain Syndrome ◽  
Pain Scale ◽  
New Technique ◽  
A New Technique

Abstract Objective Upper limb complex regional pain syndrome is an important cause of chronic pain, and its treatment is challenging. In this pilot case series, we preliminarily evaluated the feasibility, effectiveness, and safety of a new technique for brachial plexus neuromodulation in the treatment of this disease in patients refractory to conservative treatment. Methods Between 2017 and 2018, 14 patients considered to be refractory to optimized conservative treatment were recruited to this study. In the first stage, patients were trialed for seven days with a new technique of implant of the brachial plexus. Patients with ≥50% pain relief in visual analog scale (VAS) score received a definitive implantation in the second stage. Follow-ups were conducted at pre-implant and 12 months using the Neuropathic Pain Scale, SF-32, and the visual analogic scale for pain. Results After the initial trial, 10 patients had a pain reduction of ≥50% and received a permanent implant. At 12-month follow-up, VAS, Neuropathic Pain Scale, SF-12 physical and mental scores improved by 57.4% +/- 10% (P = 0.005), 60.2% +/- 12.9% (P = 0.006), and 21.9% +/- 5.9% (P = 0.015), respectively. Conclusions Our data suggest that this new technique of brachial plexus stimulation may have long-term utility in the treatment of painful upper limb complex regional pain syndrome. New more detailed comprehensive studies should be carried out to confirm our findings in a larger population and to further refine the clinical implementation of this technique.

scholarly journals Botulinum Toxin A for Treatment of Allodynia of Complex Regional Pain Syndrome: A Pilot Study

Pain Medicine ◽  
2010 ◽  
Vol 11 (9) ◽  
pp. 1411-1414 ◽  
Author(s):  
Delaram Safarpour ◽  
Arash Salardini ◽  
Diana Richardson ◽  
Bahman Jabbari
Keyword(s):  
Botulinum Toxin ◽  
Pilot Study ◽  
Complex Regional Pain Syndrome ◽  
Botulinum Toxin A ◽  
Pain Syndrome ◽  
Toxin A

scholarly journals Botulinum Toxin for the Treatment of Myofascial Pain Syndromes Involving the Neck and Back: A Review from a Clinical Perspective

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
José M. Climent ◽  
Ta-Shen Kuan ◽  
Pedro Fenollosa ◽  
Francisco Martin-del-Rosario
Keyword(s):  
Clinical Trials ◽  
Botulinum Toxin ◽  
Myofascial Pain ◽  
Botulinum Toxin A ◽  
Pain Syndrome ◽  
Trigger Points ◽  
Control Group ◽  
Injection Technique ◽  
Myofascial Pain Syndromes ◽  
Myofascial Trigger Points

Introduction. Botulinum toxin inhibits acetylcholine (ACh) release and probably blocks some nociceptive neurotransmitters. It has been suggested that the development of myofascial trigger points (MTrP) is related to an excess release of ACh to increase the number of sensitized nociceptors. Although the use of botulinum toxin to treat myofascial pain syndrome (MPS) has been investigated in many clinical trials, the results are contradictory. The objective of this paper is to identify sources of variability that could explain these differences in the results.Material and Methods. We performed a content analysis of the clinical trials and systematic reviews of MPS.Results and Discussion. Sources of differences in studies were found in the diagnostic and selection criteria, the muscles injected, the injection technique, the number of trigger points injected, the dosage of botulinum toxin used, treatments for control group, outcome measures, and duration of followup. The contradictory results regarding the efficacy of botulinum toxin A in MPS associated with neck and back pain do not allow this treatment to be recommended or rejected. There is evidence that botulinum toxin could be useful in specific myofascial regions such as piriformis syndrome. It could also be useful in patients with refractory MPS that has not responded to other myofascial injection therapies.

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