Treatment of refractory pain with botulinum toxins--an evidence-based review.

Abstract

OBJECTIVES:

To provide updated information on the role of botulinum toxins in the treatment of refractory pain based on prospective, randomized, double-blind, placebo-controlled studies. DESIGN OF THE REVIEW: Class I and class II articles were searched online through PubMed (1966 to the end of January 2011) and OvidSP including ahead-of-print manuscripts.

RESULTS:

Level A evidence (two or more class I studies-established efficacy): pain of cervical dystonia, chronic migraine, and chronic lateral epicondylitis. Level B evidence (one class I or two class II studies-probably effective and recommended): post-herpetic neuralgia, post-traumatic neuralgia, pain of plantar fasciitis, piriformis syndrome, and pain in total knee arthroplasty. Level C evidence (one class II study-possibly effective, may be used at discretion of clinician): allodynia of diabetic neuropathy, chronic low back pain, painful knee osteoarthritis, anterior knee pain with vastus lateralis imbalance, pelvic pain, post-operative pain in children with cerebral palsy after adductor hip release surgery, post-operative pain after mastectomy, and sphincter spasms and pain after hemorrhoidectomy. Level U evidence (efficacy not proven due to diverse class I and II results): myofascial pain syndrome and chronic daily headaches. Studies in episodic migraine and tension headaches have shown treatment failure (level A-negative).

CONCLUSION:

Evidence-based data indicate that administration of botulinum toxin in several human conditions can alleviate refractory pain. The problems with some study designs and toxin dosage are critically reviewed.

• Authors: Bahman Jabbari, Duarte Machado
• Journal: Pain medicine (Malden, Mass.) (Pain Med) Vol. 12 Issue 11 Pg. 1594-606 (Nov 2011) ISSN: 1526-4637 [Electronic] England
• PMID: 21958302 (Publication Type: Journal Article, Review)
• Copyright: Wiley Periodicals, Inc.

Chemical References

• Neuromuscular Agents
• Placebos
• Botulinum Toxins, Type A

Topics

• Animals
• Botulinum Toxins, Type A (therapeutic use)
• Double-Blind Method
• Evidence-Based Medicine
• Humans
• Neuromuscular Agents (therapeutic use)
• Pain, Intractable (drug therapy)
• Pain, Postoperative (drug therapy)
• Placebos
• Prospective Studies
• Randomized Controlled Trials as Topic (classification)