Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials.

Abstract

Botulinum toxin (BoNT) injection is regarded as a promising treatment for musculoskeletal pain. However, its efficacy for treating chronic shoulder pain remains unclear. We investigated the effectiveness of BoNT injections for chronic shoulder pain by conducting a systematic search of electronic databases up to March 2020 for randomized control trials (RCTs) that used BoNT injections for chronic shoulder pain treatment. The primary outcome was the between-group comparison of pain reduction, quantified by the standardized mean difference (SMD). Nine RCTs comprising 666 patients were included and divided into two groups: one group with shoulder joint pain (n = 182) and the other group with shoulder myofascial pain (n = 484). Regarding shoulder joint pain, the efficacy of BoNT injections was similar to that of the reference treatment (SMD: -0.605, 95% confidence level [CI]: -1.242 to 0.032 versus saline; SMD: -0.180, 95% CI: -0.514 to 0.153 versus corticosteroids) at one month post-intervention, and was superior (SMD: -0.648, 95% CI: -0.1071 to -0.225 versus corticosteroids) between one and three months. Likewise, in terms of shoulder myofascial pain, the effectiveness of BoNT injections did not differ from the reference treatment (SMD: -0.212, 95% CI: -0.551 to 0.127 versus saline; SMD: 0.665, 95% CI: -0.260 to 1.590 versus dry needling and SMD: 1.093; 95% CI: 0.128 to 2.058 versus lidocaine) at one month post- intervention, and appeared superior (SMD: -0.314, 95% CI: -0.516 to -0.111 versus saline) between one and three months. Our meta-analysis revealed that BoNT injections could be a safe and effective alternative for patients with chronic shoulder pain.

• Authors: Po-Cheng Hsu, Wei-Ting Wu, Der-Sheng Han, Ke-Vin Chang
• Journal: Toxins (Toxins (Basel)) Vol. 12 Issue 4 (04 12 2020) ISSN: 2072-6651 [Electronic] Switzerland
• PMID: 32290577 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Systematic Review)

Chemical References

• Botulinum Toxins, Type A

Topics

• Botulinum Toxins, Type A (therapeutic use)
• Humans
• Randomized Controlled Trials as Topic
• Shoulder Pain (drug therapy)
• Treatment Outcome