Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial.

Abstract

OBJECTIVE:

To determine the efficacy of botulinum toxin type A for the treatment of spastic shoulder pain in patients after stroke.

DESIGN:

Double-blind randomized clinical trial.

PATIENTS:

Of 31 patients enrolled from an acute-care hospital in Spain, 2 cases dropped out (drop-out rate 6.5%). Fourteen subjects were treated with infiltration of 500 units of botulinum toxin type A in the pectoralis major muscle of the paretic side, and 15 with a placebo.

METHODS:

After infiltration, both groups received transcutaneous electrical nerve stimulation for 6 weeks. Patients were assessed by the use of the Visual Analogue Scale for pain. A good result concerning pain was considered when the Visual Analogue Scale score was below 33.3 mm or less than half the initial score. The patients were followed-up for 6 months.

RESULTS:

The patients treated with botulinum toxin type A showed a significantly greater pain improvement from the first week post-infiltration. Persistent shoulder pain was observed more frequently in the placebo group, with relative risks in the range 0.32-0.41 during the follow-up period.

CONCLUSION:

Patients with spastic shoulder pain treated with a botulinum toxin type A infiltration in the pectoralis major muscle of the paretic side have a higher likelihood of pain relief (between 2.43- and 3.11-fold).

• Authors: Ester Marco, Esther Duarte, Joan Vila, Marta Tejero, Anna Guillen, Roser Boza, Ferran Escalada, Josep M Espadaler
• Journal: Journal of rehabilitation medicine (J Rehabil Med) Vol. 39 Issue 6 Pg. 440-7 (Jul 2007) ISSN: 1650-1977 [Print] Sweden
• PMID: 17624477 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Neuromuscular Agents
• Botulinum Toxins, Type A

Topics

• Adult
• Aged
• Botulinum Toxins, Type A (administration & dosage, therapeutic use)
• Double-Blind Method
• Female
• Follow-Up Studies
• Hemiplegia (complications, etiology, rehabilitation)
• Humans
• Injections, Intramuscular
• Male
• Middle Aged
• Muscle Spasticity (drug therapy, etiology)
• Neuromuscular Agents (administration & dosage, therapeutic use)
• Pain Measurement
• Range of Motion, Articular
• Shoulder Pain (drug therapy, etiology)
• Transcutaneous Electric Nerve Stimulation
• Treatment Outcome