Castiglione A, Bagnato S, Boccagni C, Romano MC, Galardi G. Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain.
To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP).
Pilot study with assessments before and after BTX-A intra-articular injection.
Hospital rehabilitation department.
Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm.
Intra-articular BTX-A injection.
Main Outcome Measure
Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection.
Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection.
We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.
List of Abbreviations:BTX-A (botulinum toxin type A), HSP (hemiplegic shoulder pain), VAS (visual analog scale)
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- Poststroke shoulder pain: its relationship to motor impairment, activity limitation, and quality of life.Arch Phys Med Rehabil. 2007; 88: 298-301
- Systematic review of aetiology and treatment of post-stroke hand oedema and shoulder-hand syndrome.Scand J Rehabil Med. 2000; 32: 4-10
- Effectiveness of corticosteroid injections versus physiotherapy for treatment of painful stiff shoulder in primary care: a randomised trial.BMJ. 1998; 317: 1292-1296
- Corticosteroid injections for shoulder pain.Cochrane Database Syst Rev. 2003; 1: CD004016
- Intramuscular botulinum toxin-A reduces hemiplegic shoulder pain: a randomized, double-blind, comparative study versus intraarticular triamcinolone acetonide.Stroke. 2008; 39: 126-131
- Neurobiological basis for the use of botulinum toxin in pain therapy.J Neurol. 2004; 251: 1-7
- Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial.Transl Res. 2009; 153: 205-216
- Botulinum neurotoxins in the treatment of refractory pain.Nat Clin Pract Neurol. 2008; 4: 676-685
- Intra-articular distension and corticosteroids in the management of capsulitis of the shoulder.BMJ. 1991; 302: 1498-1501
- A double-blind placebo-controlled study of botulinum toxin in upper limb spasticity after stroke or head injury.Clin Rehabil. 2000; 14: 5-13
- Botulinum toxin A improved burning pain and allodynia in two patients with spinal cord pathology.Pain Med. 2003; 4: 206-210
- Efficacy of intra-articular botulinum toxin type A in painful knee osteoarthritis: a pilot study.PM R. 2010; 4: 268-276
- Intra-articular botulinum toxin type A: a new approach to treat arthritis joint pain.Toxicon. 2009; 54: 658-667
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© 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.