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Review article (meta-analysis)| Volume 96, ISSUE 12, P2214-2220, December 2015

Effectiveness of Botulinum Toxin for Shoulder Pain Treatment: A Systematic Review and Meta-Analysis

  • Tao Wu
    Correspondence
    Corresponding author Tao Wu, MD, Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, 3, East Qin Chun Rd, Hangzhou, Zhe Jiang, People's Republic of China 310016.
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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  • Yu Fu
    Affiliations
    Department of Rehabilitation Medicine, Alxa League Central Hospital, Alxa, Inner Mongolia Autonomous Region, People's Republic of China
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  • Hai xin Song
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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  • Ye Ye
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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  • Yan Dong
    Affiliations
    Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang Chinese Armed Police Force, Hangzhou, People's Republic of China
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  • Jian hua Li
    Affiliations
    Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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      Abstract

      Objective

      To evaluate the current evidence of the effectiveness of botulinum toxin (BTX) treatment for shoulder pain.

      Data Sources

      Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Web of Science, and Scopus were searched from inception through week 18 of 2015.

      Study Selection

      Randomized controlled trials comparing the clinical efficacy (pain intensity and shoulder range of motion [ROM]) of BTX injection to conventional therapy (steroid or placebo injection) were included.

      Data Extraction

      Two reviewers independently screened abstracts and full texts. The results of the pain intensity and shoulder ROM were extracted and presented in the form of mean and SD. We constructed random-effects models and calculated the mean difference (MD) for continuous outcomes. A total of 219 articles were identified, of which 9 articles were eligible for the final analysis.

      Data Synthesis

      The analysis indicated a statistically significant decreased pain score in the BTX therapy group compared with the control group, with the MD=1.35 (95% confidence interval [CI], .80–1.91; P<.001; I2=81%). Patients who received BTX therapy were more likely to have a significant increase in shoulder abduction ROM than patients in the control group, with the MD=8.02 (95% CI, 1.17–14.88, P=.02, I2=89%).

      Conclusions

      Compared with conventional (steroid or placebo injection) therapy, BTX injections have beneficial effects for adult patients with shoulder pain, evidenced by improved pain scores and ROM.

      Keywords

      List of abbreviations:

      BTX (botulinum toxin), MD (mean difference), NRS (numeric rating scale), RCT (randomized controlled trial), ROM (range of motion), SASD (subacromial and subdeltoid), SB (subacromial bursitis), SIS (shoulder impingement syndrome), VAS (visual analog scale)
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