Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia

Table 1 Evidence for the use of BoNT-A in chronic pain conditions

Condition	Subjects	Studies	Comparator	Outcome^a	Ref.
EM	1838	9	Placebo	n.s.	18
CM	1508	5	Placebo	HEPM: −2.30 [95% CI: −3.7, −0.9]	18
	59	1	Topiramate	n.s.	18
	72	1	Amitriptyline	n.s.	18
CDH	1115	1	Placebo	HEPM: −2.1 [95% CI: −3.6, −0.6]	18
Any TTH	59	1	Valproate	n.s.	18
Any TTH	21	1	Steroids	HEPM: −2.5 [95% CI:−3.5, −1.5]	18
Chronic TTH	675	7	Placebo	n.s.	18
TMD	145	4	Placebo	Meta-analysis not performed	22
TMD	30	1	Manipulation	n.s.	22
CNP^b	371	8	Placebo	Little or no difference	23
CCH	32	1	Placebo	Little or no difference	23
Whiplash	96	3	Placebo	n.s.	24
TN	178	4	Placebo	PPD: −29.8 [95% CI:−38.5, −21.1]	8
Diabetic NP	76	2	Placebo	0–10 VAS: −2.0 [95% CI:−3.1, −0.8]	27
Peripheral NP	68	1	Placebo	0–10 NRS:-0.8 [95% CI:−1.0, −0.6]	26
Spinal NP	40	1	Placebo	Significant VAS reduction	28
Myofascial	332	8	Placebo	n.s.	24
PSSP	86	5	Placebo	0–10 VAS: −1.2 [95% CI:−2.4, −0.1]	29
ASP	40	1	Placebo	0–10 VAS −2.0 [95% CI:−3.7, −0.3]	29
LE	274	4	Placebo	ES: −0.5 [95% CI:−0.9, −0.1]	31
LBP	131	3	Mixed^c	Meta-analysis not performed	33
Ankle OA	75	1	HA	n.s.	34
PF	133	3	Placebo	n.s.	35
PF	136	2	Steroids	Pain relief: −0.7 [95% CI:−1.0, −0.3]	35
BPS	317	6	Placebo	0–10 VAS −1.7 [95% CI:−3.2, −0.3]	38

Here are reported chronic pain conditions for which at least one meta-analysis or systematic review was available. ASP Arthritic shoulder pain, BoNT-A Botulinum neurotoxin type A, BPS Bladder pain syndrome, CCH Chronic cervicogenic headache, CDH Chronic daily headache, CI Confidence interval, CM Chronic migraine, CNP Chronic neck pain, EM Episodic migraine, ES Effect size, HA Hyaluronic acid, HEPM Headache episodes per months, LBP Low back pain, LE Lateral epycondylitis, NP Neuropathic pain, NRS Numerical rating scale, n.s. Not significant, OA Osteoarthritis, PF Plantar fasciitis, PPD Paroxysms per day, PSSP Post-stroke shoulder pain, TMD Temporomandibular disorders, TN Trigeminal neuralgia, TTH Tension type headache, VAS Visual analogue scale
^aResults of the comparison between BoNT and comparator
^bPhysiotherapeutic exercise and analgesics were combined with both BoNT and placebo in two studies (n = 95 patients)
^cPlacebo, acupuncture or steroids

ISSN: 1129-2377