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Botulinum Toxins for Treatment of Pain in Orthopedic Disorders

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Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine

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Abstract

A considerable number of orthopedic disorders are accompanied by pain which can be a clinical challenge for clinicians and a major problem for patients. Botulinum neurotoxins (BoNTs) have been recently shown to possess analgesic effects leading to their extensive use in various situations, including pain control for orthopedic issues. This chapter presents information on BoNT treatment of five orthopedic disorders with available placebo-controlled studies. The recommendations of the Assessment Subcommittee of the American Academy of Neurology are applied to establish an evidence-based level of efficacy for these disorders that include chronic lateral epicondylitis, refractory pain following total knee arthroplasty, painful local arthritis, anterior knee pain related to vastus lateralis imbalance, and orthopedic contracture and/or pain release (French and Gronseth, Neurology 71:1634–8, 2008; Gronseth and French, Neurology 71:1639–43, 2008).

According to the studies discussed in the following sections, an “A” level of evidence has been provided for chronic lateral epicondylitis, defining BoNT-A as being “effective” for this disorder. In painful local arthritis and issues related to orthopedic contracture and/or pain release including distraction osteogenesis and correction of scoliosis, the level of evidence is “B” demonstrating BoNT-A therapy to be “probably ineffective.” For refractory pain after total knee arthroplasty, anterior knee pain related to vastus lateralis imbalance, and other problems related to orthopedic contracture and/or pain release, the level of evidence is determined as “C” or “possibly effective.” Some of the studies providing these levels of evidence are of class III and IV types, and the number of class I studies in a few of these disorders is limited. Further class I/II studies are required to support a definitive analgesic role of BoNTs in orthopedic disorders.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics, University Hospital of Hvidover, Copenhagen, Denmark

    Christian Wong

  2. Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Shahroo Etemad-Moghadam

  3. Department of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Bahman Jabbari

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  1. Christian Wong
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  2. Shahroo Etemad-Moghadam
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  3. Bahman Jabbari
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Correspondence to Bahman Jabbari .

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  1. Professor Emeritus of Neurology, Yale University School of Medicine, New Haven, CT, USA

    Bahman Jabbari

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Wong, C., Etemad-Moghadam, S., Jabbari, B. (2020). Botulinum Toxins for Treatment of Pain in Orthopedic Disorders. In: Jabbari, B. (eds) Botulinum Toxin Treatment in Surgery, Dentistry, and Veterinary Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-50691-9_10

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