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Botulinum Neurotoxins for Relief of Pain Associated with Spasticity

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Botulinum Toxin Treatment of Pain Disorders

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Abstract

Spasticity is a common and disabling complication of stroke, multiple sclerosis, brain and spinal cord injury, neurogenetic disorders, and cerebral palsy. Current pharmacological treatment of spasticity, although often effective, is confounded by undesirable side effects and, in some cases, short duration of the response. Botulinum neurotoxins (BoNTs) have been approved by FDA for treatment of upper and lower limb spasticity. The role of BoNT therapy in spasticity-related pain is not, however, sufficiently investigated. In this chapter, the literature from double-blind, placebo-controlled studies on spasticity-related pain is reviewed and discussed.

Nine double-blinded, placebo-controlled studies included assessment of pain in the investigation of BoNT efficacy in upper limb spasticity. Four studies that used validated pain scales (Visual analog scale, or VAS) reported efficacy for abobotulinumtoxinA (aboA) in spasticity-related pain (Level A, effective). For lower limb spasticity-related pain, the data is limited to three controlled studies. One study demonstrated efficacy for onaA using a validated pain scale (Level B, probably effective) and another for AboA using a scale of 0 to 5 for assessment of pain. In cerebral palsy (CP), one blinded study reported significant relief of spasticity-related pain after administration of onabotulinumA (up to12 units/kg) in children (Level B, probably effective, one class I study). Overall, this encouraging literature shows an increasing role for BoNTs in treatment of spasticity-related pain.

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Authors and Affiliations

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

    Bahman Jabbari MD, FANN

  2. Clinical Professor of Neurology, University of California, Irvine, CA, USA

    Bahman Jabbari MD, FANN

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Jabbari, B. (2022). Botulinum Neurotoxins for Relief of Pain Associated with Spasticity. In: Botulinum Toxin Treatment of Pain Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-99650-5_11

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