Botulinum Neurotoxins for Relief of Pain Associated with Spasticity

  • Bahman Jabbari


Spasticity is a common and disabling complication of stroke, multiple sclerosis, brain and spinal cord injury, and cerebral palsy. Pharmacological treatment, although effective, is confounded by undesirable side effects and short duration of response. Botulinum neurotoxins (BoNTs) have been approved by FDA for treatment of spasticity. The role of BoNT therapy in spasticity-related pain is less established. In this chapter, the literature from double-blind, placebo-controlled studies on this subject is reviewed.

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, 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 0–5 for assessment of pain. In cerebral palsy (CP), one blinded study reported significant relief of spasticity-related pain after administration of onabotulinumtoxinA (up to 12 units/kg) in children (level B, probably effective, one class I study). A number of open studies have also suggested efficacy for other types of BoNTs in children suffering from CP. Overall, this encouraging literature shows an increasing role for BoNTs in treatment of spasticity-related pain.


Spasticity Pain Botulinum toxin Botulinum neurotoxin OnabotulinumtoxinA AbobotulinumtoxinA IncobotulinumtoxinA RimabotulinumtoxinB Cerebral palsy 

Supplementary material

Video 11.1

Case 11-2. Showing EMG-guided injection into the extensor hallucis (MOV 11094 kb)

Video 11.2

(MOV 26941 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Bahman Jabbari
    • 1
  1. 1.Botulinum Toxin Treatment ProgramYale School of MedicineNew HavenUSA

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