Efficacy of Intra-Articular Injection of Botulinum Toxin Type A in Refractory Hemiplegic Shoulder Pain

Abstract

Castiglione A, Bagnato S, Boccagni C, Romano MC, Galardi G. Efficacy of intra-articular injection of botulinum toxin type A in refractory hemiplegic shoulder pain. Objective To evaluate the efficacy of intra-articular injection of botulinum toxin type A (BTX-A) in relieving hemiplegic shoulder pain (HSP). Design Pilot study with assessments before and after BTX-A intra-articular injection. Setting Hospital rehabilitation department. Participants Patients (N=5) with HSP refractory to standard treatments and pain score at rest greater than 7 on a pain visual analog scale (VAS) of 0 to 10cm. Intervention Intra-articular BTX-A injection. Main Outcome Measure Variation in VAS score at rest and during 90° passive arm abduction 2 and 8 weeks after BTX-A intra-articular injection. Results Baseline VAS score was 8.7±1 at rest and 9.8±0.4 during passive arm abduction. It clearly decreased at 2 (1.5±1.1 at rest, P=.001; 3±1.2 during arm abduction, P<.001) and 8 weeks (1.5±1.2 at rest, P=.001; 2.3±1.1 during arm abduction, P<.001) after BTX-A intra-articular injection. Conclusions We found a strong correlation between intra-articular BTX-A injection and pain relief in patients with HSP. This result could provide the rationale for blind randomized controlled trials designed to better evaluate the safety and efficacy of intra-articular BTX-A injection in patients with refractory HSP.