Relief of spasticity-related pain with botulinum neurotoxin-A (bont-A) in real life practice. Post-hoc analysis from a large international cohort series

Abstract

Pain is a common treatment goal for upper limb spasticity (ULS). Whilst clinical trials of botulinum toxin A (BoNT-A) show variable results for spasticity-related pain, here we describe treatment in real-life clinical practice. This post-hoc analysis compares patients whose primary treatment goal is pain relief, with primary goals in other areas. The Upper Limb International Spasticity (ULIS) programme is a series of observational cohort studies across > 30 countries, examining local clinical practice and patient-centred outcomes in ULS treatment with BoNT-A/concomitant therapies. ULIS-II ( NCT01020500 ) examined a single treatment cycle in stroke patients. ULIS-III ( NCT02454803 ) examines repeated cycles in all neurological conditions. Baseline data are recently available. Outcome measures: goal achievement, goal attainment scaling (GAS), Neurological Impairment Scale, Modified Ashworth Scale. In ULIS-II ( n = 456), pain was the fourth most common primary goal area, expressed by 13% of patients (pain group), whilst 87% had other primary goal areas, (e.g. function, mobility, involuntary movements). At baseline, the pain group showed significant differences in age (61 years vs. 56 years; P = 0.014) and contracture severity (5.9 vs. 4.5; P = 0.008), compared with others ( Table 1 ). Time since stroke, sex, motor impairment and spasticity were comparable between groups. The pain group showed somewhat better primary goal achievement (84% vs. 79%) and mean [standard deviation] GAS-T score (54.3 [9.4] vs. 52.5 [9.5]). Pain group goal attainment was significantly associated with improved pain visual analogue scale (Spearman rho = 0.65; P < 0.001), proximal spasticity (rho = 0.40, P = 0.002) and patient-reported global benefit (rho = 0.41; P = 0.001), but unrelated spasticity duration (rho = 0.15; P = 0.298). ULIS-III baseline data showed pain was the second most common primary goal area, identified by 25% of patients. Pain reduction is an important goal in patient-centred spasticity management, irrespective of chronicity or presence of contractures. It is increasingly identified by clinicians and patients as a primary treatment goal.