Abstract
Chronic osteoarthritis pain is an increasing worldwide problem. Treatment for osteoarthritis pain is generally inadequate or fraught with potential toxicities. Botulinum toxins (BoNTs) are potent inhibitors of neuropeptide release. Paralytic toxicity is due to inhibition at the neuromuscular junction, and this effect has been utilized for treatments of painful dystonias. Pain relief following BoNT muscle injection has been noted to be more significant than muscle weakness and hypothesized to occur because of the inhibition of peripheral neuropeptide release and reduction of peripheral sensitization. Because of this observation, BoNT has been studied as an intra-articular (IA) analgesic for chronic joint pain. In clinical trials, BoNT appears to be effective for nociceptive joint pain. No toxicity has been reported. In preclinical models of joint pain, BoNT is similarly effective. Examination of the dorsal root ganglion (DRG) and the central nervous system has shown that catalytically active BoNT is retrogradely transported by neurons and then transcytosed to afferent synapses in the brain. This suggests that pain relief may also be due to the central effects of the drug. In summary, BoNT appears to be safe and effective for the treatment of chronic joint pain. The long-term effects of IA BoNT are still being determined.
Highlights
IntroductionIt is the most common cause of chronic joint pain and is increasing in prevalence
A limited number of clinical trials using botulinum toxin for articular pain have been done in humans.These were initiated before studies were done in preclinical models due to the observation that the use of botulinum toxin for muscular dystonias relieved pain out of proportion to the production of muscle weakness
The dose of rimabotulinumtoxinB (Myobloc) was 2500 IU. These studies used varying controls, ranging from triamcinolone to saline to unspecified placebo
Summary
It is the most common cause of chronic joint pain and is increasing in prevalence. The prevalence of OA increases with age, and as the population ages, the number of people with OA is expected to increase. In the US alone, 27 million adults are affected by this disease, and by the year 2030, this number is expected to reach 67 million [1,2]. Disability from osteoarthritis varies, but the pain is the most disabling symptom [3,4]. Arthritis is a leading cause of work disability among adults in the US [5]. Because there are no treatments for OA that modify disease, treatment goals must be focused on the relief of symptoms and minimizing disability
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