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31-07-2011 | Physical rehabilitation | Article

Botox fails to improve chronic neck pain


Free abstract

MedWire News: Intramuscular injections of botulinum toxin (BoNT) are not an effective treatment for neck pain, a review states.

The evidence failed to confirm a "clinically important or statistically significant benefit" of the BoNT injection, report Michael Peloso (Merck, New Jersey, USA) and colleagues in the journal Cochrane Database of Systematic Reviews.

"Based on current evidence we have no reason for supporting the use of BoNT as a standalone therapy for neck pain, but we do suggest that researchers consider further study to clarify whether the dose can be optimized for neck pain," state the investigators.

BoNT is a popular treatment for patients with chronic neck pain, but there is little evidence supporting its use.

It is hypothesized that BoNT temporarily stops muscle contraction, and as a result relieves muscle tension common to neck disorders.

To determine the effectiveness of this treatment, Peloso and colleagues reviewed data from nine trials involving 503 participants treated with BoNT Type A (BoNT-A).

Analyzing data from five "high-quality" trials, the group observed no difference in measures of pain after 1 and 6 months among those treated with BoNT-A and those treated with saline injections.

Similarly, trials considered "low quality" showed no difference in pain after 1 and 6 months between the BoNT-A and saline arms. In these low-quality trials, patients in both arms also received physical therapy and analgesics.

Low-quality evidence from one study of 32 patients showed no difference between BoNT-A and saline for the treatment of chronic cervicogenic headache.

One small, "very-low-quality" study suggested a possible benefit in the global perceived effect in patients who received BoNT-A.

Overall, however, the researchers state that the evidence simply does not support the use, or further clinical testing at the current dose, of BoNT-A for the treatment of chronic neck pain and associated headache.

They point out there was no observed benefit in terms of disability or quality of life at 1 and 6 months in the trials analyzed.

Further studies might explore higher doses of BoNT-A, particularly in subgroups most likely to receive short- and intermediate-term benefits.

It is possible some benefits were not measured in the trials, but more carefully conducted clinical trials are needed, state Peloso and colleagues.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

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