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Intramuscular botulinum toxin A (BtxA) in complex regional pain syndrome Kharkar S; Ambady P; Yedatore V; Schwartzman RJPain Physician 2011[May]; 14 (3): 311-6BACKGROUND: Pain associated with complex regional pain syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described. OBJECTIVES: To assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment. STUDY DESIGN: Retrospective chart review. SETTING: Outpatient clinic. PATIENTS: 37 patients with spasm/dystonia in the neck and/or upper limb girdle muscles. INTERVENTION: Electromyography-guided injection of botulinum toxin A (BtxA), 10-20 U per muscle. Total dose used was 100 U in each patient. MEASUREMENT: Local pain score on an 11 point Likert scale, 4 weeks after BtxA injections. RESULTS: Mean pain score decreased by 43% (8.2 +/- 0.8 to 4.5 +/- 1.1, P < 0.001). Ninety-seven percent of the patients had significant pain relief. One patient had transient neck drop after the injections. LIMITATIONS: This is a retrospective study; it lacks a control group and therefore the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks. CONCLUSION(S): Intramuscular injection of botulinum toxin A in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS in this retrospective case series. The incidence of complications was low (2.7%).|Botulinum Toxins, Type A/*administration & dosage[MESH]|Complex Regional Pain Syndromes/*drug therapy[MESH]|Dystonic Disorders/*drug therapy[MESH]|Female[MESH]|Humans[MESH]|Injections, Intramuscular/methods[MESH]|Male[MESH]|Neuromuscular Agents/*administration & dosage[MESH]|Retrospective Studies[MESH]|Spasm/*drug therapy[MESH] |
