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Treatment Applications of Botulinum Toxins in the Multidisciplinary and Integrated Management of Pain Syndromes

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A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Bacterial Toxins".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 16554

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Special Issue Editors

Prof. Dr. Marialuisa Gandolfi

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Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

Prof. Dr. Marco Testa

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Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova, Italy

Dr. Simone Battista

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Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health University of Genova, Italy

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Dear Colleagues,

Botulinum neurotoxin (BoNT) treatment applications have been progressively expanded in the last decade to include a wide range of motor and non-motor disorders. Particularly relevant is the use of BoNT in the management of patients with chronic neuropathic, nociceptive and visceral pain conditions. In line with a bio-psycho-social care process, the management of pain conditions requires a multidisciplinary approach combining pharmacological and non-pharmacological interventions. Note that the literature suggests the importance of identifying interventions that could enhance the BoNT pharmacological effects especially in chronic musculoskeletal and neurological conditions such as primary headaches, myofascial pain syndrome and pain due to acquired central nervous system lesions. The proposal made here aims at collecting the best evidence on the effects of care models dedicated to implementing physical, rehabilitative and psychological approaches in rehabilitation that can express all the therapeutic potentials of an integrated multidisciplinary approach in which the effect of BoNT treatment is enriched. Multi- and single-centre randomized controlled trials, original reports, innovative and informative case studies or series, systematic reviews and meta-analyses in human populations are all welcome.

Prof. Dr. Marialuisa Gandolfi
Prof. Dr. Marco Testa
Dr. Simone Battista
Guest Editors

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Keywords

physical therapy modalities
interdisciplinary studies
pain
spasticity
headache disorders
myofascial pain syndromes
musculoskeletal pain
visceral pain

Published Papers (5 papers)

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15 pages, 1710 KiB

Open AccessArticle

Measuring Effects on Pain and Quality of Life after Abobotulinum Toxin A Injections in Children with Cerebral Palsy

by Christian Wong, Ian Westphall and Josephine Sandahl Michelsen

Toxins 2022, 14(1), 43; https://doi.org/10.3390/toxins14010043 - 5 Jan 2022

Cited by 5 | Viewed by 2394

Abstract

Sixty-seven percent of children with cerebral palsy (CCP) experience pain. Pain is closely interrelated to diminished quality of life. Despite this, pain is an overlooked and undertreated clinical problem. The objective of this study was to examine the analgesic effect of a single lower extremity intramuscular injection of Abobotulinum toxin A/Dysport in CCP. Twenty-five CCP with at least moderate pain (r-FLACC ≥ 4) during passive range of motion were included. Localized pain and pain in everyday living were measured by r-FLACC and the Paediatric Pain Profile (PPP), respectively. Functional improvements were evaluated by the goal attainment scale (SMART GAS). Quality of life was evaluated by either the CPCHILD or the CP-QOL. The subjects were evaluated at baseline before injection, then after 4, 12, and 28 weeks. Twenty-two subjects had a significant mean and maximum localized pain reduction (p < 0.001) at four weeks post-treatment in 96% (21/22). The reduction was maintained at 12 (19/19) and 28 weeks (12/15). Daily pain evaluated by the PPP was significantly reduced and functional SMART GAS goals were significantly achieved from 4 to 28 weeks. Quality of life improved significantly at four weeks (CPCHILD). Significant functional gains and localized and daily pain reduction were seen from 4 to 28 weeks. Full article

(This article belongs to the Special Issue Treatment Applications of Botulinum Toxins in the Multidisciplinary and Integrated Management of Pain Syndromes)

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10 pages, 289 KiB

Open AccessArticle

Effectiveness of Botulinum Toxin on Pain in Stroke Patients Suffering from Upper Limb Spastic Dystonia

by Carlo Trompetto, Lucio Marinelli, Laura Mori, Luca Puce, Chiara Avanti, Elena Saretti, Giulia Biasotti, Roberta Amella, Filippo Cotellessa, Domenico A. Restivo and Antonio Currà

Toxins 2022, 14(1), 39; https://doi.org/10.3390/toxins14010039 - 5 Jan 2022

Cited by 8 | Viewed by 2084

Abstract

This observational study aimed at investigating pain in stroke patients with upper limb spastic dystonia. Forty-one consecutive patients were enrolled. A 0–10 numeric rating scale was used to evaluate pain at rest and during muscle tone assessment. Patients were asked to indicate the most painful joint at passive mobilization (shoulder, elbow, wrist-fingers). The DN4 questionnaire was administered to disclose neuropathic pain. All patients were assessed just before and 1 month after incobotulinumtoxin-A treatment. Pain was present in 22 patients, worsened or triggered by passive muscle stretching. DN4 scored < 4 in 20 patients. The most painful joints were wrist–fingers in 12 patients, elbow in 5 patients and shoulder in the remaining 5 patients. Both elbow and wrist–fingers pain correlated with muscle tone. BoNT-A treatment reduced pain in all the joints, including the shoulder. We discussed that nociceptive pain is present in a vast proportion of patients with upper limb spastic dystonia. BoNT-A treatment reduced both spastic dystonia and pain in all the joints but the shoulder, where the effect on pain could be mediated by the reduction of pathological postures involving the other joints. Full article

(This article belongs to the Special Issue Treatment Applications of Botulinum Toxins in the Multidisciplinary and Integrated Management of Pain Syndromes)

16 pages, 987 KiB

Open AccessArticle

Effects of Botulinum Toxin Type A on Pain among Trigeminal Neuralgia, Myofascial Temporomandibular Disorders, and Oromandibular Dystonia

by Kazuya Yoshida

Toxins 2021, 13(9), 605; https://doi.org/10.3390/toxins13090605 - 29 Aug 2021

Cited by 11 | Viewed by 4111

Abstract

The differences in analgesic effects of botulinum toxin type A were compared in 28 patients with trigeminal neuralgia, 53 patients with myofascial temporomandibular disorders, and 89 patients with the jaw closing oromandibular dystonia. The patients were treated by injection of botulinum toxin type A into the masseter, temporalis, medial pterygoid, and other muscles based on the symptoms of each patient. The pain severity was evaluated using the visual analog scale, pain frequency, and pain scale of the oromandibular dystonia rating scale. Botulinum toxin injection was performed 1068 times in all patients without significant adverse effects. The visual analog, pain frequency, and pain scales at baseline were reduced (p < 0.001) after two, four, eight, and 12 weeks after the first botulinum toxin therapy and at the endpoint. The effects differed significantly (p < 0.001) among the groups (repeated-measures analysis of variance). The mean improvement (0%, no effect; 100%, complete recovery) at the endpoint was 86.8% for trigeminal neuralgia, 80.8% for myofascial pain, and 75.4% for oromandibular dystonia. Injection of the botulinum toxin can be a highly effective and safe method to treat trigeminal neuralgia, myofascial pain, and oromandibular dystonia. Full article

(This article belongs to the Special Issue Treatment Applications of Botulinum Toxins in the Multidisciplinary and Integrated Management of Pain Syndromes)

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12 pages, 2817 KiB

Open AccessSystematic Review

Botulinum Toxin-A Injection in Chronic Pelvic Pain Syndrome Treatment: A Systematic Review and Pooled Meta-Analysis

by Andrea Panunzio, Alessandro Tafuri, Giovanni Mazzucato, Clara Cerrato, Rossella Orlando, Vincenzo Pagliarulo, Alessandro Antonelli and Maria Angela Cerruto

Toxins 2022, 14(1), 25; https://doi.org/10.3390/toxins14010025 - 1 Jan 2022

Cited by 10 | Viewed by 4174

Abstract

Introduction: Pain management of patients with chronic pelvic pain syndrome (CPPS) is challenging, because pain is often refractory to conventional treatments. Botulinum toxin A (BTX-A) may represent a promising therapeutic strategy for these patients. The aim of this systematic review was to investigate the role of BTX-A in CPPS treatment. Methods: We reviewed the literature for prospective studies evaluating the use of BTX-A in the treatment of CPPS. A comprehensive search in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases was performed from English language articles published between January 2000 and October 2021. The primary outcome was to evaluate pain improvement in CPPS after BTX-A treatment. Pooled meta-analysis of the included studies, considering the effect of BTX-A on pain evaluated at last available follow-up compared to baseline values, was performed together with meta-regression analysis. Results: After screening 1001 records, 18 full-text manuscripts were selected, comprising 13 randomized clinical trials and five comparative studies. They covered overall 896 patients of both sexes and several subtype of CPPS (interstitial cystitis/bladder pain syndrome, chronic prostatitis/prostate pain syndrome, chronic scrotal pain, gynecological pelvic pain, myofascial pelvic pain). The clinical and methodological heterogeneity of studies included makes it difficult to do an overall estimation of the real effect of BTX-A on pain and other functional outcomes of various CPPS subtypes. However, considering pooled meta-analysis results, a benefit in pain relief was showed for BTX-A-treated patients both in the overall studies populations and in the overall cohorts of patients with CPP due to bladder, prostate, and gynecological origin. Conclusions: BTX-A could be an efficacious treatment for some specific CPPS subtypes. Higher level studies are needed to assess the efficacy and safety of BTX-A and provide objective indications for its use in CPPS management. Full article

(This article belongs to the Special Issue Treatment Applications of Botulinum Toxins in the Multidisciplinary and Integrated Management of Pain Syndromes)

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17 pages, 936 KiB

Open AccessSystematic Review

The Use of Botulinum Toxin A as an Adjunctive Therapy in the Management of Chronic Musculoskeletal Pain: A Systematic Review with Meta-Analysis

by Simone Battista, Luca Buzzatti, Marialuisa Gandolfi, Cinzia Finocchi, Luca Falsiroli Maistrello, Antonello Viceconti, Benedetto Giardulli and Marco Testa

Toxins 2021, 13(9), 640; https://doi.org/10.3390/toxins13090640 - 10 Sep 2021

Cited by 7 | Viewed by 2794

Abstract

Several studies have investigated the effect of botulinum toxin A (BoNT-A) for managing chronic musculoskeletal pain, bringing contrasting results to the forefront. Thus far, however, there has been no synthesis of evidence on the effect of BoNT-A as an adjunctive treatment within a multimodal approach. Hence, Medline via PubMed, EMBASE, and the Cochrane Library-CENTRAL were searched until November 2020 for randomised controlled trials (RCTs) that investigated the use of BoNT-A as an adjunctive therapy for chronic musculoskeletal pain. The risk of bias (RoB) and the overall quality of the studies were assessed through RoB 2.0 and the GRADE approach, respectively. Meta-analysis was conducted to analyse the pooled results of the six included RCTs. Four were at a low RoB, while two were at a high RoB. The meta-analysis showed that BoNT-A as an adjunctive therapy did not significantly decrease pain compared to the sole use of traditional treatment (SDM −0.89; 95% CI −1.91; 0.12; p = 0.08). Caution should be used when interpreting such results, since the studies displayed very high heterogeneity (I = 94%, p < 0.001). The overall certainty of the evidence was very low. The data retrieved from this systematic review do not support the use of BoNT-A as an adjunctive therapy in treating chronic musculoskeletal pain. Full article

(This article belongs to the Special Issue Treatment Applications of Botulinum Toxins in the Multidisciplinary and Integrated Management of Pain Syndromes)

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