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Chapter 32 - Use of Botulinum Toxin in Musculoskeletal Pain and Arthritis

Published online by Cambridge University Press:  02 November 2023

By
Jasvinder A. Singh
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
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Summary

Osteoarthritis (OA) is the most common type of non-inflammatory arthritis that affects the aging population but can present at a younger age in those with trauma or obesity. Inflammatory arthritis (e.g., rheumatoid arthritis [RA] and gout) is characterized by swelling of the joint lining that leads to joint destruction and bony erosions when not optimally treated. The treatment of refractory joint pain remains a big challenge with few available therapeutic options, which include oral analgesics and anti-inflammatories, topical treatments, intra-articular therapies and physical therapy.

Several contraindications and common adverse events limit the long-term use of each medication.

This chapter reviews studies on the use of BoNT-A (onabotulinumtoxinA, ONA) for osteoarticular pain. Supported by pre-clinical laboratory evidence of anti-nociception, intra-articular BoNT seems to be efficacious for knee, shoulder, ankle and tennis elbow joint pain, based on RCT and systematic review data. Injection techniques for these joints are discussed, along with dosing recommendations and clear anatomical illustrations showing injection approach and placement.

Keywords

Botulinum toxinosteoarthritisrheumatoid arthritisperiphral sensitizationcentral sensitization
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 260 - 268
Publisher: Cambridge University Press
Print publication year: 2023

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References

Boon, AJ, Smith, J, Dahm, DL et al. (2010). Efficacy of intra-articular botulinum toxin type A in painful knee osteoarthritis: a pilot study. PM R, 2, 268–76.CrossRefGoogle ScholarPubMed
Chen, YW, Chiu, YW, Chen, CY, Chuang, SK (2015). Botulinum toxin therapy for temporomandibular joint disorders: a systematic review of randomized controlled trials. Int J Oral Maxillofac Surg, 44, 1018–26.CrossRefGoogle ScholarPubMed
Courseau, M, Salle, PV, Ranoux, D, de Pouilly Lachatre, A (2018). Efficacy of intra-articular botulinum toxin in osteoarticular joint pain: a meta-analysis of randomized controlled trials. Clin J Pain, 34, 383–9.CrossRefGoogle ScholarPubMed
Dykstra, D, Stuckey, MW, Schimpff, SN, Singh, JA, Mahowald, ML (2007). The effects of intra-articular botulinum toxin on sacroiliac, cervical/lumbar facet and sterno-calvicular joint pain and C-2 root and lumbar disc pain: a case series of 11 patients. Pain Clin, 19, 27–32.CrossRefGoogle Scholar
Hayton, MJ, Santini, AJ, Hughes, PJ et al. (2007). Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study. J Bone Joint Surg Am, 87, 503–7.Google Scholar
Hsu, PC, Wu, WT, Han, DS, Chang, KV (2020). Comparative effectiveness of botulinum toxin injection for chronic shoulder pain: a meta-analysis of randomized controlled trials. Toxins, 12, 251.CrossRefGoogle ScholarPubMed
Keizer, SB, Rutten, HP, Pilot, P et al. (2002). Botulinum toxin injection versus surgical treatment for tennis elbow: a randomized pilot study. Clin Orthop Relat Res, (401), 125–31.CrossRefGoogle Scholar
Mahowald, ML, Krug, HE, Singh, JA, Dykstra, D (2009). Intra-articular Botulinum Toxin Type A: a new approach to treat arthritis joint pain. Toxicon, 54, 658–67.Google Scholar
Mahowald, ML, Singh, JA, Dykstra, D (2006). Long term effects of intra-articular botulinum toxin A for refractory joint pain. Neurotox Res, 9 , 179–88.CrossRefGoogle ScholarPubMed
Marchini, C, Acler, M, Bolognari, MA et al. (2010). Efficacy of botulinum toxin type A treatment of functional impairment of degenerative hip joint: Preliminary results. J Rehabil Med, 42, 691–3.Google ScholarPubMed
Mendes, JG, Natour, J, Nunes-Tamashiro, JC et al. (2019). Comparison between intra-articular Botulinum toxin type A, corticosteroid, and saline in knee osteoarthritis: a randomized controlled trial. Clin Rehabil, 33, 1015–26.CrossRefGoogle ScholarPubMed
Morre, HH, Keizer, SB, van Os, JJ (1997). Treatment of chronic tennis elbow with botulinum toxin. Lancet, 349, 1746.Google Scholar
Neugebauer, V, Lucke, T, Schaible, HG (1993). N-methyl-D-aspartate (NMDA) and non-NMDA receptor antagonists block the hyperexcitability of dorsal horn neurons during development of acute arthritis in rat’s knee joint. J Neurophysiol, 70, 1365–77.CrossRefGoogle ScholarPubMed
Schaible, HG, Del Rosso, A, Matucci-Cerinic, M (2005). Neurogenic aspects of inflammation. Rheum Dis Clin North Am, 31, 77–101.Google Scholar
Schaible, HG, Richter, F, Ebersberger, A et al. (2009). Joint pain. Exp Brain Res, 196, 153–62.CrossRefGoogle ScholarPubMed
Schaible, HG, Schmelz, M, Tegeder, I (2006). Pathophysiology and treatment of pain in joint disease. Adv Drug Deliv Rev, 58, 323–42.CrossRefGoogle ScholarPubMed
Singer, BJ, Silbert, PL, Dunne, JW, Song, S, Singer, KP (2006). An open label pilot investigation of the efficacy of botulinum toxin type A [Dysport] injection in the rehabilitation of chronic anterior knee pain. Disabil Rehabil, 28, 707–13.CrossRefGoogle ScholarPubMed
Singh, JA, Mahowald, ML, Kushnaryov, A, Goelz, E, Dykstra, D (2009a). Repeat injections of intra-articular botulinum toxin a for the treatment of chronic arthritis joint pain. J Clin Rheumatol, 15, 35–8.Google Scholar
Singh, JA, Mahowald, ML, Noorbaloochi, S (2009b). Intra-articular botulinum toxin A for refractory shoulder pain: a randomized, double-blinded, placebo-controlled trial. Transl Res, 153, 205–16.CrossRefGoogle ScholarPubMed
Sun, S-F, Hsu, C-W, Lin, H-S et al. (2014). Efficacy of intraarticular botulinum toxin A and intraarticular hyaluronate plus rehabilitation exercise in patients with unilateral ankle osteoarthritis: a randomized controlled trial. J Foot Ankle Res, 7, 9.CrossRefGoogle ScholarPubMed
Wong, SM, Hui, AC, Tong, PY et al. (2005). Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med, 143, 793–7.CrossRefGoogle ScholarPubMed
Woolf, CJ, Costigan, M (1999). Transcriptional and posttranslational plasticity and the generation of inflammatory pain. Proc Natl Acad Sci U S A, 96, 7723–30.CrossRefGoogle ScholarPubMed

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