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

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

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.

Citation

Battista, S., Buzzatti, L., Gandolfi, M., Finocchi, C., Maistrello, L. F., Viceconti, A., …Testa, M. (2021). The Use of Botulinum Toxin A as an Adjunctive Therapy in the Management of Chronic Musculoskeletal Pain: A Systematic Review with Meta-Analysis. Toxins, 13(9), 640. https://doi.org/10.3390/toxins13090640

• Journal Article Type: Article
• Acceptance Date: Sep 1, 2021
• Online Publication Date: Sep 10, 2021
• Publication Date: Sep 10, 2021
• Deposit Date: Feb 20, 2024
• Publicly Available Date: Feb 26, 2024
• Journal: Toxins
• Publisher: MDPI
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Issue: 9
• Pages: 640
• DOI: https://doi.org/10.3390/toxins13090640
• Keywords: Health, Toxicology and Mutagenesis; Toxicology