Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial

Ester Marco, Esther Duarte, Joan Villa, Marta Tejero, Anna Guillen, Roser Boza, Ferran Escalada, Josep M. Espadaler

Research output: Contribution to journalArticleResearchpeer-review

71 Citations (Scopus)

Abstract

Objective: To determine the efficacy of botulinum toxin type A for the treatment of spastic shoulder pain in patients after stroke. Design: Double-blind randomized clinical trial. Patients: Of 31 patients enrolled from an acute-care hospital in Spain, 2 cases dropped out (drop-out rate 6.5%). Fourteen subjects were treated with infiltration of 500 units of botulinum toxin type A in the pectoralis major muscle of the paretic side, and 15 with a placebo. Methods: After infiltration, both groups received transcutaneous electrical nerve stimulation for 6 weeks. Patients were assessed by the use of the Visual Analogue Scale for pain. A good result concerning pain was considered when the Visual Analogue Scale score was below 33.3 mm or less than half the initial score. The patients were followed-up for 6 months. Results: The patients treated with botulinum toxin type A showed a significantly greater pain improvement from the first week post-infiltration. Persistent shoulder pain was observed more frequently in the placebo group, with relative risks in the range 0.32-0.41 during the follow-up period. Conclusion: Patients with spastic shoulder pain treated with a botulinum toxin type A infiltration in the pectoralis major muscle of the paretic side have a higher likelihood of pain relief (between 2.43- and 3.11-fold). © 2007 Foundation of Rehabilitation Information.
Original languageEnglish
Pages (from-to)440-447
JournalJournal of Rehabilitation Medicine
Volume39
Issue number6
DOIs
Publication statusPublished - 1 Jul 2007

Keywords

  • Botulinum toxin
  • Cerebrovascular disease
  • Muscle spasticity
  • Rehabilitation
  • Shoulder pain

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