Botulinum Toxins for Treatment of Pain in Orthopedic Disorders Publisher



Wong C¹ ; Etemadmoghadam S² ; Jabbari B³ Show Affiliations
Source: Botulinum Toxin Treatment in Surgery# Dentistry# and Veterinary Medicine Published:2020

Abstract

A considerable number of orthopedic disorders are accompanied by pain which can be a clinical challenge for clinicians and a major problem for patients. Botulinum neurotoxins (BoNTs) have been recently shown to possess analgesic effects leading to their extensive use in various situations, including pain control for orthopedic issues. This chapter presents information on BoNT treatment of five orthopedic disorders with available placebo-controlled studies. The recommendations of the Assessment Subcommittee of the American Academy of Neurology are applied to establish an evidence-based level of efficacy for these disorders that include chronic lateral epicondylitis, refractory pain following total knee arthroplasty, painful local arthritis, anterior knee pain related to vastus lateralis imbalance, and orthopedic contracture and/or pain release (French and Gronseth, Neurology 71:1634-8, 2008; Gronseth and French, Neurology 71:1639-43, 2008). According to the studies discussed in the following sections, an A level of evidence has been provided for chronic lateral epicondylitis, defining BoNT-A as being effective for this disorder. In painful local arthritis and issues related to orthopedic contracture and/or pain release including distraction osteogenesis and correction of scoliosis, the level of evidence is B demonstrating BoNT-A therapy to be probably ineffective. For refractory pain after total knee arthroplasty, anterior knee pain related to vastus lateralis imbalance, and other problems related to orthopedic contracture and/or pain release, the level of evidence is determined as C or possibly effective. Some of the studies providing these levels of evidence are of class III and IV types, and the number of class I studies in a few of these disorders is limited. Further class I/II studies are required to support a definitive analgesic role of BoNTs in orthopedic disorders. © Springer Nature Switzerland AG 2020. All rights reserved.