TY - JOUR
T1 - The use of botulinum toxin a as an adjunctive therapy in the management of chronic musculoskeletal pain: A systematic review with meta-analysis
AU - Battista, Simone
AU - Buzzatti, Luca
AU - Gandolfi, Marialuisa
AU - Finocchi, Cinzia
AU - Maistrello, Luca Falsiroli
AU - Viceconti, Antonello
AU - Giardulli, Benedetto
AU - Testa, Marco
N1 - Funding Information:
This work was developed within the DINOGMI Department of Excellence framework of MIUR 2018-2022 (Legge 232 del 2016).
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - Botulinum toxins
KW - Chronic pain
KW - Combined modality therapy
KW - Musculoskeletal disease
KW - Musculoskeletal pain
KW - Physical and rehabilitation medicine
KW - Physical therapy modalities
KW - Physical therapy specialty
KW - Rehabilitation
KW - Type A
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U2 - 10.3390/toxins13090640
DO - 10.3390/toxins13090640
M3 - Review article
AN - SCOPUS:85115269802
SN - 2072-6651
VL - 13
JO - Toxins
JF - Toxins
IS - 9
M1 - 640
ER -