TDNet Discover

Background: Botulinum toxin (BoNT) injections are not currently used in the routine treatment of muscle spasticity and neuropathic pain related to spinal cord injury (SCI). Current recommendations include pharmacologic agents like baclofen tizanidine, or gabapentin, which all have adverse side effects and no agreed upon administration timeline for optimal efficacy. More research is required to identify the best treatment options for muscle spasticity and neuropathic pain related to SCI, especially alternative treatments like BoNT injections. However, current research is limited to small study sizes and there is a lack of consistent administration across studies. Purpose: The purpose of this research was to identify the efficacy and optimal administration timeline of botulinum toxin as compared to other interventions or placebo in treating neuropathic pain and spasticity in the adult population post spinal cord injury. By identifying the gold standard treatment plan for patients with SCI related spasticity and neuropathic pain, providers can have confidence in their treatment plans and patients can be reassured they are receiving the best care. Methods: PUBMED, Academic Search Complete, Google Scholar, EBSCO, MedLine Complete, and Cochrane Library databases were searched for articles related to the treatment of SCI induced muscle spasticity and neuropathic pain with BoNT injections compared to placebo treatments or other pharmacologic agents. Data was synthesized using the PICO method after a standardized screening and evaluation had been performed using the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tool. Results: Three studies with a total of 384 patients (141 males, 243 females) were identified and included in this review. Among the 3 studies, 1 was blind and a randomized control trial and 2 v were randomized, double blind, placebo controlled. The duration of the studies ranged from 6 to 12 weeks. A visual analog score was used to assess pain levels and the Ashworth scale was used to determine spasticity levels. The results of the included studies were divided into reduction of pain, reduction of spasticity, and compared across BTX-A, baclofen, and placebo/physical therapy. Among the three studies, there was found to be improved neuropathic pain scores and spasticity levels with the use of BoNT injections. However, the three studies varied in which results they found to be statistically significant, thus establishing a further need to study BoNT. Conclusion: Due to the differences in statistically significant findings, this evidence based clinical review (EBCR) demonstrated the need for further research and clarification regarding the optimal administration timeline for effective treatment of neuropathic pain and spasticity post spin cord injury