Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan.
Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
Toxins (Basel). 2020 Apr 12;12(4):251. doi: 10.3390/toxins12040251.
Botulinum toxin (BoNT) injection is regarded as a promising treatment for musculoskeletal pain. However, its efficacy for treating chronic shoulder pain remains unclear. We investigated the effectiveness of BoNT injections for chronic shoulder pain by conducting a systematic search of electronic databases up to March 2020 for randomized control trials (RCTs) that used BoNT injections for chronic shoulder pain treatment. The primary outcome was the between-group comparison of pain reduction, quantified by the standardized mean difference (SMD). Nine RCTs comprising 666 patients were included and divided into two groups: one group with shoulder joint pain ( = 182) and the other group with shoulder myofascial pain ( = 484). Regarding shoulder joint pain, the efficacy of BoNT injections was similar to that of the reference treatment (SMD: -0.605, 95% confidence level [CI]: -1.242 to 0.032 versus saline; SMD: -0.180, 95% CI: -0.514 to 0.153 versus corticosteroids) at one month post-intervention, and was superior (SMD: -0.648, 95% CI: -0.1071 to -0.225 versus corticosteroids) between one and three months. Likewise, in terms of shoulder myofascial pain, the effectiveness of BoNT injections did not differ from the reference treatment (SMD: -0.212, 95% CI: -0.551 to 0.127 versus saline; SMD: 0.665, 95% CI: -0.260 to 1.590 versus dry needling and SMD: 1.093; 95% CI: 0.128 to 2.058 versus lidocaine) at one month post- intervention, and appeared superior (SMD: -0.314, 95% CI: -0.516 to -0.111 versus saline) between one and three months. Our meta-analysis revealed that BoNT injections could be a safe and effective alternative for patients with chronic shoulder pain.
肉毒杆菌毒素 (BoNT) 注射被认为是治疗肌肉骨骼疼痛的一种有前途的治疗方法。然而，其治疗慢性肩痛的疗效尚不清楚。我们通过对截至 2020 年 3 月的电子数据库进行系统搜索，以寻找使用 BoNT 治疗慢性肩痛的随机对照试验 (RCT)，以研究 BoNT 注射治疗慢性肩痛的疗效。主要结果是通过标准化均数差 (SMD) 比较两组疼痛减轻的情况。共纳入了 9 项 RCT，包括 666 例患者，分为两组：一组为肩关节疼痛 ( = 182)，另一组为肩肌筋膜疼痛 ( = 484)。关于肩关节疼痛，BoNT 注射的疗效与对照治疗相似（1 个月时 SMD：-0.605，95%置信区间 [CI]：-1.242 至 0.032 对比盐水；SMD：-0.180，95%CI：-0.514 至 0.153 对比皮质类固醇），而在 1 至 3 个月时则优于（SMD：-0.648，95%CI：-0.1071 至 -0.225 对比皮质类固醇）。同样，对于肩肌筋膜疼痛，BoNT 注射的疗效与对照治疗无差异（1 个月时 SMD：-0.212，95%CI：-0.551 至 0.127 对比盐水；SMD：0.665，95%CI：-0.260 至 1.590 对比干针；SMD：1.093，95%CI：0.128 至 2.058 对比利多卡因），而在 1 至 3 个月时则优于（SMD：-0.314，95%CI：-0.516 至 -0.111 对比盐水）。我们的荟萃分析表明，BoNT 注射可能是慢性肩痛患者的一种安全有效的治疗选择。
