Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genova, Italy.
Department of Physiotherapy, Human Physiology and Anatomy, Experimental Anatomy Research Group, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium.
Toxins (Basel). 2021 Sep 10;13(9):640. doi: 10.3390/toxins13090640.
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; = 0.08). Caution should be used when interpreting such results, since the studies displayed very high heterogeneity (I = 94%, < 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.
几项研究调查了肉毒杆菌毒素 A（BoNT-A）治疗慢性肌肉骨骼疼痛的效果，结果却大相径庭。然而，迄今为止，尚无关于 BoNT-A 作为多模式治疗辅助手段的效果的综合证据。因此，我们在 2020 年 11 月前通过 Medline（通过 PubMed）、EMBASE 和 Cochrane Library-CENTRAL 检索了随机对照试验（RCT），这些试验调查了 BoNT-A 作为慢性肌肉骨骼疼痛辅助治疗的用途。我们通过 RoB 2.0 和 GRADE 方法分别评估了偏倚风险（RoB）和研究的总体质量。我们对纳入的六项 RCT 的汇总结果进行了荟萃分析。其中四项研究的 RoB 较低，而两项研究的 RoB 较高。荟萃分析表明，BoNT-A 作为辅助治疗与单独使用传统治疗相比，并未显著减轻疼痛（SMD-0.89；95%CI-1.91；0.12；=0.08）。由于研究显示出非常高的异质性（I = 94%，<0.001），因此在解释这些结果时应谨慎。证据的总体确定性非常低。从本次系统评价中检索到的数据不支持 BoNT-A 作为治疗慢性肌肉骨骼疼痛的辅助治疗。
