Hichem Khenioui
Practitioner Hospitals, France
Title: Usefulness of Intra-Articular Botulinum Toxin Injections. A Literature Review
Biography
Biography: Hichem Khenioui
Abstract
Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by exces-sive muscular contractions. Recent studies have assessed the analgesic effect of botulinum toxin in jointpain and started to unravel its mechanisms.
Literature-search-methodology:
We searched the international literature via the Medline database usingthe term “intraarticular botulinum toxin injection” combined with any of the following terms: “knee”,“ankle”, “shoulder”, “osteoarthritis”, “adhesive capsulitis of the shoulder”.
Results:
Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized con-trolled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain afterjoint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indicationsand the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator wasusually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primaryoutcome measure.
Discussion-conclusion:
The number of randomized trials and sample sizes are too small to provide asatisfactory level of scientific evidence or statistical power. Unanswered issues include the effectivedosage and the optimal dilution and injection modalities of botulinum toxin.