Botulinum toxin A and musculoskeletal pain]

Relaxant muscle properties and pain relieve effectiveness in neurological spasmodic disorders of botulinum toxin A (BTXA) suggested its relevance to relieve musculoskeletal pain. The aim of this article was to collect literature data and to assess the different analgesia indications of BTXA proposed in the treatment of musculoskeletal pains.The international literature was carried out with the Medline data bank using keywords toxin and pain. Only clinical trials have been analysed.Three hundred and seventeen articles were collected and 12 clinical trials were retained. They are focused on 4 chronic diseases, neck pain, tennis elbow, Piriformis syndrome and low back pain. Results of the 6 chronic neck pain studies are contradictory and emphasize the difficulty to display a satisfactory analgesia effect of BTXA in this indication. Results of the studies concerning other indications (tennis elbow, Piriformis syndrome and low back pain) seem to be more effective and clinically pertinent.Analgesia BTXA effect seems to be conditioned by the presence of an objective muscular spasm or stringy disease inducing musculoskeletal pain.The first data concerning use of BTXA to treat musculoskeletal pains are few and are worth specifying by other studies.