A prospective randomized controlled study of the role of botulinum toxin in whiplash-associated disorder.
OBJECTIVE
To investigate the effectiveness of botulinum toxin in preventing the development of chronic whiplash-associated disorder.


METHODS
Prospective, randomized, placebo-controlled double-blind study.


METHODS
Regional Neurological Rehabilitation Centre with participants being at home.


METHODS
Thirty-seven patients with whiplash-associated disorder who remained symptomatic two months after injury.


METHODS
Patients were randomized to receive either 250 units botulinum toxin type A (Dysport) or placebo (normal saline). Four trigger points were injected with 0.625 mL of injectant.


METHODS
Tenderness to palpation scores, visual analogue pain scale, Vernon-Mior Neck Pain and Disability Index and cervical range of motion. Follow-up assessments were carried out at four weeks and three months after treatment.


RESULTS
Twenty participants received botulinum toxin and 17 received placebo. Both groups showed a tendency towards improvement in pain scores, Vernon-Mior Index and range of motion at four weeks and three months, with the changes being more pronounced in the toxin group. The change in Vernon-Mior Index in the toxin group was both statistically and clinically significant (i.e. a change of score of > or = 5 from baseline to follow-up). Group comparisons did not meet statistical significance.


CONCLUSIONS
The improvements in outcome measures suggest that botulinum toxin type A may have a role to play in the management of whiplash-associated disorder but larger studies are required to clarify the situation.
National Rehabilitation Hospital, Dublin, Ireland. Aine.Carroll@NRH.ie
Aine
A
Carroll
Mike
M
Barnes
Catherine
C
Comiskey
D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000188:drug therapy* / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014911:Whiplash Injuries / Q000188:drug therapy* / Q000503:physiopathology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A