title: Botulinum toxin assessment, intervention and aftercare for paediatric and adult niche indications including pain: international consensus statement.
abstract: Evidence is emerging for the use of botulinum neurotoxin type-A (BoNT-A) for niche indications including pain independent of spasticity. Pain indications such as chronic nociceptive back pain, piriformis syndrome, chronic myofascial pain, pelvic pain, complex regional pain syndrome, facial pain and neuropathic pain are outlined in this paper. Of these, class I evidence is available for the treatment of chronic nociceptive low back pain, piriformis syndrome, myofascial pain, facial pain, neuropathic pain and plantar fasciitis. Peri-operative use of BoNT-A is emerging, with indications including planning for surgery and facilitating surgery, as well as healing and improving analgesia post-operatively. Evidence is limited, although there are some reports that clinicians are successfully using BoNT-A peri-operatively. There is class I evidence showing pre-operative use of BoNT-A has a beneficial effect on outcomes following adductor-release surgery. The use of BoNT for treatment of tremor, other than neck tremor in the setting of cervical dystonia, including evidence for upper limb tremor, cranial tremor and non-dystonic neck tremor is reviewed. The evidence is variable at this stage, and further study is required to develop definitive recommendations for the clinical utility of BoNT-A for these indications.
authors.affiliation: Victorian Paediatric Rehabilitation Service, Monash Medical Centre, Clayton, Victoria, Australia. barry.rawicki@med.monash.edu.au
authors.forename: B
authors.initials: B
authors.lastname: Rawicki
authors.forename: G
authors.initials: G
authors.lastname: Sheean
authors.forename: V S C
authors.initials: VS
authors.lastname: Fung
authors.forename: S
authors.initials: S
authors.lastname: Goldsmith
authors.forename: C
authors.initials: C
authors.lastname: Morgan
authors.forename: I
authors.initials: I
authors.lastname: Novak
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002986:Clinical Trials as Topic; D006801:Humans; D038622:Internationality; D009209:Myofascial Pain Syndromes / Q000188:drug therapy / Q000503:physiopathology; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010148:Intractable Pain / Q000145:classification* / Q000188:drug therapy* / Q000503:physiopathology; D010149:Postoperative Pain / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods / Q000639:trends; D014202:Tremor / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology
chemical_list: D000700:Analgesics; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A