title: Botulinum toxin for subacute/chronic neck pain.
abstract: BACKGROUND
  Neck disorders are common, disabling and costly. Botulinum toxin (BoNT) intramuscular injections are often used with the intention of treating neck pain.
  
  
  OBJECTIVE
  To systematically evaluate the literature on the treatment effectiveness of BoNT for neck pain, disability, global perceived effect and quality of life in adults with neck pain with or without associated cervicogenic headache, but excluding cervical radiculopathy and whiplash associated disorder.
  
  
  METHODS
  We searched CENTRAL, MEDLINE, AMED, Index to Chiropractic Literature, CINAHL, LILACS, and EMBASE from their origin to 20 September 2010.
  
  
  METHODS
  We included randomised and quasi-randomised controlled trials in which BoNT injections were used to treat subacute or chronic neck pain.
  
  
  METHODS
  A minimum of two review authors independently selected articles, abstracted data, and assessed risk of bias, using the Cochrane Back Review Group criteria. In the absence of clinical heterogeneity, we calculated standardized mean differences (SMD) and relative risks, and performed meta-analyses using a random-effects model. The quality of the evidence and the strength of recommendations were assigned an overall grade for each outcome.
  
  
  RESULTS
  We included nine trials (503 participants). Only BoNT type A (BoNT-A) was used in these studies.High quality evidence suggests there was little or no difference in pain between BoNT-A and saline injections at four weeks (five trials; 252 participants; SMD pooled -0.07 (95% confidence intervals (CI) -0.36 to 0.21)) and six months for chronic neck pain. Very low quality evidence indicated little or no difference in pain between BoNT-A combined with physiotherapeutic exercise and analgesics and saline injection with physiotherapeutic exercise and analgesics for patients with chronic neck pain at four weeks (two trials; 95 participants; SMD pooled 0.09 (95% CI -0.55 to 0.73)) and six months (one trial; 24 participants; SMD -0.56 (95% CI -1.39 to 0.27)). Very low quality evidence from one trial (32 participants) showed little or no difference between BoNT-A and placebo at four weeks (SMD 0.16 (95% CI -0.53 to 0.86)) and six months (SMD 0.00 (95% CI -0.69 to 0.69)) for chronic cervicogenic headache. Very low quality evidence from one trial (31 participants), showed a difference in global perceived effect favouring BoNT-A in chronic neck pain at four weeks (SMD -1.12 (95% CI: -1.89 to -0.36)).
  
  
  CONCLUSIONS
  Current evidence fails to confirm either a clinically important or a statistically significant benefit of BoNT-A injection for chronic neck pain associated with or without associated cervicogenic headache. Likewise, there was no benefit seen for disability and quality of life at four week and six months.
authors: Cliniques Physio Interactive, Département de réadaptation, Faculté de Médecine, Université Laval, 1100 boul Chaudière, CP 75217, Quebec City, PQ, Canada, G1Y 3C7.
authors: Pierre
authors: P
authors: Langevin
authors: Paul Michael J
authors: PM
authors: Peloso
authors: Janet
authors: J
authors: Lowcock
authors: May
authors: M
authors: Nolan
authors: Jeff
authors: J
authors: Weber
authors: Anita
authors: A
authors: Gross
authors: John
authors: J
authors: Roberts
authors: Charles H
authors: CH
authors: Goldsmith
authors: Nadine
authors: N
authors: Graham
authors: Stephen J
authors: SJ
authors: Burnie
authors: Ted
authors: T
authors: Haines
mesh_terms: D000208:Acute Disease; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002908:Chronic Disease; D006801:Humans; D019547:Neck Pain / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A