title: Relationship Between Botulinum Toxin, Spasticity, and Pain: a Survey of Patient Perception.
abstract: OBJECTIVE
  To assess the prevalence of pain in adults with spasticity and to assess the association between the subjective experience of pain and spasticity.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  outpatient spasticity management clinic of a rehabilitation centre.
  
  
  METHODS
  Patients with upper motor neuron lesions and spasticity (n=131) were recruited.
  
  
  METHODS
  We assessed pain intensity and location, relationship between spasticity and pain perception, and perception of pain relief from botulinum toxin type-A (BoNTA) injections.
  
  
  METHODS
  Pain perception rated on a 10-point numerical rating scale and pain quality.
  
  
  RESULTS
  65% of the patients with spasticity reported presence of pain and 60% described it as an aching pain. More patients reported pain with movement (34%) compared to rest (21%). There was a statistically poor correlation between the severity of pain and spasticity (r=0.16; p>0.05). Most patients (80%) believed that their pain was related to spasticity and 62% reported that BoNTA injections decreased their pain.
  
  
  CONCLUSIONS
  The high incidence of pain noted within our sample suggests that physicians may have to consider pain management as part of spasticity treatment. Participants reported that their pain was related to their spasticity, and that it decreased after BoNTA treatment. Further study is needed to explore the relationships between objective measures of spasticity and pain.
authors.affiliation: 1Spasticity Research Program, Faculty of Medicine,University of Toronto,Toronto,Ontario,Canada.
authors.forename: Adil
authors.initials: A
authors.lastname: Shaikh
authors.affiliation: 1Spasticity Research Program, Faculty of Medicine,University of Toronto,Toronto,Ontario,Canada.
authors.forename: Chetan P
authors.identifier: http://orcid.org/0000-0003-0957-7941
authors.initials: CP
authors.lastname: Phadke
authors.affiliation: 1Spasticity Research Program, Faculty of Medicine,University of Toronto,Toronto,Ontario,Canada.
authors.forename: Farooq
authors.initials: F
authors.lastname: Ismail
authors.affiliation: 1Spasticity Research Program, Faculty of Medicine,University of Toronto,Toronto,Ontario,Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Boulias
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000150:complications* / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010146:Pain / Q000453:epidemiology / Q000209:etiology*; D059408:Pain Management; D015995:Prevalence; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA
keywords: botulinum toxin; cerebral palsy; multiple sclerosis; muscle spasticity; pain; spinal cord injury; stroke