Intra-articular injections of botulinum toxin a for refractory joint pain: a systematic review and meta-analysis.
OBJECTIVE
To assess the benefit of intra-articular injection of Botulinum toxin A (BoNT-A) for chronic refractory joint pain regardless of joint or pathology.


METHODS
The search was performed on Ovid MEDLINE(R) In-Process and Other Non-Indexed Citations, Ovid MEDLINE(R), Ovid EMBASE, Web of Science, and Scopus inception through Week 12, 2016. Trial selection: Clinical randomized controlled trials that evaluated BoNT-A intra-articular injection in patients with refractory joint pain were included.


METHODS
Two independent reviewers conducted data extraction.


RESULTS
A total of 6 out of 284 records were included. The analysis indicated that a statistically significant decreased pain score was found in BoNT-A therapy group than control group with WMD=1.10 (95% CI: 0.35 to 1.85; P<0.001; I2=95%); WMD=0.7 (95% CI: 0.09 to 1.32; P=0.02; I2=0%) at week 4, and 8 after injection, respectively. WOMAC score was also significant decreased in BoNT-A therapy group than control group with WMD=4.71 (95% CI: 2.76 to 6.67; P<0.001; I2=0%); WMD=3.67 (95% CI: 1.08 to 6.26; P=0.006; I2=27%) at week 4 and12 after injection, respectively. There was no difference in adverse event between BoNT-A therapy group and control group with OR=1.25 (95% CI: 0.88 to 1.78; P=0.47; I2=0%).


CONCLUSIONS
As compared with conventional therapy, BoNT-A intra-articular injection have beneficial effects with improved pain score and WOMAC score in adult patients with refractory joint pain.
1 Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, PR China.|Tao Wu and Hai-xin Song contributed equally to this work.
Tao
T
Wu
1 Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, PR China.|Tao Wu and Hai-xin Song contributed equally to this work.
Hai-Xin
HX
Song
2 Department of Rehabilitation Medicine, Hangzhou Hospital of Zhejiang CAPF, Hang Zhou, PR China.
Yan
Y
Dong
1 Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, PR China.
Ye
Y
Ye
1 Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hang Zhou, PR China.
Jian-Hua
JH
Li
D018771:Arthralgia / Q000188:drug therapy* / Q000209:etiology; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007270:Injections, Intra-Articular; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010148:Intractable Pain / Q000188:drug therapy* / Q000209:etiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
Intra-articular injection; Osteoarthritis; botulinum toxin; pain; systematic review