We conducted a systematic review and meta-analysis to examine the protective effects of botulinum toxin-A (Botox-A) on spasticity and nociceptive pain in individuals with spinal cord injuries (SCIs). PubMed, Embase, and Cochrane Library databases were searched from inception to July 2023. The primary outcome of interest was spasticity and nociceptive pain. We pooled the available data using the generic inverse variance method, and we used a fixed-effect/random-effects model. We then calculated standardized mean difference (SMD) and 95% confidence intervals (95% CIs) to estimate the effect size. A total of fourteen studies meeting the inclusion criteria comprised two randomized controlled trials, five pre-post studies, and seven case reports. Across the various study designs, the majority of trials were assessed to have fair to high quality. The meta-analysis shows that Botox-A significantly decreased spasticity (SMD, -1.73; 95% CI, -2.51 to -0.95; p<0.0001, I2=48%) and nociceptive pain (SMD, -1.79; 95% CI, -2.67 to -0.91; p<0.0001, I2=0%) in SCI patients. Furthermore, Botox-A intervention improved motor function, activities of daily living (ADL), and quality of life. Our study suggests that Botox-A may alleviate spasticity and nociceptive pain in SCI patients. Moreover, the observed improvements in motor function, ADL, and overall quality of life following Botox-A intervention underscore its pivotal role in enhancing patient outcomes.

Citations

• Botulinum Toxin for Spasticity: Real-World Effects on Patient Health-Related Quality of Life and Caregiver Burden -A Long-Term Retrospective Study
  Giorgio Mandalà, Maria Luisa Capuana, Giacomo Fisco, Giuliana Grimaldi, Provvidenza Sansone, Maria Silvia Mangano
  Applied Medical Research.2026; 13(4): 1.     CrossRef
• Botulinum Toxin for Spasticity: Real-World Effects on Patient Health-Related Quality of Life and Caregiver Burden -A Long-Term Retrospective Study
  Giorgio Mandalà, Maria Luisa Capuana, Giacomo Fisco, Giuliana Grimaldi, Provvidenza Sansone, Maria Silvia Mangano
  Applied Medical Research.2026; 13(4): 1.     CrossRef
• Novel approaches for drug development against chronic primary pain: A systematic review
  Valéria Tékus, Éva Borbély, Andreas Goebel, Ralf Baron, Zsófia Hajna, Zsuzsanna Helyes
  British Journal of Pharmacology.2025;[Epub]     CrossRef
• Combined Extracorporeal Shock Wave Therapy and Botulinum Toxin Injection for Spasticity in the Acute Phase of Spinal Cord Injury: A Case Report
  Maiko Nishimura, Risa Harada, Takumi Hirabayashi, Yuka Muranaka, Toshiki Usui, Mariko Nagase, Ryoga Kashima, Wataru Saho, Ryo Yoshikawa, Yoshitada Sakai
  Progress in Rehabilitation Medicine.2025; 10: n/a.     CrossRef