Annals of Rehabilitation Medicine

"Nociceptive pain"

Review Article

Spinal cord injury

Effects of Botulinum Toxin-A for Spasticity and Nociceptive Pain in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis: Dewan Md. Sumsuzzman, Zeeshan Ahmad Khan, Irin Sultana Nila, Vanina Myuriel Villagra Moran, Madhuvilakku Rajesh, Won Jong Yang, Yonggeun Hong; Ann Rehabil Med 2024;48(3):192-202. Published online June 28, 2024; DOI: https://doi.org/10.5535/arm.240034

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

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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

10,026 View
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Original Articles

The Availability of Quantitative Assessment of Pain Perception in Patients With Diabetic Polyneuropathy: Tae Jun Park, Sung Hoon Kim, Hi Chan Lee, Sae Hoon Chung, Ji Hyun Kim, Jin Park; Ann Rehabil Med 2018;42(3):433-440. Published online June 27, 2018; DOI: https://doi.org/10.5535/arm.2018.42.3.433

Abstract
PDF

Objective
To evaluate the usefulness of the quantitative assessment of pain perception (QAPP) in diabetic polyneuropathy (DPN) patients.
Methods
Thirty-two subjects with DPN were enrolled in this study. The subjects’ pain perception was assessed quantitatively. Current perception threshold (CPT) and pain equivalent current (PEC) were recorded. All patients were tested with a nerve conduction study (NCS) for evaluation of DPN and pain-related evoked potential (PREP) for evaluation of small fiber neuropathy (SFN) on bilateral upper and lower limbs. All patients were asked to participate in tests such as visual analogue scale (VAS) and SF-36 Health Survey Version 2 to evaluate their subjective pain and quality of life, respectively.
Results
The PEC of QAPP showed significant correlations with VAS (p=0.002) and physical function surveyed with SF-36 Health Survey Version 2 (p=0.035). The results of QAPP had no correlation with NCS, but there was a significant relationship between the CPT of QAPP and PREP (p=0.003).
Conclusion
The QAPP may be useful not only in providing objective evaluations of subjective pain in patients with DPN but also in the assessment of diabetic SFN.

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Structural Nerve Remodeling at 3-T MR Neurography Differs between Painful and Painless Diabetic Polyneuropathy in Type 1 or 2 Diabetes
Johann M. E. Jende, Jan B. Groener, Zoltan Kender, Christian Rother, Artur Hahn, Tim Hilgenfeld, Alexander Juerchott, Fabian Preisner, Sabine Heiland, Stefan Kopf, Peter Nawroth, Martin Bendszus, Felix T. Kurz
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Effect of Topical Capsaicin on Painful Sensory Peripheral Neuropathy in Patients with Type 2 Diabetes: A Double-Blind Placebo-Controlled Randomised Clinical Trial
Batakeh Ba Agoons, Mesmin Dehayem Yefou, Jean-Claude Katte, Martine Claude Etoa Etoga, Dayawa D Agoons, Faustin Yepnjio, Anne Boli, Yves Wasnyo, Eugene Sobngwi, Jean-Claude Mbanya
Cureus.2020;[Epub] CrossRef

8,058 View
156 Download
2 Web of Science
2 Crossref

Pain-Related Evoked Potential in Healthy Adults: Kyung Joon Oh, Sung Hoon Kim, Young-Hee Lee, Jong Heon Kim, Hong Sun Jung, Tae Jun Park, Jin Park, Jong Mock Shinn; Ann Rehabil Med 2015;39(1):108-115. Published online February 28, 2015; DOI: https://doi.org/10.5535/arm.2015.39.1.108

Abstract
PDF

Objective

To investigate the normal data of pain-related evoked potentials (PREP) elicited with a concentric surface electrode among normal, healthy adults and the relationship between PREP and pain intensity.

Methods

Sixty healthy volunteers (22 men and 38 women; aged 36.4±10.7 years; height, 165.4±7.8 cm) were enrolled. Routine nerve conduction study (NCS) was done to measure PREP following electrical stimulation of hands (C7 dermatome) and feet (L5 dermatome). Negative peak (N), positive peak (P) latencies, peak to peak (NP) amplitudes, conduction velocity (CV), and verbal rating scale (VRS) score were obtained. Linear regression analysis tested for significant relevance between variables of PREP and VRS score.

Results

Normal NCS results were obtained in all subjects. N latency of hand PREP was 163.8 ±40.0 ms (right) and 161.0±39.9 ms (left). N latency of foot PREP was 178.0±43.9 ms (right), 180.4±43.4 ms (left). NP amplitude of hands was 20.6±10.6 µV (right) and 21.9±11.6 µV (left). NP amplitude of feet was 18.8±8.3 µV (right) and 19.0±8.4 µV (left). The calculated CV was 13.2±4.7 m/s and VRS score was 3.8±1.0. A highly significant positive correlation was evident between VRS score and NP amplitude (y=0.1069x+1.781, r=0.877, n=60, p<0.0001).

Conclusion

PREP among normal, healthy adults revealed a statistically significant correlation between PREP amplitude and VRS score.

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