Efficacy of Long-term Effect and Repeat Intraarticular Botulinum toxin in Patients with Painful Total Joint Arthroplasty: A Retrospective Study
Journal Title: Journal of Advances in Medicine and Medical Research - Year 2014, Vol 4, Issue 1
Abstract
Objective: Based on recent success of intra-articular (IA) Botulinum neurotoxin type A (BoNT/A; OnabotulinumtoxinA) in patients with osteoarthritis, we examined if repeat IA-BoNT/A is an effective antinociceptive in patients with refractory arthroplasty pain. Methods: 11 patients with refractory chronic arthroplasty joint pain without any evidence of infection or prosthesis loosening were referred by orthopedic surgeons. After discussion of off-label use, each patient underwent IA injection of BoNT/A, repeated based on return of pain on numeric rating scale (NRS) and functional limitation on composite validated scales, Western Ontario McMaster Osteoarthritis index (WOMAC) or Shoulder Pain and Disability (SPADI). Results: 11 patients (10 men, 1 woman) with 14 painful arthroplasty joints (3 bilateral; 12 knee and 2 shoulder) underwent ≥1 IA-BoNT/A injections (8 joints injected once, one joint injected twice only, five joints injected thrice) with doses ranging 100-300 units. Mean age was 68 years (standard deviation, 12) and follow-up ranged 1-28 months. Clinically meaningful reduction of 2-units in pain severity and really meaningful reduction in pain severity (50% reduction) were reported by 6/11 patients (6/13 joints) and 3/11 patients (3/13 joints), respectively, 1 month after the first IA-BoNT/A (100-units each). Significant improvements were noted in composite functional scales (WOMAC/SPADI). Pain relief was sustained at 3-4 month follow-up and was reproducible in those who received repeat injections. No significant adverse events were seen in any patients. Conclusions: A single intra-articular injection of BoNT/A improved pain and function in patients with chronic, refractory painful knee or shoulder arthroplasty, which sustained with repeat injections. Patients, who were refractory to the first injection, did not respond to subsequent injections of higher dose of IA-BoNT/A.
Authors and Affiliations
Jasvinder A. Singh
Keywords
Related Articles
- EP ID EP348511
- DOI 10.9734/BJMMR/2014/4897
- Views 75
- Downloads 0
Tolerability of The Copper- T Intrauterine Device by Acceptors at Jos University Teaching Hospital, Jos, North-Central Nigeria
Background: The Copper-T (Cu-T) Intrauterine device (IUD) is one of the oldest and most reliable forms of contraception. Its widespread use has been limited by side effects, such as heavy menstrual flow and pain on inser...
Exploring Medicine Information Needs of Hypertensive Patients Using Short Message Service
Aims: To explore the pattern of unmet medicine information needs of hypertensive patients on long term therapy and their attitude to use of SMS (mobile phone short message service) for medicine information exchange with...
Wolf-parkinson-white Syndrome-current Concepts in Anesthetic Practice
Wolf-Parkinson-White (WPW) syndrome is a disorder of conduction system of heart caused by presence of an abnormal accessory conduction pathway between the atria and ventricles. It is associated with tachyarrhythmias diag...
Dental Graduates Awareness of Child Abuse and Neglect (CAN)
Aims: To assess the knowledge and attitude of dental graduates regarding identification of child abuse and neglect (CAN). Study Design: This study included Dental graduates from Krishna and West Godavari districts of And...
Modulation of Macrophage Activity by a Herbo-mineral Formulation in Murine Model
Aim: The present paper investigates the effect on immune responses by a herbo-mineral formulation, Khamira Marwarid [KM], prescribed in the Indian subcontinent as a rejuvenator, especially to convalescing patients of typ...