Article

The aim of this study was to assess the efficacy of botulinum toxin
type A injections in reducing pain, impairment, and disability in patients who
have had a stroke with shoulder pain and spasticity.
DESIGN: In this prospective
randomized, double-blind, placebo-controlled trial, adults
(n = 37) with
post-stroke shoulder spasticity were screened for preinjection spasticity, rated
3 or 4 on the Modified Ashworth Scale for the shoulder adductors/internal
rotators and shoulder pain. After the baseline screening, 21 subjects were
randomized to receive either onabotulinumtoxinA (Botox; 140-200 units), into the
pectoralis major with or without injections to the teres major, or placebo
(saline) injections. Daily pain ratings using visual analog scales of best and
worst pain and Disability Assessment Scale for dressing, hygiene, pain, and
cosmesis; McGill Pain Questionnaire-Short Form;
Fugl-Meyer Scale; upper limb
range of motion; and Modified Ashworth Scale scores were assessed at baseline and
2, 4, and 12 wks after injection. Primary outcomes were assessed at week 4.
RESULTS: The subject groups were well matched at baseline. Both the botulinum
toxin type A and placebo groups showed decreased pain scores at 4 wks (P's <
0.05), with no significant differences between the groups found for any of the
daily pain ratings (P's > 0.05). Significant improvement (P < 0.05) in change
scores for hygiene on the Disability Assessment Scale was found in the botulinum
toxin type A group compared with the placebo group at week 4, and there was a
similar trend toward significance for improvement on the Disability Assessment
Scale dressing scale (P = 0.061). CONCLUSIONS: Although botulinum toxin type A
shoulder muscle injections in patients who have had a stroke with spasticity and
shoulder pain resulted in improvement in selected disability measures, the
observed pain reduction was not greater than that found for placebo.

Langue : ANGLAIS