What is the evidence for botulinum toxin is the treatment of shoulder pain?
AMSTAR Rating
Summary
Patient Population:
No information was provided on the patient population except to identify all patients as adults.
Intervention:
The conclusions provided are for intramuscular injection. No summary of this information is otherwise provided.
Comparison:
Botulinum toxin injections were compared against a control group in the treatment of shoulder pain. 6 RCTs were identified for inclusion in the review. Included studies were all small and assessment of study quality revealed significant risk for study bias. Although planned, there is no subgroup analysis re: dose or approach.
Outcome:
- Pain: botulinum toxin vs. control – significant difference in favour of injection at 6-12 weeks, 3 studies (absolute risk difference 12%; 95% CI 1% to 24%; NNT=4).
- ROM: botulinum toxin vs. control – increased external rotation at one month but not at 3-6 months, 5 studies (MD = 9.8deg.; 95% CI 0.2 to 19.4).
- Safety: RR = 1.46 (95% CI = 0.64 to 3.36), absolute risk difference = 9% (95%CI -22% to 39%) associated with use of botulinum toxin injection (3 studies).
