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Cochrane Database of Systematic Reviews

Botulinum toxin for subacute/chronic neck pain

Overview of attention for article published in Cochrane database of systematic reviews, May 2015
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Title
Botulinum toxin for subacute/chronic neck pain
Published in
Cochrane database of systematic reviews, May 2015
DOI 10.1002/14651858.cd008626.pub3
Pubmed ID
Authors

Pierre Langevin, Paul Michael J Peloso, Janet Lowcock, May Nolan, Jeff Weber, Anita Gross, John Roberts, Charles H Goldsmith, Nadine Graham, Stephen J Burnie, Ted Haines

Abstract

Neck disorders are common, disabling and costly. Botulinum toxin (BoNT) intramuscular injections are often used with the intention of treating neck pain. To systematically evaluate the literature on the treatment effectiveness of BoNT for neck pain, disability, global perceived effect and quality of life in adults with neck pain with or without associated cervicogenic headache, but excluding cervical radiculopathy and whiplash associated disorder. We searched CENTRAL, MEDLINE, AMED, Index to Chiropractic Literature, CINAHL, LILACS, and EMBASE from their origin to 20 September 2010. We included randomised and quasi-randomised controlled trials in which BoNT injections were used to treat subacute or chronic neck pain. A minimum of two review authors independently selected articles, abstracted data, and assessed risk of bias, using the Cochrane Back Review Group criteria. In the absence of clinical heterogeneity, we calculated standardized mean differences (SMD) and relative risks, and performed meta-analyses using a random-effects model. The quality of the evidence and the strength of recommendations were assigned an overall grade for each outcome. We included nine trials (503 participants). Only BoNT type A (BoNT-A) was used in these studies.High quality evidence suggests there was little or no difference in pain between BoNT-A and saline injections at four weeks (five trials; 252 participants; SMD pooled -0.07 (95% confidence intervals (CI) -0.36 to 0.21)) and six months for chronic neck pain. Very low quality evidence indicated little or no difference in pain between BoNT-A combined with physiotherapeutic exercise and analgesics and saline injection with physiotherapeutic exercise and analgesics for patients with chronic neck pain at four weeks (two trials; 95 participants; SMD pooled 0.09 (95% CI -0.55 to 0.73)) and six months (one trial; 24 participants; SMD -0.56 (95% CI -1.39 to 0.27)). Very low quality evidence from one trial (32 participants) showed little or no difference between BoNT-A and placebo at four weeks (SMD 0.16 (95% CI -0.53 to 0.86)) and six months (SMD 0.00 (95% CI -0.69 to 0.69)) for chronic cervicogenic headache. Very low quality evidence from one trial (31 participants), showed a difference in global perceived effect favouring BoNT-A in chronic neck pain at four weeks (SMD -1.12 (95% CI: -1.89 to -0.36)). Current evidence fails to confirm either a clinically important or a statistically significant benefit of BoNT-A injection for chronic neck pain associated with or without associated cervicogenic headache. Likewise, there was no benefit seen for disability and quality of life at four week and six months.

Mendeley readers

The data shown below were compiled from readership statistics for 64 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 2%
Unknown 63 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 13 20%
Student > Doctoral Student 9 14%
Researcher 6 9%
Student > Postgraduate 6 9%
Other 5 8%
Other 18 28%
Unknown 7 11%
Readers by discipline Count As %
Medicine and Dentistry 32 50%
Agricultural and Biological Sciences 7 11%
Nursing and Health Professions 7 11%
Design 2 3%
Psychology 2 3%
Other 5 8%
Unknown 9 14%