TY - JOUR T1 - Botulinum Toxin Intramuscular Injections for Neck Pain: A Systematic Review and Metaanalysis JF - The Journal of Rheumatology JO - J Rheumatol DO - 10.3899/jrheum.100739 SP - jrheum.100739 AU - Pierre Langevin AU - Janet Lowcock AU - Jeffrey Weber AU - May Nolan AU - Anita R. Gross AU - Paul M. Peloso AU - John Roberts AU - Nadine Graham AU - Charles H. Goldsmith AU - Stephen J. Burnie AU - Ted Haines Y1 - 2010/12/01 UR - http://www.jrheum.org/content/early/2010/11/25/jrheum.100739.abstract N2 - Objective To assess the effect of intramuscular botulinum toxin type A (BoNT-A) injections on pain, function/disability, global perceived effect, and quality of life (QOL) in adults with neck pain (NP). Methods We searched Central, Medline, and Embase databases up to June 2010. A minimum of 2 authors independently selected articles, abstracted data, and assessed risk of bias and clinical applicability. We estimated standard mean differences (SMD) with 95% CI, relative risks (RR), and performed metaanalyses (SMDp) using a random-effects model for nonheterogeneous data. The approach of the Grading of Recommendations Assessment, Development, and Evaluation working group summarizes the quality of evidence. Results We selected 14 trials. High-quality evidence suggested BoNT-A was no better than saline at 4 weeks [4 trials/183 participants; SMDp –0.21 (95% CI –0.50 to 0.07)] and 6 months for chronic NP. Moderate-quality evidence showed a similar effect for subacute/chronic whiplash-associated disorder (WAD) on pain [4 trials/122 participants; SMDp –0.21 (95% CI –0.57 to 0.15)], disability, and QOL. Very low-quality evidence indicated BoNT-A combined with exercise and analgesics was not significant for chronic NP reduction at 4 weeks [3 trials/114 participants; SMDp –0.08 (95% CI –0.45 to 0.29)] but was at 6 months [2 trials/43 participants; SMDp –0.66 (95% CI –1.29 to –0.04)]. Conclusion Current evidence does not confirm a clinically or statistically significant benefit of BoNT-A used alone on chronic NP in the short term or on subacute/chronic WAD pain, disability, and QOL. Larger trials, subgroups, and predictors of responses defined a priori (to facilitate selection of patients most likely to benefit) and factorial designs to explore BoNT as an adjunct treatment to physiotherapeutic exercise and analgesics are needed. ER -