Effectiveness of Botulinum Toxin A for Persistent Upper Limb Pain After Breast Cancer Treatment: A Double-Blinded Randomized Controlled Trial

• DOI: 10.1016/j.apmr.2017.12.032
• Publication Date: 2018-02-01T15:07:38Z
• Authors: An De Groef; Nele Devoogdt; Marijke Van Kampen; Ines Nevelsteen; Ann Smeets; Patrick Neven; Inge Geraerts; Lore Dams; Elien Van der Gucht; Philippe Debeer
• Keywords: Adult; Shoulder; Antineoplastic Protocols; Breast Neoplasms; Middle Aged; Combined Modality Therapy; Exercise Therapy; 3. Good health; Upper Extremity; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Double-Blind Method; Neuromuscular Agents; Musculoskeletal Pain; Quality of Life; Humans; Female; Botulinum Toxins, Type A

To investigate the effect of a single botulinum toxin A (BTX-A) infiltration in the pectoralis major muscle in addition to a standard physical therapy program for treatment of persistent upper limb pain in breast cancer survivors.Double-blinded (patient and assessor) randomized controlled trial.A university hospital.Breast cancer patients (N=50) with pain.The intervention group received a single BTX-A infiltration. The control group received a placebo (saline) infiltration. Within 1 week after the infiltration, all patients attended an individual physical therapy program (12 sessions) during the first 3 months and a home exercise program up to 6 months after infiltration.The primary outcome was change in pain intensity at the upper limb (visual analog scale, 0-100) after 3 months. Secondary outcomes were prevalence rate of pain, pressure hypersensitivity, pain quality, shoulder function, and quality of life. Measures were taken before the intervention and at 1, 3, and 6 months' follow-up.No significant difference in change in pain intensity after 3 months was found (mean difference in change, 3/100; 95% confidence interval [CI], -13 to 19). From baseline up to 6 months, a significantly different change in upper limb pain intensity was found between groups in favor of the intervention group (mean difference in change, 16/100; 95% CI, 1-31).A single BTX-A infiltration in combination with an individual physical therapy program significantly decreased pain intensity at the upper limb in breast cancer survivors up to 6 months. However, the effect size was not clinically relevant, and no other beneficial effects were found.