The effects of intra-articular botulinum toxin on sacroiliac, cervical/lumbar facet and sternoclavicular joint pain and C-2 root and lumbar disc pain: A case series of 11 patients

Aims and Objective: In this small case series, we evaluated the effects and safety of injecting botulinum toxin type A (BoTN/A; Botox) and botulinum toxin type B (BoTN/B; Myobloc) into the sacroiliac joints, cervical/lumbar facet joints, C-2 roots, sternoclavicular joint and lumbar disc in patients with refractory pain. Methods: Eleven adult patients with refractory pain were injected with BoTN/A or BoTN/B. Results: All 11 patients had either a decrease (8 out of 11) or no change (3 out of 11) in their pain score after BoTN injection. All patients who responded to the injections noted improved function in activities of daily living and range of motion because of pain reduction. No side effects were noted. The mean duration of pain relief for the first BoTN treatments was 2.0 months. The median difference of duration of pain relief between BoTN and previous steroid injection was 1.6 months with BoTN being superior. The median change in pain score (0 to 10) after BoTN injection was -3. Conclusions: In the population of patients injected with BoTN in this case series, BoTN lasted longer than steroid injections and gave excellent pain relief. Based on the positive findings of this study, we feel that further, randomized, controlled trials for the use of BoTN/A and BoTN/B in root and joint pain are warranted.