Pain Reduction with Repeated Injections of Botulinum Toxin A in Upper Limb Spasticity: A Longitudinal Analysis from the ULIS-III Study

TY - JOUR

T1 - Pain Reduction with Repeated Injections of Botulinum Toxin A in Upper Limb Spasticity

T2 - A Longitudinal Analysis from the ULIS-III Study

AU - Turner-Stokes, Lynne

AU - Buchwald, Khan

AU - Ashford, Stephen A

AU - Fheodoroff, Klemens

AU - Jacinto, Jorge

AU - Narayanan, Ajit

AU - Siegert, Richard J

N1 - Publisher Copyright: © 2025 by the authors.

PY - 2025/3/1

Y1 - 2025/3/1

N2 - Pain reduction is a common goal of the treatment of upper limb spasticity with botulinum toxin (BoNT-A). ULIS-III was a large international, observational, longitudinal study (N = 953) conducted in real-life clinical practice over two years. In this secondary post hoc analysis, we examine whether goals for pain reduction were met over repeated injection cycles. We report serial changes in pain severity and explore predictors of pain reduction and injection frequency. Patients were selected if pain reduction was a primary/secondary goal for at least one cycle (n = 438/953). They were assessed at the start and end of each cycle using the goal attainment T-score alongside a self-report of pain severity (range 0–10). Across all cycles, pain-related goals were set for 1189/1838 injections (64.7%) and were achieved in 839 (70.6%). Patients continued to show a significant reduction in pain (p < 0.001) for each injection up to seven cycles, with some cumulative benefit (p < 0.001). Those requiring more frequent injections tended to have higher starting pain scores and a smaller reduction in pain score, but these differences were not significant when other covariates (age, previous injection history, time since onset, severity and distribution of spasticity) were taken into account (p > 0.713). Conclusion: Repeated BoNT-A administration continued to result in a significant reduction in upper limb spasticity-related pain, regardless of patient-related factors.

AB - Pain reduction is a common goal of the treatment of upper limb spasticity with botulinum toxin (BoNT-A). ULIS-III was a large international, observational, longitudinal study (N = 953) conducted in real-life clinical practice over two years. In this secondary post hoc analysis, we examine whether goals for pain reduction were met over repeated injection cycles. We report serial changes in pain severity and explore predictors of pain reduction and injection frequency. Patients were selected if pain reduction was a primary/secondary goal for at least one cycle (n = 438/953). They were assessed at the start and end of each cycle using the goal attainment T-score alongside a self-report of pain severity (range 0–10). Across all cycles, pain-related goals were set for 1189/1838 injections (64.7%) and were achieved in 839 (70.6%). Patients continued to show a significant reduction in pain (p < 0.001) for each injection up to seven cycles, with some cumulative benefit (p < 0.001). Those requiring more frequent injections tended to have higher starting pain scores and a smaller reduction in pain score, but these differences were not significant when other covariates (age, previous injection history, time since onset, severity and distribution of spasticity) were taken into account (p > 0.713). Conclusion: Repeated BoNT-A administration continued to result in a significant reduction in upper limb spasticity-related pain, regardless of patient-related factors.

KW - Humans

KW - Muscle Spasticity/drug therapy

KW - Botulinum Toxins, Type A/administration & dosage

KW - Longitudinal Studies

KW - Male

KW - Female

KW - Adult

KW - Middle Aged

KW - Upper Extremity

KW - Neuromuscular Agents/administration & dosage

KW - Pain/drug therapy

KW - Aged

KW - Treatment Outcome

KW - Pain Measurement

UR - http://www.scopus.com/inward/record.url?scp=105001167982&partnerID=8YFLogxK

U2 - 10.3390/toxins17030117

DO - 10.3390/toxins17030117

M3 - Article

C2 - 40137890

SN - 2072-6651

VL - 17

JO - Toxins

JF - Toxins

IS - 3

M1 - 117

ER -