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
Y1 - 2025/3
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 - botulinum toxin
KW - goal attainment scaling
KW - pain
KW - rehabilitation
KW - upper limb spasticity
UR - http://www.scopus.com/inward/record.url?scp=105001167982&partnerID=8YFLogxK
U2 - 10.3390/toxins17030117
DO - 10.3390/toxins17030117
M3 - Article
AN - SCOPUS:105001167982
SN - 2072-6651
VL - 17
JO - Toxins
JF - Toxins
IS - 3
M1 - 117
ER -