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

Publication date: July 2018

Source: Archives of Physical Medicine and Rehabilitation, Volume 99, Issue 7

Author(s): An De Groef, Nele Devoogdt, Marijke Van Kampen, Ines Nevelsteen, Ann Smeets, Patrick Neven, Inge Geraerts, Lore Dams, Elien Van der Gucht, Philippe Debeer

Abstract

Objective

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.

Design

Double-blinded (patient and assessor) randomized controlled trial.

Setting

A university hospital.

Participants

Breast cancer patients (N=50) with pain.

Intervention

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.

Main Outcome Measures

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.

Results

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).

Conclusions

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.

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