Treatment of neck pain with type A botulinum toxin evaluated by Neck Pain Questionnaire (NPQ)

To investigate the effects of a treatment with botulinum toxin in patients suffering of cervical pain can be defined as a painful condition of the upper region of the spinal column affecting neck and shoulders. It is one of the most frequent complaints and estimates suggest it affects 7 out of 10 people, with varying degrees of intensity. Although there is a number of causes, most often muscular contraction is involved as a probable consequence of a variety of irritative phenomena.

In our study 26 patients suffering from cervical pain were treated (21 women and 5 men, mean age 60.8 years, range 37-88). Three scales were used to evaluate pain: the Visual Analogue Scale (VAS), the Verbal Scale (VS) and the Neck ad Pain Questionnaire (NPQ). Scoring on all three of these scales was carried out at time 0 (T0) prior to treatment and at time 1 (T1) after 4 months. Patients were treated with 500 MU of Type A Dysport Toxin (Ipsen SpA), made up with 2.5 ml of sodium chloride solution at 0.9%, giving 20 units of toxin in 1 ml. An average of 180 units of toxin were administered to each patient, equivalent to 0.9 ml per point/unit (range 40- 360 units). Patients were given from 1 to 4 units at each session with an average of 2 units. The most common muscles injected were splenius cervicis, the sternocleidomastioid, trapetius, paravertebral and levator scapulae. of patients with cervical pain treated with botulinum toxin were as follows: the mean score on the Visual analogue scale (VAS) at T0 was 6.31, while at T1 it fell to 2.65, i.e. a decrease of 3.66 scores, equivalent to 58%. On the verbal scale (VS), the mean score at T0 was 2, which dropped to 0.8 at T1, a decrease of 1.2 scores, equivalent to 60%. By the Neck Pain Questionnaire (NPQ) the mean T0 score was 12.76, a figure which fell to 7.62 at T1, a drop of 5.14 points, equivalent to 40.28%. The statistical analysis shows that between T0 and T1 the decrease in the VAS, VA and NPQ scores was highly significant (p< 0.01).

The administration of botulinum toxin appears to be a useful therapy for the treatment of muscular-skeletal pain. Technically, the therapeutic use and efficacy of botulinum toxin principally consists in the practical possibility of delivering the toxin principally remains in the target structures. If performed by qualified personnel, the treatment with botulinum toxin can be carried out in day surgery and it appears to be safe, with few risks and a minimum of side effects. To conclude, the main goals in the treatment of muscular-skeletal pain with botulinum toxin are in the breaking of the vicious circle of contraction pain -contraction, in stopping the pain from becoming chronic and achieving a valid alternative therapy.