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Analgesic effect of botulinum toxin in children with cerebral palsy: A systematic review
Stramkauskaite Almina1, Ylaite Karile1, Prasauskiene Audrone1
1Department of Children's Rehabilitation, Lithuanian University of Health Sciences, Lithuania.
Insights
Botulinum toxin (BTX) shows promise for managing hypertonia-related pain in non-ambulant children with cerebral palsy (CP). However, evidence for its effectiveness in other CP populations and post-operative pain is currently mixed.
Area of Science:
- Pediatric Neurology
- Pain Management
- Rehabilitation Medicine
Background:
- Children with cerebral palsy (CP) often experience significant pain, particularly related to muscle hypertonia.
- Effective pain management strategies are crucial for improving the quality of life for children with CP.
- Botulinum toxin (BTX) is increasingly explored as a therapeutic option for various conditions in pediatric populations.
Purpose of the Study:
- To systematically review the existing literature on the analgesic efficacy of botulinum toxin (BTX) for pain management in children with cerebral palsy (CP).
- To evaluate the evidence supporting BTX use for hypertonia-related pain and post-operative pain in pediatric CP patients.
Main Methods:
- A systematic literature search was conducted in July-August 2020, including interventional studies of children (0-18 years) with CP treated with BTX.
- Eligibility criteria focused on studies measuring pain or satisfaction with pain management, published in English-language peer-reviewed journals.
- Eleven studies met the criteria, encompassing nine on hypertonia-related pain and two on post-operative pain, with evidence levels ranging from II to IV.
Main Results:
- High-quality evidence (Level II) from one study and observational data from two studies support BTX for muscle hypertonia-related pain in non-ambulant children with CP (GMFCS levels IV-V).
- Evidence for BTX's analgesic effects in children with CP in GMFCS levels I-III was contradictory, potentially due to study heterogeneity and design.
- Mixed evidence exists for BTX in reducing post-operative pain, likely influenced by variations in surgical techniques, injection protocols, and outcome measures.
Conclusions:
- Botulinum toxin (BTX) demonstrates potential as an analgesic for hypertonia-related pain in specific pediatric CP populations (non-ambulant, GMFCS IV-V).
- Further high-quality research is needed to clarify the efficacy of BTX for pain management in ambulatory children with CP (GMFCS I-III).
- The utility of BTX for post-operative pain management in pediatric CP requires more standardized research protocols and outcome assessments.
Abstract:
This review aims to determine the analgesic efficacy of botulinum toxin (BTX) for the management of pain in children with cerebral palsy (CP). During July and August 2020, a systematic literature search was performed using a mixture of subject headings and free text. The eligibility criteria for inclusion in the review were: (1) interventional studies, (2) participants: children aged 0-18 with CP, (3) participants were treated with BTX, (4) an outcome measure of pain or satisfaction with pain management, and (5) published in an English-language peer-reviewed journal. Eleven studies met the eligibility criteria; nine studies explored analgesic effects of BTX for hypertonia related pain and two for postoperative pain. The studies were of level II to level IV evidence. We identified one high-quality study, which provides level II evidence, and two observational studies that supported BTX therapy for muscle hypertonia related pain in non-ambulant children with CP (GMFCS levels IV and V). For children in GMFCS levels I to III, the evidence for the analgesic effects of BTX was contradictory possibly due to the heterogeneity of the studies and/or weak study design. Mixed evidence for the use of BTX to reduce pain after hip surgery was found likely due to differences in the surgical method, injection protocols, and outcome measures.
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