Botulinum toxin type A for subacute/chronic neck pain.

Area of Science:

• Neurology
• Pain Management
• Musculoskeletal Disorders

Background:

• Botulinum toxin type A (BoNT-A) injections are a common treatment for neck pain unresponsive to other therapies.
• The benefit-harm profile of BoNT-A for neck pain remains uncertain, necessitating a comprehensive review of current evidence.

Purpose of the Study:

• To assess the benefits and harms of intramuscular BoNT-A injections for individuals with subacute to chronic neck pain.
• To synthesize evidence from randomized controlled trials (RCTs) evaluating BoNT-A for neck pain.

Main Methods:

• A systematic search of multiple databases (CENTRAL, MEDLINE, Embase, CINAHL) and trial registers was conducted up to March 2026.
• Included were RCTs comparing BoNT-A to placebo or no treatment in adults with subacute to chronic neck disorder.
• Outcomes included pain, function-disability, quality of life, treatment success, and adverse events. Risk of bias was assessed using ROB 2, and certainty of evidence with GRADE.

Main Results:

• BoNT-A may provide slight-to-small short-term pain relief (6% absolute improvement) and perceived treatment success (20% absolute improvement).
• No significant long-term benefits were observed for physical function or health-related quality of life.
• A moderate risk reduction in pain events (23% absolute) may be overestimated due to publication bias. Non-serious adverse events, such as injection soreness, were 16% more frequent.

Conclusions:

• BoNT-A offers limited short-term benefits for neck pain, with no demonstrated long-term advantages in function or quality of life.
• The evidence is limited by high risk of bias, imprecision, and potential publication bias, indicating a need for larger, high-quality studies.
• While non-serious adverse events are more common, the overall benefit-harm profile remains uncertain, warranting cautious consideration of BoNT-A for neck pain management.