What is the role of botulinum toxin (BTX) injection for the treatment of chronic pain following neck dissection surgery?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Neck dissection surgery and radiation therapy for the treatment of carcinoma of the head and neck often results in chronic pain. Four of 6 volunteers with muscular neck pain and spasm after radiotherapy for treatment of carcinoma of the head and neck who received BTX-A injections into affected sternocleidomastoid muscle in 1 or 2 locations achieved pain relief. [102]

A prospective, open-label study of 16 patients with chronic neck pain after dissection received 80-320 U of BTX-A (Dysport) injected into muscular trigger points. Outcome measures included chronic and shooting pain using VAS and quality of life improvement measures before and 4 weeks after treatment. All patients showed a significant reduction in chronic pain (4.5 before to 3.3 after treatment, p =.005) and shooting pain (6.1 before to 4.7 after treatment, p =.005), including a trend toward improvement in measures of global quality of life and function. [103]

In another study, 23 patients with chronic neuropathic pain after neck dissection were selected for an open, prospective phase II trial. [104] One group of patients received BTX-A SC in a low-dose concentration of 10 U/0.1 mL saline (n=13) compared with a high-dose-group (n=10) of 20 U/0.1 mL saline. Pain and quality of life measures were assessed at day 0 and day 28. The low-dose BTX-A group showed significant pain reduction by VAS of 4.3 at day 0 to 3 at day 28 (P< .05); however, the mean pain VAS values did not significantly improve in the high-dose group. Trends toward improvement in quality of life were only in the low-dose BTX-A group.


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