Content » Vol 39, Issue 6

Original report

Is botulinum toxin type A effective in the treatment of spastic shoulder pain in patients after stroke? A double-blind randomized clinical trial

Ester Marco, Esther Duarte, Joan Vila, Marta Tejero, Anna Guillen, Roser Boza, Ferran Escalada and Josep M. Espadaler
DOI: 10.2340/16501977-0066


Objective: To determine the efficacy of botulinum toxin type A for the treatment of spastic shoulder pain in patients after stroke.
Design: Double-blind randomized clinical trial.
Patients: Of 31 patients enrolled from an acute-care hospital in Spain, 2 cases dropped out (drop-out rate 6. 5%). Fourteen subjects were treated with infiltration of 500 units of botulinum toxin type A in the pectoralis major muscle of the paretic side, and 15 with a placebo.
Methods: After infiltration, both groups received transcutaneous electrical nerve stimulation for 6 weeks. Patients were assessed by the use of the Visual Analogue Scale for pain. A good result concerning pain was considered when the Visual Analogue Scale score was below 33. 3 mm or less than half the initial score. The patients were followed-up for 6 months.
Results: The patients treated with botulinum toxin type A showed a significantly greater pain improvement from the first week post-infiltration. Persistent shoulder pain was observed more frequently in the placebo group, with relative risks in the range 0. 32–0. 41 during the follow-up period.
Conclusion: Patients with spastic shoulder pain treated with a botulinum toxin type A infiltration in the pectoralis major muscle of the paretic side have a higher likelihood of pain relief (between 2. 43- and 3. 11-fold).

Lay Abstract


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