• Siddharth Kharkar, Prakash Ambady, Yedatore Venkatesh, and Robert J Schwartzman.
• Hahnemann University Hospital, Philadelphia, PA and Department of Neurology, Drexel University College of Medicine, Philadelphia, PA 19107, USA.
• Pain Physician. 2011 Sep 1;14(5):419-24.

BackgroundPain associated with Complex Regional Pain Syndrome (CRPS) is frequently excruciating and intractable. The use of botulinum toxin for relief of CRPS-associated pain has not been well described.ObjectivesTo assess whether intramuscular botulinum toxin injections cause relief of pain caused by CRPS, and to assess the risks of this treatment.Study DesignRetrospective chart review.SettingOutpatient clinic.Methods37 patients with spasm/dystonia in the neck and/or upper limb girdle muscles.InterventionEMG-guided injection of Botulinum Toxin - A (BtxA), 10-20 units per muscle. Total dose used was 100 units in each patient. Local pain score was measured on an 11-point Likert scale, 4 weeks after BtxA injections.ResultsMean pain score decreased by 43% (8.2 ± 0.8 to 4.5 ± 1.1, P < 0.001). 97% patients had significant pain relief. One patient had transient neck drop after the injections.LimitationsThis is a retrospective study, it lacks a control group and hence the placebo effect cannot be eliminated. This study does not provide information on the efficacy of this treatment after 4 weeks.ConclusionsIntramuscular injection of botulinum toxin in the upper limb girdle muscles was beneficial for short term relief of pain caused by CRPS. The incidence of complications was low (2.7%).

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