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Botulinum Toxin A for the treatment of cervical/shoulder pain following acute SCI

PI: Gary Maerz, MD
Funded by: Nielson Foundation
Dates: 2006-2008
Contact: Amy Dannels McClure, ND, RN – adannels-McClure@craighospital.org 303 789 8562

Pain is one of the most significant and disabling complaints following a traumatic SCI. Due to the mechanism of injury, muscles in the upper back and neck become shortened, rock hard, and extremely tender with even the slightest touch or stretch. For a subgroup of individuals with tetraplegia, this severe upper back/shoulder and neck pain limits rehabilitation productivity and potential and often affects their quality of life.

Current interventions for pain can be broadly classified into four types: surgical, pharmacological, physical and psychological. Despite the many options available, clinicians still struggle to effectively treat pain in people with SCI. For those who are not responding to multiple classes of medications, modalities, and other treatments, they suffer not only from the pain, but from the fatigue, sedation, expense, and loss of useful rehabilitation time due to attempted remedies.

In a search for another form of treatment, botulinum toxin A (BTXA) may be promising for pain control in people with tetraplegia whose pain has proven resistant to current treatment options. Clinically, BTXA is increasingly being recommended and used for treatment of pain of varying origins. In fact, one of the specific indications is for myogenic pain due to short, tight, strained muscles – just as we see with our population, but its application has not been studied in people with tetraplegia. Thus, the genesis of this project and the hope to help our patients evolved.

This treatment must be studied carefully, as proposed in our protocol, to determine its efficacy and potential application for people with spinal cord injuries. We are conducting a pilot randomized placebo-controlled trial to evaluate the efficacy of BTXA in neck and shoulder pain for people with tetraplegia while they are in their initial rehabilitation programs. We plan to enroll 20 individuals in this study, 10 will receive the placebo and 10 will receive the BTXA treatment. This project has been funded by The Craig Neilsen Foundation.