Botox for Shoulder Pain from Osteoarthritis

Most people associate Botox with treatment for wrinkles and droopy eyelids -- cosmetic therapy by dermatologists and plastic surgeons with good benefit for those who can afford it. In patients with a 6-month history of moderate to severe shoulder pain, the ability of Botox to provide meaningful relief when injected into the joint space suggests a novel form of pain therapy for osteoarthritis. Botox may prove beneficial at multiple sites, including knees, ankles and the small joints of the hands and wrists.

Recent data from the November meeting of the American College of Rheumatology includes a report from the Minneapolis Veterans Administration Medical Center regarding use of botulinum toxin (Botox is the brand name) to manage shoulder pain caused by osteoarthritis. Dr. Singh studied a treatment group of 43 patients with moderate to severe shoulder osteoarthritis. Twenty-one patients received joint injection with Botox while 22 patients received a sham injection to the shoulder (placebo). Patients who received study drug reported a significant improvement in pain scores (30 percent), compared with 9 percent improvement in those receiving sham injections. For rheumatologists, these preliminary data are encouraging, and we await further details.

Traditional approaches to shoulder osteoarthritis pain management have included oral therapy, joint injection of lidocaine/steroid combinations and eventual joint replacement. The use of Botox suggests that neurotoxins may play a role in pain modulation, and further clinical studies are needed to study this possibility. Many details have yet to be worked out, however, including the cost of such injections, the length of benefit from injectable Botox and selection criteria for candidate patients.

Jonathan D. Krant, MD, FACP