Authors' objectives: To determine whether there is any evidence on the effectiveness of Botulinum toxin (botox), A or B, in treating painful neuroma.

Authors' results and conclusions: There were 156 published studies identified through the search and after duplicates were removed, 136 published studies were identified through the search. Upon examination of the titles and abstracts of these 136 published studies, there were twenty-two studies thought to be relevant to the use of botox A/B in in treating painful neuroma; 74 were excluded due to incorrect population, 13 due to incorrect interventions, two due to incorrect outcomes, 23 due to incorrect study design, and two were animal/cell culture studies. Of the 22 studies that were retrieved in full, one was excluded due to incorrect population, one was excluded due to incorrect intervention, two were excluded due to incorrect outcomes, four were excluded due to incorrect study design and three were found in the original systematic review. Five systematic reviews on botox as a treatment for pain neuromas were identified. Therefore, six new published studies that are relevant to this systematic review. When compared to pre-intervention levels, botox treatment improves pain outcomes in four studies, botox treatment had no effect on pain outcomes compared preintervention levels in two studies. Across all studies, there was no standard protocol for botox therapy regarding the methods such as Botox dosage/type of intervention and total number of treatment sessions. There are six low level, low-quality studies (level of evidence 4) reporting on the use of botulinum toxin type A/B for the treatment of painful neuromas. When compared to pre-intervention levels, results were inconclusive with botox treatment improving pain outcomes in four studies and having no effect/not reported in two studies. It should be noted that selection bias, lack of studies population, and methodological inconsistencies cannot be excluded from the reported outcomes. Therefore, further randomized controlled studies need to be completed to determine if there is any conclusive evidence reporting on the efficacy of botox in the treatment of painful neuromas.

Authors' methods: In 2015, WorkSafeBC Evidence-based Practice Group (EPBG) commissioned a systematic review to investigate the efficacy or effectiveness of Botulinum toxin (botox), A or B, in treating painful neuroma. The findings concluded that there is low-level, low-quality data from small case series studies, level of evidence 5, reporting the benefit of botox injections in reducing pain among patients diagnosed with neuroma. Conversely, one higher-quality study, level of evidence 1, failed to show the benefit of botox injections in reducing pain among neuroma patients. This current update seeks to review the literature from the last update in 2015 in order to determine the efficacy of botox in treating painful neuromas. A systematic literature search was started on May 8, 2024. This literature search was conducted on commercial medical literature databases. The search was done by employing a combination of keywords. No other limitations were implemented in any of these searches. A manual search was also planned and conducted on the references of the articles that were retrieved in full.

Project Status: Completed

URL for project: https://www.worksafebc.com/en/about-us/research-services/evidence-based-medicine-and-systematic-reviews

Year Published: 2024

URL for published report: https://www.worksafebc.com/en/resources/health-care-providers/guides/effectiveness-botulinum-toxin-botox-a-or-b-in-treating-painful-neuroma-2024-update?lang=en&origin=s&returnurl=https%3A%2F%2Fwww.worksafebc.com%2Fen%2Fforms-resources%23sort%3DDate%26q%3DEffectiveness%2520of%2520Botulinum%2520toxin%2520(botox)%252C%2520A%2520or%2520B%252C%2520in%2520Treating%2520Painful%2520Neuroma%253A%25202024%2520Update%26f%3Alanguage-facet%3D%5BEnglish%5D%26tags%3DGuide%7C2d7eb4b30f6a4a319e0d40565c9abbab%2CHealth%2520Care%2520Provider%7C13468b0b3f074f6bade3f57ac3cdfb8e%2CSystematic%2520Review%7Cf78c29d570c14ec3b5a394385905df70&highlight=Effectiveness%20of%20Botulinum%20toxin%20(botox),%20A%20or%20B,%20in%20Treating%20Painful%20Neuroma:%202024%20Update

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Canada

Organisation Name: WorkSafeBC

Contact Address: 6591 Westminster Highway, Richmond, BC, V7C 1C6 Canada. Tel: 604-231-8417; Fax: 604-279-7698

Contact Name: ebpg@worksafebc.com

Contact Email: ebpg@worksafebc.com

Copyright: WorkSafe BC