Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials

Published: 20 May 2024
Abstract Views: 505
PDF: 243
Supplementary materials: 38
HTML: 4
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Pain represents a common symptom of several diseases and is often associated with a reduction in rehabilitation outcomes and recovery. The effectiveness of pain alleviation by botulinum toxin has been recently demonstrated. We searched in PubMed the papers about this topic published in the last ten years, and we selected clinical trials, guidelines, meta-analyses, reviews, and systematic reviews. We used different approaches: multiperspective presentation, lexical evaluation, and systematic review. The systematic review was only performed for the randomized controlled trials. We predominantly found reviews and trials about the rehabilitation of stroke/brain injury and epicondylitis. The most common outcome measures were pain, function, and spasticity. Among the common words, pain was the most frequent and the terms were grouped into different families, especially concerning the outcomes. Rehabilitation showed a relatively low frequency. Finally, the systematic review showed moderate-low levels of bias which confirms the effectiveness of botulinum toxin for pain treatment. The current literature about botulinum toxin is wide and globally diffuse but with some limitations in study strategies and clearness in the formal presentation. The evidence justifies the use of botulinum toxin in treating pain in different diseases.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Santiago BVM, Oliveira ABG, Silva GMRD, et al. Prevalence of chronic pain in Brazil: A systematic review and meta-analysis. Clinics (Sao Paulo) 2023;78:100209. DOI: https://doi.org/10.1016/j.clinsp.2023.100209
Raja SN, Carr DB, Cohen M, et al. The revised International Association for the study of pain definition of pain: concepts, challenges, and compromises. Pain 2020;161:1976-82. DOI: https://doi.org/10.1097/j.pain.0000000000001939
Duncan G. Mind-body dualism and the biopsychosocial model of pain: what did Descartes really say? J Med Philos 2000;25:485-513. DOI: https://doi.org/10.1076/0360-5310(200008)25:4;1-A;FT485
Fonseca-Rodrigues D, Rodrigues A, Martins T, et al. Correlation between pain severity and levels of anxiety and depression in osteoarthritis patients: a systematic review and meta-analysis. Rheumatology (Oxford) 2021;61:53-75. DOI: https://doi.org/10.1093/rheumatology/keab512
Sandrini G, Tamburin S, Paolucci S, et al. Time for a consensus conference on pain in neurorehabilitation. Eur J Phys Rehabil Med 2016;52:714-16. DOI: https://doi.org/10.2147/JPR.S84646
Riganello F, Soddu A, Tonin P. Addressing pain for a proper rehabilitation process in patients with severe disorders of consciousness. Front Pharmacol 2021;12:628980. DOI: https://doi.org/10.3389/fphar.2021.628980
Lamper C, Beckers L, Kroese M, Verbunt J, Huijnen I. Interdisciplinary care networks in rehabilitation care for patients with chronic musculoskeletal pain: a systematic review. J Clin Med 2021;10:2041. DOI: https://doi.org/10.3390/jcm10092041
Rivano Fischer M, Schult ML, Löfgren M, Stålnacke BM. Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive-behavioural therapy-based programmes. J Int Med Res 2021;49:3000605211027435. DOI: https://doi.org/10.1177/03000605211027435
Kumar, R. Therapeutic use of botulinum toxin in pain treatment. Neuronal Signal 2018;2:NS20180058. DOI: https://doi.org/10.1042/NS20180058
Chen YT, Zhang C, Liu Y, et al. The effects of botulinum toxin injections on spasticity and motor performance in chronic stroke with spastic hemiplegia. Toxins (Basel) 2020;12:492. DOI: https://doi.org/10.3390/toxins12080492
Kumar R, Dhaliwal HP, Kukreja RV, Singh BR. The botulinum toxin as a therapeutic agent: molecular structure and mechanism of action in motor and sensory systems. Semin Neurol 2016;36:10-9. DOI: https://doi.org/10.1055/s-0035-1571215
Mense S. Neurobiological basis for the use of botulinum toxin in pain therapy. J Neurol 2004;251 Suppl 1:I1-7. DOI: https://doi.org/10.1007/s00415-004-1102-z
Coraci D, Tognolo L, Maccarone MC, et al. Water-based rehabilitation in the elderly: data science approach to support the conduction of a scoping review. Appl Sci 2022;12:8999. DOI: https://doi.org/10.3390/app12188999
Coraci D, Capobianco SV, Romano M, et al. Neuropathic pain and ultrasonography: a multiperspective literature evaluation. Diagnostics (Basel) 2021;11:1705. DOI: https://doi.org/10.3390/diagnostics11091705
Muka T, Glisic M, Milic J, et al. A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research. Eur J Epidemiol 2020;35:49-60. DOI: https://doi.org/10.1007/s10654-019-00576-5
Han P, Zhang W, Kang L, et al. Clinical evidence of exercise benefits for stroke. Adv Exp Med Biol 2017;1000:131-51. DOI: https://doi.org/10.1007/978-981-10-4304-8_9
Belendiuk KA, Baldini LL, Bonn-Miller MO. Narrative review of the safety and efficacy of marijuana for the treatment of commonly state-approved medical and psychiatric disorders. Addict Sci Clin Pract 2015;10:10. DOI: https://doi.org/10.1186/s13722-015-0032-7
Coraci D, Giovannini S, Fusco A, et al. low back pain: literature review based on graph theory. Pain Pract 2020;20:946-947. DOI: https://doi.org/10.1111/papr.12904
Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928. DOI: https://doi.org/10.1136/bmj.d5928
Li H, Lv H, Lin T. Comparison of efficacy of eight treatments for plantar fasciitis: A network meta-analysis. J Cell Physiol 2018;234:860-70. DOI: https://doi.org/10.1002/jcp.26907
Long L, Briscoe S, Cooper C, et al. What is the clinical effectiveness and cost-effectiveness of conservative interventions for tendinopathy? An overview of systematic reviews of clinical effectiveness and systematic review of economic evaluations. Health Technol Assess 2015;19:1-134. DOI: https://doi.org/10.3310/hta19080
Chou R, Côté P, Randhawa K, et al. The global spine care initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J 2018;27:851-60. DOI: https://doi.org/10.1007/s00586-017-5433-8
Simpson DM, Hallett M, Ashman EJ, et al. Practice guideline update summary: botulinum neurotoxin for the treatment of blepharospasm, cervical dystonia, adult spasticity, and headache: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 2016;86:1818-26. DOI: https://doi.org/10.1212/WNL.0000000000002560
Andringa A, van de Port I, van Wegen E, et al. Effectiveness of botulinum toxin treatment for upper limb spasticity poststroke over different ICF domains: a systematic review and meta-analysis. Arch Phys Med Rehabil 2019;100:1703-25. DOI: https://doi.org/10.1016/j.apmr.2019.01.016
Liu WC, Chen CT, Lu CC, et al. Extracorporeal shock wave therapy shows superiority over injections for pain relief and grip strength recovery in lateral epicondylitis: a systematic review and network meta-analysis. Arthroscopy 2022;38:2018-34.e12. DOI: https://doi.org/10.1016/j.arthro.2022.01.025
Byrnes KG, Sahebally SM, McCawley N, Burke JP. Optimal management of functional anorectal pain: a systematic review and network meta-analysis. Eur J Gastroenterol Hepatol 2022;34:249-59. DOI: https://doi.org/10.1097/MEG.0000000000002222
Xie HM, Guo TT, Sun X, et al. Effectiveness of botulinum toxin a in treatment of hemiplegic shoulder pain: a systematic review and meta-analysis. Arch Phys Med Rehabil 2021;102:1775-87. DOI: https://doi.org/10.1016/j.apmr.2020.12.010
Saeidiborojeni S, Mills PB, Reebye R, Finlayson H. Peri-operative botulinum neurotoxin injection to improve outcomes of surgeries on spastic limbs: a systematic review. Toxicon 2020;188:48-54. DOI: https://doi.org/10.1016/j.toxicon.2020.10.005
Shearer HM, Verville L, Côté P, et al. Clinical course of pain intensity in individuals with cerebral palsy: a prognostic systematic review. Dev Med Child Neurol 2023;65:24-37. DOI: https://doi.org/10.1111/dmcn.15358
Lee SH, Choi HH, Chang MC. The effectiveness of facet joint injection with steroid and botulinum toxin in severe lumbar central spinal stenosis: a randomized controlled trial. Toxins (Basel) 2022;15:11. DOI: https://doi.org/10.3390/toxins15010011
Ahadi T, Nik SS, Forogh B, et al. Comparison of the effect of ultrasound-guided injection of botulinum toxin type a and corticosteroid in the treatment of chronic plantar fasciitis: a randomized controlled trial. Am J Phys Med Rehabil 2022;101:733-7. DOI: https://doi.org/10.1097/PHM.0000000000001900
Chen L, Zhang Y, Chen Y, et al. Efficacy and safety of botulinum toxin a and pulsed radiofrequency on postherpetic neuralgia: a randomized clinical trial. Contrast Media Mol Imaging 2022;1579937. DOI: https://doi.org/10.1155/2022/1579937
Dimitrova R, Kim H, Meilahn J, et al. Efficacy and safety of onabotulinumtoxinA with standardized physiotherapy for the treatment of pediatric lower limb spasticity: a randomized, placebo-controlled, phase III clinical trial. NeuroRehabilitation 2022;50:33-46. DOI: https://doi.org/10.3233/NRE-210070
Tan B, Jia L. Ultrasound-guided BoNT-A (botulinum toxin A) injection into the subscapularis for hemiplegic shoulder pain: a randomized, double-blind, placebo-controlled trial. Stroke 2021;52:3759-67. DOI: https://doi.org/10.1161/STROKEAHA.121.034049
Zirovich MD, Pangarkar SS, Manh C, et al. Botulinum toxin type A for the treatment of post-traumatic headache: a randomized, placebo-controlled, cross-over study. Mil Med 2021;186:493-9. DOI: https://doi.org/10.1093/milmed/usaa391
Levesque A, Ploteau S, Michel F, et al. Botulinum toxin infiltrations versus local anaesthetic infiltrations in pelvic floor myofascial pain: multicentre, randomized, double-blind study. Ann Phys Rehabil Med 2021;64:101354. DOI: https://doi.org/10.1016/j.rehab.2019.12.009
Rezasoltani Z, Azizi S, Najafi S, et al. Physical therapy, intra-articular dextrose prolotherapy, botulinum neurotoxin, and hyaluronic acid for knee osteoarthritis: randomized clinical trial. Int J Rehabil Res 2020;43:219-27. DOI: https://doi.org/10.1097/MRR.0000000000000411
Lee SH, Choi HH, Chang MC. The effect of botulinum toxin injection into the common extensor tendon in patients with chronic lateral epicondylitis: a randomized trial. Pain Med 2020;21:1971-6. DOI: https://doi.org/10.1093/pm/pnz323
Kasapoğlu-Aksoy M, Aykurt-Karlıbel İ, Altan L. Comparison of the efficacy of intramuscular botulinum toxin type-A injection into the pectoralis major and the teres major muscles and suprascapular nerve block for hemiplegic shoulder pain: a prospective, double-blind, randomized, controlled trial. Neurol Sci 2020;41:2225-30. DOI: https://doi.org/10.1007/s10072-020-04334-4
De Groef A, Devoogdt N, Van Kampen M, et al. The effectiveness of botulinum toxin A for treatment of upper limb impairments and dysfunctions in breast cancer survivors: a randomised controlled trial. Eur J Cancer Care (Engl) 2020;29:e13175. DOI: https://doi.org/10.1111/ecc.13175
Cahlin BJ, Lindberg C, Dahlström L. Cerebral palsy and bruxism: effects of botulinum toxin injections-A randomized controlled trial. Clin Exp Dent Res 2019;5:460-8. DOI: https://doi.org/10.1002/cre2.207
Chun A, Levy I, Yang A, et al. Treatment of at-level spinal cord injury pain with botulinum toxin A. Spinal Cord Ser Cases 2019;5:77. DOI: https://doi.org/10.1038/s41394-019-0221-9
Kütük SG, Özkan Y, Kütük M, Özdaş T. Comparison of the efficacies of dry needling and botox methods in the treatment of myofascial pain syndrome affecting the temporomandibular joint. J Craniofac Surg 2019;30:1556-9. DOI: https://doi.org/10.1097/SCS.0000000000005473
Eleopra R, Rinaldo S, Lettieri C, et al. AbobotulinumtoxinA: a new therapy for hip osteoarthritis. A prospective randomized double-blind multicenter study. Toxins (Basel) 2018;10;448. DOI: https://doi.org/10.3390/toxins10110448
De Groef A, Devoogdt N, Van Kampen M, et al. Effectiveness of botulinum toxin a for persistent upper limb pain after breast cancer treatment: a double-blinded randomized controlled trial. Arch Phys Med Rehabil 2018;99:1342-51. DOI: https://doi.org/10.1016/j.apmr.2017.12.032
Wein T, Esquenazi A, Jost WH, et al. OnabotulinumtoxinA for the treatment of poststroke distal lower limb spasticity: a randomized trial. PM R 2018;10:693-703. DOI: https://doi.org/10.1016/j.pmrj.2017.12.006
Rosales RL, Balcaitiene J, Berard H, et al. Early AbobotulinumtoxinA (Dysport(®)) in post-stroke adult upper limb spasticity: ONTIME pilot study. Toxins (Basel) 2018;10:253. DOI: https://doi.org/10.3390/toxins10070253
Bao X, Tan JW, Flyzik M, et al. Effect of therapeutic exercise on knee osteoarthritis after intra-articular injection of botulinum toxin type A, hyaluronate or saline: a randomized controlled trial. J Rehabil Med 2018;50:534-41. DOI: https://doi.org/10.2340/16501977-2340
Yi YG, Kim K, Yi Y, et al. Botulinum toxin type A injection for cervical dystonia in adults with dyskinetic cerebral palsy. Toxins (Basel) 2018;10:203. DOI: https://doi.org/10.3390/toxins10050203
Creuzé A, Petit H, de Sèze M. Short-term effect of low-dose, electromyography-guided botulinum toxin A injection in the treatment of chronic lateral epicondylar tendinopathy: a randomized, double-blinded study. J Bone Joint Surg Am 2018;100:818-26. DOI: https://doi.org/10.2106/JBJS.17.00777
Park SJ, Yoon KB, Yoon DM, Kim SH. Botulinum toxin treatment for nocturnal calf cramps in patients with lumbar spinal stenosis: a randomized clinical trial. Arch Phys Med Rehabil 2017;98:957-63. DOI: https://doi.org/10.1016/j.apmr.2017.01.017
Guo YH, Kuan TS, Chen KL, et al. Comparison between steroid and 2 different sites of botulinum toxin injection in the treatment of lateral epicondylalgia: a randomized, double-blind, active drug-controlled pilot study. Arch Phys Med Rehabil 2017;98:36-42. DOI: https://doi.org/10.1016/j.apmr.2016.08.475
Hsieh LF, Wu CW, Chou CC, et al. Effects of botulinum toxin landmark-guided intra-articular injection in subjects with knee osteoarthritis. PM R 2016;8:1127-35. DOI: https://doi.org/10.1016/j.pmrj.2016.05.009
Roca B, Mendoza MA, Roca M. Comparison of extracorporeal shock wave therapy with botulinum toxin type A in the treatment of plantar fasciitis. Disabil Rehabil 2016;38:2114-21. DOI: https://doi.org/10.3109/09638288.2015.1114036
Wissel J, Ganapathy V, Ward AB, et al. OnabotulinumtoxinA improves pain in patients with post-stroke spasticity: findings from a randomized, double-blind, placebo-controlled trial. J Pain Symptom Manage 2016;52:17-26. DOI: https://doi.org/10.1016/j.jpainsymman.2016.01.007
Pasquina PF, Perry BN, Alphonso AL, et al. Residual limb hyperhidrosis and rimabotulinumtoxinB: a randomized placebo-controlled study. Arch Phys Med Rehabil 2016;97:659-64.e2. DOI: https://doi.org/10.1016/j.apmr.2015.12.027
Han ZA, Song DH, Oh HM, Chung ME. Botulinum toxin type A for neuropathic pain in patients with spinal cord injury. Ann Neurol 2016;79:569-78. DOI: https://doi.org/10.1002/ana.24605
Kwanchuay P, Petchnumsin T, Yiemsiri P, et al. Efficacy and safety of single botulinum toxin type A (Botox®) injection for relief of upper trapezius myofascial trigger point: a randomized, double-blind, placebo-controlled study. J Med Assoc Thai 2015;98:1231-36.
Gracies JM, Brashear A, Jech R, et al. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial. Lancet Neurol 2015;14;992-1001. DOI: https://doi.org/10.1016/S1474-4422(15)00216-1
Wu KP, Chen CK, Lin SC, et al. Botulinum toxin type A injections for patients with painful hallux valgus: a double-blind, randomized controlled study. Clin Neurol Neurosurg 2015;129 Suppl 1:S58-62. DOI: https://doi.org/10.1016/S0303-8467(15)30014-7
Tassorelli C, De Icco R, Alfonsi E, et al. Botulinum toxin type A potentiates the effect of neuromotor rehabilitation of Pisa syndrome in Parkinson disease: a placebo controlled study. Parkinsonism Relat Disord 2014;20:1140-4. DOI: https://doi.org/10.1016/j.parkreldis.2014.07.015
Gracies JM, Bayle N, Goldberg S, Simpson DM. Botulinum toxin type B in the spastic arm: a randomized, double-blind, placebo-controlled, preliminary study. Arch Phys Med Rehabil 2014;95:1303-11. DOI: https://doi.org/10.1016/j.apmr.2014.03.016
Dawson A, Dawson J, Ernberg M. The effect of botulinum toxin A on patients with persistent idiopathic dentoalveolar pain-A systematic review. J Oral Rehabil 2020;47:1184-91. DOI: https://doi.org/10.1111/joor.13053
Padoa A, McLean L, Morin M, Vandyken C. The overactive pelvic floor (OPF) and sexual dysfunction. Part 2: evaluation and treatment of sexual dysfunction in OPF patients. Sex Med Rev 2021;9:76-92. DOI: https://doi.org/10.1016/j.sxmr.2020.04.002
Danchenko N, Johnston KM, Whalen J. The cost-effectiveness of abobotulinumtoxinA (Dysport) and onabotulinumtoxinA (Botox) for managing spasticity of the upper and lower limbs, and cervical dystonia. J Med Econ 2022;25:919-29. DOI: https://doi.org/10.1080/13696998.2022.2092354
Pils K. Aspects of physical medicine and rehabilitation in geriatrics. Wien Med Wochenschr 2016;166:44-7. DOI: https://doi.org/10.1007/s10354-015-0420-3
Olanrewaju O, Trott M, Smith L, et al. Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries. Qual Life Res 2023;32:1031-41. DOI: https://doi.org/10.1007/s11136-022-03317-6
Schlaeger JM, Glayzer JE, Villegas-Downs M, et al. Evaluation and treatment of vulvodynia: state of the science. J Midwifery Womens Health 2023;68:9-34. DOI: https://doi.org/10.1111/jmwh.13456
Hary V, Schitter S, Martinez V. Efficacy and safety of botulinum A toxin for the treatment of chronic peripheral neuropathic pain: a systematic review of randomized controlled trials and meta-analysis. Eur J Pain 2022;26:980-90. DOI: https://doi.org/10.1002/ejp.1941
Datta Gupta A, Edwards S, Smith J, et al. A systematic review and meta-analysis of efficacy of botulinum toxin a for neuropathic pain. Toxins (Basel) 2022;14:36. DOI: https://doi.org/10.3390/toxins14010036
Coraci D, Luchetti R, Paolasso I, et al. Intermittent ulnar nerve compression due to accessory abductor digiti minimi muscle: crucial diagnostic role of nerve ultrasound. Muscle Nerve 2015;52:463-4. DOI: https://doi.org/10.1002/mus.24660
Renna R, Coraci D, De Franco P, et al. Ultrasound study is useful to discriminate between axonotmesis and neurotmesis also in very small nerves: a case of sensory digital ulnar branch study. Med Ultrason 2012;14:352-4.
Mihai EE, Popescu MN, Iliescu AN, Berteanu M. A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy. Eur J Phys Rehabil Med 2022;58:565-74. DOI: https://doi.org/10.23736/S1973-9087.22.07136-2
Ahmed S, Subramaniam S, Sidhu K, et al. Effect of local anesthetic versus botulinum toxin-A injections for myofascial pain disorders: a systematic review and meta-analysis. Clin J Pain 2019;35:353-67. DOI: https://doi.org/10.1097/AJP.0000000000000681
Leggio M, Fusco A, Coraci D, et al. Exercise training and atrial fibrillation: a systematic review and literature analysis. Eur Rev Med Pharmacol Sci 2021;25:5163-75.
Struyf P, Triccas LT, Schillebeeckx F, Struyf F. The place of botulinum toxin in spastic hemiplegic shoulder pain after stroke: a scoping review. Int J Environ Res Public Health 2023;20:2797. DOI: https://doi.org/10.3390/ijerph20042797
Hsu PC, Chang KV, Chiu YH, et al. Comparative effectiveness of botulinum toxin injections and extracorporeal shockwave therapy for post-stroke spasticity: a systematic review and network meta-analysis. EClinicalMedicine 2021;43:101222. DOI: https://doi.org/10.1016/j.eclinm.2021.101222
Wang C, Zhao J, Gao F, et al. The efficacy and safety of intra-articular botulinum toxin type A injection for knee osteoarthritis: a meta-analysis of randomized controlled trials. Toxicon 2023;224:107026. DOI: https://doi.org/10.1016/j.toxicon.2023.107026
Grüner S, Schulz A, Schlüter-Brust K, Lippert-Grüner M. Botulinum toxin for chronic lateral epicondylitis (LE). Z Orthop Unfall 2021;159:554-64. DOI: https://doi.org/10.1055/a-1202-6220
Soleiman F, Kouhzad Mohamadi H, Saadat M, Derisfard F, Nassadj G. A protocol for a randomized trial on pain neuroscience education vs. routine physical therapy in people with chronic neck pain. Eur J Transl Myol 2022;32:10674. DOI: https://doi.org/10.4081/ejtm.2022.10674
Guo X, Wallace R, Tan Y, et al. Technology-assisted assessment of spasticity: a systematic review. J Neuroeng Rehabil 2022;19:138. DOI: https://doi.org/10.1186/s12984-022-01115-2
Park HS, Jo SM, Dasari S, Moon YL. Comparison of clinical outcomes of platelet-rich plasma for epicondylitis, elbow: simultaneous lateral and medial versus lateral versus medial. Orthop Surg 2023;15:2110-5. DOI: https://doi.org/10.1111/os.13732
Pariona-Vargas F, Mun KT, Lo EH, et al. Circadian variation in stroke onset: differences between ischemic and hemorrhagic stroke and weekdays versus weekends. J Stroke Cerebrovasc Dis 2023;32:107106. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107106
Ferreira ACL, Pereira DS, da Silva SLA, et al. Validity and reliability of the short form brief pain inventory in older adults with nociceptive, neuropathic and nociplastic pain. Geriatr Nurs 2023;52:16-23. DOI: https://doi.org/10.1016/j.gerinurse.2023.04.011
Giovannini S, Coraci D, Brau F, et al. Neuropathic pain in the elderly. Diagnostics (Basel) 2021;11:613. DOI: https://doi.org/10.3390/diagnostics11040613

How to Cite

Coraci, D., Maccarone, M. C., Ragazzo, L., Tognolo, L., Restivo, D. A., Santilli, G., Moreira, A. L., Ferrara, P. E., Ronconi, G., & Masiero, S. (2024). Botulinum toxin in the rehabilitation of painful syndromes: multiperspective literature analysis, lexical analysis and systematic review of randomized controlled trials. European Journal of Translational Myology, 34(2). https://doi.org/10.4081/ejtm.2024.12509