57. Treatment of shoulder pain with botulinum toxin type A in spastic hemiplegia.

The purpose of this study was to assess the beneficial effect of BTX- A in the treatment of hemiplegic shoulder pain in chronic phase. 31 consecutive hemiplegic patients with different degree of hypertonus (groups 1 and 2) of the muscles of the painful shoulder, referred to 5 Rehabilitation Centers and underwent to neuromuscular blockade with pure BTX-A (150 Kd). The rating scales were: the FAT, the MAS, the pROM, the MRC and the VAS at rest and during nursing. Evaluations were performed at enrollment (T0), after 1month (T1) and after 3months post-treatment with BTX (T3). At T1 It has been observed a statistically significant reduction in VAS at rest and during nursing (p <0.0001);in the MAS (p =0.04) and passive ROM (p <0.0001) at the shoulder level, without further changes at T3. At T2 reappearance of hypertonus without pain. The degree of pain reduction was similar in both groups of patients with different degrees of spasticity. There were no significant changes obtained with regard to the MRC and FAT. Our data suggest a role of BTX in reducing shoulder pain through an antinociceptive mechanism independent from the level of spasticity. [Copyright &y& Elsevier]