Photo Credit: asbe

The following is a summary of “Efficacy and Safety of Botulinum Neurotoxin Type A in Treating Chronic Low Back Pain: A Systematic Review, Meta-Analysis, Trial Sequential Analysis, and Meta-Regression,” published in the February 2025 issue of European Journal of Pain by Wagrees et al. 

Chronic low back pain (CLBP) is a significant cause of disability, and botulinum neurotoxin type A (BoNT-A) might offer pain relief through its anti-spasmodic and analgesic effects.  

Researchers conducted a retrospective study to evaluate the efficacy and safety of BoNT-A in individuals with CLBP.  

They searched PubMed, Scopus, Cochrane, and Web of Science for studies comparing BoNT-A to other treatments for CLBP. Pain improvement was assessed using the visual analog scale (VAS) and a 50% or greater reduction in VAS score. Trial sequential analysis (TSA) was conducted to validate findings, and the GRADE approach was used to evaluate evidence quality.  

The results showed that 9 studies were identified, including 7 randomized clinical trials (RCTs) and 2 prospective observational studies, while, BoNT-A increased the incidence of clinically significant pain improvement (RR = 4.82, 95% CI (3.00, 7.76), P < 0.00001) and functional improvement (RR = 3.81, 95% CI (2.40, 6.04), P < 0.00001) (low-certainty evidence). The BoNT-A also reduced the VAS score (mean difference [MD] = −1.62, 95% CI (−3.13, −0.11), P = 0.04) (very low-certainty evidence). Subgroup analysis indicated effectiveness against normal saline (moderate-certainty evidence) and comparability to steroids and local anesthetics (very low-certainty evidence). The TSA confirmed clinical and functional improvement findings.  

Investigators concluded that BoNT-A was a tolerable and effective treatment for CLBP with prolonged effects, but further robust studies were necessary for confirmation. 

Source: onlinelibrary.wiley.com/doi/10.1002/ejp.4796