Clinical efficacy of botulinum toxin type A in the treatment of fasciitis pain: A systematic review and meta-analysis

The purpose of this meta-analysis was to assess the effectiveness of botulinum toxin type A (BoNT-A) in reducing pain associated with fasciitis. By synthesizing the findings from multiple studies, we aimed to provide a comprehensive evaluation of the current evidence regarding the efficacy of BoNT-A in the treatment of fasciitis pain. METHODS: To identify studies for our report, we conducted electronic database searches of Embase, PubMed, Web of Science, and the Cochrane Library from their inception to November 20, 2022. We included only randomized controlled trials that examined the therapeutic effects of BoNT-A on fasciitis pain, with the primary outcome measure being the visual analog scale. We conducted statistical analyses using RevMan 5.4 software. RESULTS: Our final meta-analysis comprised 14 randomized controlled trials involving 537 participants, with 271 patients in the BoNT-A group and 266 patients in the control group. The overall effectiveness of BoNT-A in reducing fasciitis pain was significant, with a mean difference (MD) in visual analog scale score of −2.59 (95% confidence interval [CI], −3.36, −1.82); P < .00001; I(2) = 88%. Subgroup analysis revealed that BoNT-A was particularly effective in treating plantar fasciitis (MD = −3.34 [95% CI, −4.08, −2.78]; P < .00001; I(2) = 75%), lumbar back fasciitis (MD = −2.17 [95% CI, −3.82, −0.52]; P = .001; I(2) = 93%), and neck and shoulder fasciitis (MD = −1.49 [95% CI, −2.76, −0.22]; P = .02; I(2) = 61%). CONCLUSION: BoNT-A has a significant analgesic effect on fasciitis pain. Therefore, BoNT-A presents a promising alternative treatment option for fasciitis (PROSPERO 2022: CRD42022382805).