The use of botulinum toxin injection for post-radiation breast cancer survivors with shoulder pain

Research Objectives: To evaluate the effectiveness of botulinum toxin injections for post-radiation breast cancer survivors with shoulder pain by physiatry. A secondary objective was to determine other physiatry interventions ordered.

Design: Retrospective Review

Setting: National Cancer Institute Comprehensive Cancer Center

Participants: 47 patients were referred by breast radiation oncology to PM&R from 1/1/2018-12/31/2021.

Interventions: not applicable

Main Outcome Measures: Physiatric (PM&R) interventions utilized

Results: 2 out of 49 total patients referred to PM&R by breast radiation oncology were for reasons other than shoulder pain/dysfunction. After PM&R evaluation, 28/47 shoulder pain/dysfunction patients evaluated had botulinum toxin recommended, however, only 18/28 received the botulinum toxin injection. Out of the 10 patients who did not receive botulinum toxin injection, 2/10 preferred to get botulinum toxin by a physiatrist/neurologist closer to home, 1/10 decided on a trigger point injection instead, and 7/10 were lost to follow-up. 17/18 patients who received botulinum toxin injection voiced improvement in pain after injection. 24/28, 16/18, and 2/10 patients who had toxin injection recommended, toxin injection received, and toxin injection not recommended respectively, had spasms, cramping or Charley horses mentioned in their PM&R evaluations.

Conclusions: 17/18 patients reported improvement in pain with botulinum toxin injection. Most patients complained of muscle spasms before toxin injection was recommended. Additional research on the effectiveness of botulinum toxin injection in post-radiation breast cancer survivors with muscle spasm related pain is needed.

Author(s) Disclosures: n/a