Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief
By blocking the release of neurotransmitters, botulinum toxin A (BoNT-A) is an effective treatment for muscle over-activity and pain in stroke patients. BoNT-A has also been reported to increase passive range of motion (p-ROM), the decrease of which is mainly due to muscle shortening (i.e., muscle c...
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| Format: | Article |
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MDPI AG
2023-05-01
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| Series: | Toxins |
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| Online Access: | https://www.mdpi.com/2072-6651/15/5/335 |
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| author | Carlo Trompetto Lucio Marinelli Laura Mori Nicola Bragazzi Giulia Maggi Filippo Cotellessa Luca Puce Lucilla Vestito Franco Molteni Giulio Gasperini Nico Farina Luciano Bissolotti Francesco Sciarrini Marzia Millevolte Fabrizio Balestrieri Domenico Antonio Restivo Carmelo Chisari Andrea Santamato Alessandra Del Felice Paolo Manganotti Carlo Serrati Antonio Currà |
| author_facet | Carlo Trompetto Lucio Marinelli Laura Mori Nicola Bragazzi Giulia Maggi Filippo Cotellessa Luca Puce Lucilla Vestito Franco Molteni Giulio Gasperini Nico Farina Luciano Bissolotti Francesco Sciarrini Marzia Millevolte Fabrizio Balestrieri Domenico Antonio Restivo Carmelo Chisari Andrea Santamato Alessandra Del Felice Paolo Manganotti Carlo Serrati Antonio Currà |
| author_sort | Carlo Trompetto |
| collection | DOAJ |
| description | By blocking the release of neurotransmitters, botulinum toxin A (BoNT-A) is an effective treatment for muscle over-activity and pain in stroke patients. BoNT-A has also been reported to increase passive range of motion (p-ROM), the decrease of which is mainly due to muscle shortening (i.e., muscle contracture). Although the mechanism of action of BoNT-A on p-ROM is far from understood, pain relief may be hypothesized to play a role. To test this hypothesis, a retrospective investigation of p-ROM and pain was conducted in post-stroke patients treated with BoNT-A for upper limb hypertonia. Among 70 stroke patients enrolled in the study, muscle tone (Modified Ashworth Scale), pathological postures, p-ROM, and pain during p-ROM assessment (Numeric Rating Scale, NRS) were investigated in elbow flexors (48 patients) and in finger flexors (64 patients), just before and 3–6 weeks after BoNT-A treatment. Before BoNT-A treatment, pathological postures of elbow flexion were found in all patients but one. A decreased elbow p-ROM was found in 18 patients (38%). Patients with decreased p-ROM had higher pain-NRS scores (5.08 ± 1.96, with a pain score ≥8 in 11% of cases) than patients with normal p-ROM (0.57 ± 1.36) (<i>p</i> < 0.001). Similarly, pathological postures of finger flexion were found in all patients but two. A decreased finger p-ROM was found in 14 patients (22%). Pain was more intense in the 14 patients with decreased p-ROM (8.43 ± 1.74, with a pain score ≥ 8 in 86% of cases) than in the 50 patients with normal p-ROM (0.98 ± 1.89) (<i>p</i> < 0.001). After BoNT-A treatment, muscle tone, pathological postures, and pain decreased in both elbow and finger flexors. In contrast, p-ROM increased only in finger flexors. The study discusses that pain plays a pivotal role in the increase in p-ROM observed after BoNT-A treatment. |
| first_indexed | 2024-03-11T03:15:18Z |
| format | Article |
| id | doaj.art-47bd65ee54fa40958be535c9593b54a2 |
| institution | Directory Open Access Journal |
| issn | 2072-6651 |
| language | English |
| last_indexed | 2024-03-11T03:15:18Z |
| publishDate | 2023-05-01 |
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| series | Toxins |
| spelling | doaj.art-47bd65ee54fa40958be535c9593b54a22023-11-18T03:33:35ZengMDPI AGToxins2072-66512023-05-0115533510.3390/toxins15050335Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain ReliefCarlo Trompetto0Lucio Marinelli1Laura Mori2Nicola Bragazzi3Giulia Maggi4Filippo Cotellessa5Luca Puce6Lucilla Vestito7Franco Molteni8Giulio Gasperini9Nico Farina10Luciano Bissolotti11Francesco Sciarrini12Marzia Millevolte13Fabrizio Balestrieri14Domenico Antonio Restivo15Carmelo Chisari16Andrea Santamato17Alessandra Del Felice18Paolo Manganotti19Carlo Serrati20Antonio Currà21Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyLaboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, CanadaDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyDepartment of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, GE, ItalyVilla Beretta Rehabilitation Center, 23845 Costa Masnaga, LC, ItalyVilla Beretta Rehabilitation Center, 23845 Costa Masnaga, LC, ItalyVilla Beretta Rehabilitation Center, 23845 Costa Masnaga, LC, ItalyRehabilitation Service, Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, BS, ItalyIntensive Rehabilitation Center, USL 1 Umbria, 06065 Passignano, PG, ItalyClinica di Neuroriabilitazione, AOU Ospedali Riuniti, 60030 Ancona, AN, ItalySOSD Gravi Cerebrolesioni Acquisite, AUSL Toscana Centro, 50141 Florence, FI, ItalyNeurologic Unit, Department of Medicine, “Garibaldi” Hospital, 95124 Catania, CT, ItalySection of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, 56124 Pisa, PI, ItalySpasticity and Movement Disorders “ReSTaRt” Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, University of Foggia, 71122 Foggia, FG, ItalyDepartment of Neuroscience, University of Padua, 35122 Padua, PD, ItalyClinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital, University of Trieste, 34127 Trieste, TS, ItalyDepartment of Neurology, Imperia Hospital, 18100 Imperia, IM, ItalyAcademic Neurology Unit, Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, 04019 Terracina, LT, ItalyBy blocking the release of neurotransmitters, botulinum toxin A (BoNT-A) is an effective treatment for muscle over-activity and pain in stroke patients. BoNT-A has also been reported to increase passive range of motion (p-ROM), the decrease of which is mainly due to muscle shortening (i.e., muscle contracture). Although the mechanism of action of BoNT-A on p-ROM is far from understood, pain relief may be hypothesized to play a role. To test this hypothesis, a retrospective investigation of p-ROM and pain was conducted in post-stroke patients treated with BoNT-A for upper limb hypertonia. Among 70 stroke patients enrolled in the study, muscle tone (Modified Ashworth Scale), pathological postures, p-ROM, and pain during p-ROM assessment (Numeric Rating Scale, NRS) were investigated in elbow flexors (48 patients) and in finger flexors (64 patients), just before and 3–6 weeks after BoNT-A treatment. Before BoNT-A treatment, pathological postures of elbow flexion were found in all patients but one. A decreased elbow p-ROM was found in 18 patients (38%). Patients with decreased p-ROM had higher pain-NRS scores (5.08 ± 1.96, with a pain score ≥8 in 11% of cases) than patients with normal p-ROM (0.57 ± 1.36) (<i>p</i> < 0.001). Similarly, pathological postures of finger flexion were found in all patients but two. A decreased finger p-ROM was found in 14 patients (22%). Pain was more intense in the 14 patients with decreased p-ROM (8.43 ± 1.74, with a pain score ≥ 8 in 86% of cases) than in the 50 patients with normal p-ROM (0.98 ± 1.89) (<i>p</i> < 0.001). After BoNT-A treatment, muscle tone, pathological postures, and pain decreased in both elbow and finger flexors. In contrast, p-ROM increased only in finger flexors. The study discusses that pain plays a pivotal role in the increase in p-ROM observed after BoNT-A treatment.https://www.mdpi.com/2072-6651/15/5/335spastic dystoniaspasticitypathological postureslimb posturesstretch |
| spellingShingle | Carlo Trompetto Lucio Marinelli Laura Mori Nicola Bragazzi Giulia Maggi Filippo Cotellessa Luca Puce Lucilla Vestito Franco Molteni Giulio Gasperini Nico Farina Luciano Bissolotti Francesco Sciarrini Marzia Millevolte Fabrizio Balestrieri Domenico Antonio Restivo Carmelo Chisari Andrea Santamato Alessandra Del Felice Paolo Manganotti Carlo Serrati Antonio Currà Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief Toxins spastic dystonia spasticity pathological postures limb postures stretch |
| title | Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief |
| title_full | Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief |
| title_fullStr | Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief |
| title_full_unstemmed | Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief |
| title_short | Increasing the Passive Range of Joint Motion in Stroke Patients Using Botulinum Toxin: The Role of Pain Relief |
| title_sort | increasing the passive range of joint motion in stroke patients using botulinum toxin the role of pain relief |
| topic | spastic dystonia spasticity pathological postures limb postures stretch |
| url | https://www.mdpi.com/2072-6651/15/5/335 |
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