Botulinum toxin type A for the treatment of chronic neck pain after neck dissection

BACKGROUND: Neck dissection surgery is often followed by chronic head and neck pain. To date optimal treatment of this type of pain is lacking. Botulinum toxin type A (BTX-A) has been shown to be effective in the treatment of myofascial pain syndrome and headache. In a pilot study, we wanted to test the effectiveness of BTX-A for the treatment of chronic neck pain after neck dissection. METHODS: Sixteen patients with chronic neck pain after neck dissection were included in this prospective, open study. Eighty to 320 units of BTX-A (Dysport) were injected into muscular trigger points. Outcome measures included chronic pain and shooting pain on the basis of visual analog scales and quality of life improvement (EORTC QLQ-C-30; EORTC QLQ-H and N35) before and 4 weeks after treatment. RESULTS: Patients showed a significant reduction in chronic pain (4.5 before to 3.3 after treatment, p =,005) and in shooting pain (6.1 before to 4.7 after treatment, p =.005). There was a trend toward improvement in global quality of life (QLQ-C30, p =.097) and an increase on the functional scale "pain" (QLQ-H and N35, p =.071). CONCLUSIONS: BTX-A treatment of subjects with chronic neck pain after neck dissection resulted in a fast and significant reduction of pain. A significant improvement in quality of life may be expected in a longer time course after treatment.