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Original research
Onabotulinum toxin injections for shoulder and chest wall muscle pain in breast cancer survivors: retrospective study – preliminary report
  1. Jack B Fu1,
  2. Radhika Manne2,
  3. An Ngo-Huang1,
  4. Jegy M Tennison1,
  5. Amy H Ng1,
  6. Clark Andersen3,
  7. Wendy A Woodward4 and
  8. Eduardo Bruera1
  1. 1Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  3. 3Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Jack B Fu, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; jfu{at}mdanderson.org

Abstract

Objectives The primary objective of this retrospective review is to describe patient-reported improvement in muscular pain after initial treatment with onabotulinum toxin. A secondary objective was to determine other physiatry (physical medicine & rehabilitation (PM&R)) interventions ordered.

Methods Preliminary retrospective review of physiatry interventions for 47 patients referred by breast radiation oncology to PM&R at a tertiary referral-based academic cancer centre clinic from 1 January 2018 to 31 December 2021 for muscular shoulder/chest wall pain.

Results Patients were most commonly diagnosed with muscle spasm 27/47 (58%), lymphedema 21/47 (45%), myalgia/myofascial pain 16/47 (34%), radiation fibrosis 14/47 (30%), fatigue/deconditioning 13/47 (28%), neurological impairment 11/47 (23%) and joint pathology 3/47 (6%). The top three physiatric interventions were home exercise programme education (17/47, 36%), botulinum toxin injection (17/47, 36%) and physical or occupational therapy referral (15/47, 32%). Patients who had muscle spasms documented were more likely to have botulinum toxin recommended by physiatry (24/24) compared with those with questionable spasms (4/7) and those without spasms(0/16) (p=0.0005). 17/28 (60.7%) received botulinum toxin injection, and a total of 35 injections were performed during the study period. 94% (16/17) of patients who received botulinum toxin injection voiced improvement in pain after injection.

Conclusion Botulinum toxin injections may play a role in the treatment of muscle spasm-related pain in breast cancer survivors. Additional blinded controlled research on the effectiveness of botulinum toxin injection after breast cancer treatment with spastic muscular shoulder/chest wall pain is needed.

  • Breast
  • Rehabilitation
  • Quality of life
  • Survivorship
  • Outpatients

Data availability statement

Data are available upon request.

https://doi.org/10.1136/spcare-2024-004987

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    Data availability statement

    Data are available upon request.

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    Footnotes

    • X @jackfumd, @JegyTennisonMD

    • Presented at This study was partially presented as a poster abstract at the American Congress of Rehabilitation Medicine 99th Annual Conference, 10 November 2022, Chicago, Illinois.

    • Contributors JBF is the guarantor for this publication. JBF and WAW contributed to the study conception and design. JBF and JT performed data collection. JBF, RM, AN-H, AN and EB were substantially involved in manuscript writing and revisions. CA performed data analysis and statistical advice. All authors approved the final draft. JBF is responsible for the overall content of the manuscript.

    • Funding Supported in part by the M.D. Anderson Cancer Center support grant # CA 016672.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.