Journal of the Bahrain Medical Society
Year 2020, Volume 32, Issue 3, Pages 1-8
https://doi.org/10.26715/jbms.32_2020_3_1Moutasem Al Mashour1*, Badriya Toorani2, Nada Al Mansoori3, Shaker Asheeri4, Owais Ahmed5
1Consultant, Anesthesia and Pain Management, Salmaniya Medical Complex, Manama, Bahrain
2Consultant, Orthopedic Spine Surgeon, Salmaniya Medical Complex, Manama, Bahrain
3Consultant, Anesthesia Department, Salmaniya Medical Complex, Manama, Bahrain.
4Chief Resident, Orthopedic Department, Salmaniya Medical Complex, Manama, Bahrain
5Chief Resident, Anesthesia Department, Salmaniya Medical Complex, Manama, Bahrain
*Corresponding author:
Moutasem Al Mashour, Consultant, Anesthesia and Pain Management, Salmaniya Medical Complex, Manama, Bahrain; Email: moutasem73@hotmail.com
Received date: April 17, 2020; Accepted date: July 20, 2020; Published date: September 30, 2020
Abstract
Background: Sickle cell disease patients have a tendency for vaso-occlusive attacks involving their bones. Osteonecrosis results in infarction of the articular surfaces and heads of long bones, leading to chronic joint pain, significant interference in functioning and quality of life. Intraarticular Botox injection is safe andreduces chronic pain while patients’ mobility.
Objective: The study aimed to evaluate the symptomatic change and its duration after intra-articular Botox injection, in sickle cell disease patients with chronic pain.
Methods: Sickle cell disease patients with chronic joint pain observed at Salmaniya medical complex were included. Patients were injected with Botox intraarticularly and followed up for a year.Symptomatic parameters were assessed at every follow- up, raw data collected was entered into Microsoft Excel spreadsheet were the numerical variables analyzed and graphs were created.
Results: Forty-eight sickle cell disease patients were included.Postthe intraarticular injection at 3 months, the level of pain according to, Numerical rating scale (NRS) reduced by 44.6 % (p-value <0.005) and 27.8%( p-value < 0.001) at 6 months and 9.54% ( p-value <0.01) at 1 year, and significant improvement of other parameters.
Conclusion: Intraarticular BoNT/ A injection provides an alternative treatment in sickle disease patients with good results in reduction of pain, improved physical function, mood, and sleep pattern lasting at least 6 months. Although a small scale study, the results suggest that BoNT/ A is an effective and safe treatment.
Keywords: Avascular Necrosis of Bone; Botulinum toxin; Chronic Pain; Injections; Intra-Articular; Sickle cell disease (SCD)