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Use of botulinum toxin-A for musculoskeletal pain in patients with whiplash associated disorders [ISRCTN68653575]

DOI: 10.1186/1471-2474-5-5

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This is a prospective, randomized, controlled clinical trial and botulinum toxin-A (Botox?) injections will be compared with placebo injections. The primary objective is to determine the efficacy of Botox? in the management of musculoskeletal pain in whiplash associated disorders.Botulinum toxin type-A toxin has been studied in small trials on whiplash associated disorder patients and has generally been found to relieve pain and improve range of motion. Specifically, we seek to assess the efficacy of Botox? in reducing pain and to improve the cervical spine range of movement, during the 6-month trial period.The term "whiplash" has been used to describe a mechanism of injury, and the various clinical manifestations as a consequence of the injury. Moreover, signs and symptoms have been designated the 'whiplash syndrome'. In 1995, the Quebec Task Force (QTF) on Whiplash Associated Disorders (WAD) adopted the following definition of whiplash: "whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during diving or other mishaps. The impact may result in bony or soft-tissue injuries (whiplash-injury), which in turn may lead to a variety of clinical manifestations called Whiplash Associated Disorders"[1]. Whiplash patients can be classified according to severity of signs and symptoms. The QTF-WAD classification system consists of five levels: WAD 0 indicates no complaints or physical signs; WAD I indicates neck complaints but no physical signs; WAD II indicates neck complaints and musculoskeletal signs (such as a decreased range of motion or muscle tenderness); WAD III and IV indicate neck complaints and neurological signs (WAD III) or fracture/dislocation (WAD IV), respectively. Research [2-5] has revealed that the most common presenting symptoms following an acute motor vehicle collision were neck pain (88–100 percent) and headache (54–66 percent). Other s


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