In the many types of knee pain injections, some researchers and clinicians are suggesting that “Botox” or botulinum toxin can be an effective short-term treatment for knee pain from osteoarthritis or rheumatoid arthritis. Botulinum toxin injections typically do not regenerate damage tissue. They work by helping to block nerve signals that are involved in muscle pain. A January 2023 paper (1) writes: “Studies have also shown that botulinum toxin A may reduce the expression of pro-inflammatory cytokines such as IL-1β, IL-6, and TNF-α, dampening the inflammatory process and reducing pain propagation resulting from peripheral stimuli (nerve signaling).
An April 2024 study (2) compared intraarticular botulinum toxin type A to corticosteroid and hyaluronic acid. A meta-analysis of data from six randomized control studies and 348 patients was performed.
- Intraarticular botulinum toxin type A showed similar efficacy with corticosteroid as evidenced by the changes of pain, stiffness and function based on patient reported outcomes.
- Intraarticular botulinum toxin type A was shown to be more effective than hyaluronic acid in improving pain.
A March 2023 study (3) reviewed patient data from seven studies and 548 participants to suggest effectiveness and safety of intra-articular botulinum toxin type A injection for knee osteoarthritis. The researchers found that at 4 weeks post-treatment intra-articular botulinum toxin type A injection reduced pain but the effects were not seen at 8 weeks and beyond.
A February 2025 study (4) compared the effects of intra-articular botulinum neurotoxin type A to other interventions on pain and activity limitations in the short (less than 3 months), intermediate (3-6 months) and long term (more than 6 months), and their adverse effects, in people with joint pain. The researchers examined data from seven randomized control trials (549 participants) compared intra-articular botulinum neurotoxin type A with an intra-articular treatment in the knee: short-, intermediate-, and long-term. The researchers found ” intra-articular botulinum neurotoxin type A may reduce joint pain in the short term for small and medium-sized joints (ie, base-of-thumb and shoulder), but not for large joints (ie, knee).”
An September 2020 study (5) compared botulinum neurotoxin type A , hyaluronic acid and prolotherapy as a treatment for knee osteoarthritis. In data from 120 patients, researchers showed botulinum neurotoxin and dextrose prolotherapy were the most, and hyaluronic acid was the least efficient treatments for controlling pain and recovering function in patients.
Similar articles
Research on: Platelet Rich Plasma Injections for knee osteoarthritis
Research on bone marrow aspirate concentrate – stem cell therapy – knee cartilage repair
References
1 Ismiarto YD, Prasetiyo GT. Efficacy and safety of intra-articular botulinum toxin A injection for knee osteoarthritis: a systematic review, meta-analysis, and meta-regression of clinical trials. JBJS Open Access. 2023 Jan 1;8(1):e22.
2 Yang Y, Li G, Su Y. Intraarticular botulinum toxin type A versus corticosteroid or hyaluronic acid for painful knee osteoarthritis: A meta-analysis of head-to-head randomized controlled trials. Toxicon. 2024 Feb 22:107656.
3 Wang C, Zhao J, Gao F, Jia M, Hu L, Gao C. The efficacy and safety of intra-articular botuinum toxin type A injection for knee osteoarthritis: A meta‐analysis of randomized controlled trials. Toxicon. 2023 Mar 1;224:107026.
4 Gagnière M, Daste C, Campagna R, Drapé JL, Feydy A, Guerini H, Lefèvre-Colau MM, Rannou F, Nguyen C. Efficacy and safety of intra-articular botulinum toxin injection therapy for joint pain: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine. 2025 Feb 1;68(1):101877.
5 Rezasoltani Z, Azizi S, Najafi S, Sanati E, Dadarkhah A, Abdorrazaghi F. Physical therapy, intra-articular dextrose prolotherapy, botulinum neurotoxin, and hyaluronic acid for knee osteoarthritis: randomized clinical trial. International Journal of Rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue Internationale de Recherches de Readaptation. 2020 Sep 1;43(3):219-27.