Graduation Year

2025

Document Type

Senior Thesis

Degree

Bachelor of Science in Nursing

Primary Major

nursing

Thesis Advisor

Deborah Meshel BSN, MSN

Abstract

Abstract

Background

Chronic neck and shoulder myofascial pain has long been challenging patients and medical professionals due to its limited response to traditional therapies on top of high recurrence. Physical therapy, oral analgesics, and trigger point injections have only provided partial or short-term relief. As a result, botulinum toxin type A injections have been explored as an alternative treatment. Previous studies have shown promising short-term outcomes, but concerns regarding long-term safety, cost-effectiveness, and potential adverse effects, particularly in older adults, have remained unresolved. These gaps have highlighted the need for comprehensive evaluation from both clinical and nursing perspectives.

Objective

The purpose of this study is to assess the clinical effectiveness of botulinum toxin type A injections in reducing chronic neck and shoulder myofascial pain compared with conventional treatments. Special attention is given to adults aged 70 and above to highlight any age-related risks. Findings will be used to support nursing practices, including intervention planning, patient education, and safe implementation strategies for long-term care.

Method

All procedures and monitoring will be coordinated by nurses. Data will be collected over 12 weeks, including pain scores, functional improvement, and side effect monitoring. Nurses will be responsible for administering assessments, conducting patient education, and recording patient-reported outcomes during follow-up visits.

Results

It is hypothesised that participants who receive BoNT-A injections will experience reduced short-term pain and improved functional outcomes compared to those who receive placebo. Pain scores will be measured by the Wong-Baker Pain Scale. Among older adults (70+), the treatment was generally well tolerated, but side effects such as mild dysphagia and fatigue were more commonly reported than in younger participants. These side effects were detected using tools like the Gugging Swallowing Screen and Fatigue Severity Scale. Subgroup analysis confirmed that although BoNT-A was effective across all age groups, careful monitoring is needed in the elderly due to a slightly higher risk of adverse effects. Overall, the findings support the clinical use of BoNT-A for CNSMP and confirm the critical role of nurses in managing side effects and ensuring safe treatment practices.

Descriptive statistics will be used to summarize baseline characteristics, pain scores, functional outcomes, and the incidence of side effects. These will include means, standard deviations, and frequency distributions. To evaluate group differences, paired t-tests will compare pre- and post-treatment changes within each group, while independent t-tests will compare outcomes between the BoNT-A and placebo groups. Subgroup analysis will be conducted between younger adults and elderly patients (70+) to assess age-related treatment responses. A p-value < 0.05 will be considered statistically significant.

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