Osteoarthritis (OA) is the most common type of non-inflammatory arthritis that affects the aging population but can present at a younger age in those with trauma or obesity. Inflammatory arthritis (e.g., rheumatoid arthritis [RA] and gout) is characterized by swelling of the joint lining that leads to joint destruction and bony erosions when not optimally treated. The treatment of refractory joint pain remains a big challenge with few available therapeutic options, which include oral analgesics and anti-inflammatories, topical treatments, intra-articular therapies and physical therapy.

Several contraindications and common adverse events limit the long-term use of each medication.

This chapter reviews studies on the use of BoNT-A (onabotulinumtoxinA, ONA) for osteoarticular pain. Supported by pre-clinical laboratory evidence of anti-nociception, intra-articular BoNT seems to be efficacious for knee, shoulder, ankle and tennis elbow joint pain, based on RCT and systematic review data. Injection techniques for these joints are discussed, along with dosing recommendations and clear anatomical illustrations showing injection approach and placement.