The aim of the study was to analyze which step of the procedure of toxin botulinum injection is the most painful between skin break-in, electric stimulation, injection and needle withdrawal.

Post-stroke spasticity management by botulinum toxin injections may be limited by pain or discomfort at the injection side.

Particularly tracking by electrostimulation, but also skin puncture, toxin injection or needle withdrawal may be painful.

The objective of this study is to define an individual injection strategy in order to limit pain.

Inclusion Criteria:

• stroke
• severe upper or lower limb spasticity (Ashworth score ≥ 2 for at least one muscle)
• patients requiring a treatment by botulinum toxin
• patients refusing analgesia for injections.

Exclusion Criteria:

• severe aphasia (severity subscore of the BDAE <3)
• cognitive impairment or psychiatric disease altering the reliability of pain evaluation
• patient medically unstable.

Consecutive patients were assessed during routine botulinum toxin injection in the day clinic of our department