Surreal digital illustration of neurological recovery and pain relief in a human arm.

Beyond Botox: Can Electrical Stimulation Ease Post-Stroke Spasticity and Pain?

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"A combined approach offers hope for improved quality of life and function for stroke survivors."

Surviving a stroke is often just the beginning of a long journey toward recovery. Many stroke survivors face lasting challenges, including spasticity (muscle stiffness) and chronic pain, which can significantly impact their ability to perform everyday tasks and enjoy a good quality of life.

Botulinum neurotoxin type A (BoNTA), commonly known as Botox, has become a popular treatment for managing spasticity by relaxing targeted muscles. However, a promising complementary therapy, functional electrical stimulation (FES), is also gaining traction in rehabilitation. FES uses mild electrical pulses to stimulate muscles, helping to improve their function and reduce stiffness.

Now, researchers are exploring whether combining BoNTA injections with FES can provide even greater benefits for stroke patients struggling with spasticity and pain. This article delves into a recent case study that sheds light on the potential of this combined approach to enhance function and overall well-being after a stroke.

BoNTA and FES: A Synergistic Approach to Stroke Recovery

Surreal digital illustration of neurological recovery and pain relief in a human arm.

A recent case study published in Future Neurology highlights the use of BoNTA and FES in a 57-year-old male who experienced right-side upper limb spasticity four years after suffering a stroke. The patient had previously tried baclofen and BoNTA alone, with limited success and bothersome side effects.

In this case, doctors administered BoNTA injections into specific muscles in the patient's arm (biceps brachii, triceps, pronator teres, and several flexor muscles). Immediately before and after the injections, the patient received FES therapy, where electrodes were placed on the skin over the targeted muscles, delivering controlled electrical stimulation.

BoNTA Injections: Relaxes targeted muscles by blocking nerve signals, reducing stiffness.
Functional Electrical Stimulation (FES): Uses electrical pulses to stimulate muscles, improving function and reducing pain.
Combined Approach: Aims to enhance the benefits of both therapies for improved outcomes.

The study assessed the patient's pain and quality of life (QOL) before and after the combined treatment. The results showed a significant increase in the patient's QOL score after three months of BoNTA and FES therapy. While pain scores didn't change drastically, the improved functionality suggests a valuable impact on the patient's daily life.

Hope for Improved Stroke Recovery

This case study offers a promising glimpse into the potential of combining BoNTA and FES to improve the lives of stroke survivors struggling with spasticity and pain. While more research is needed, this approach could significantly enhance functional abilities and overall quality of life.

Further studies with larger groups of patients are necessary to determine the optimal combination of BoNTA dosage and FES parameters, as well as to identify which patients are most likely to benefit from this combined therapy. Understanding the underlying mechanisms that make this combined approach effective is also crucial.

Ultimately, continued research in this area could lead to more effective and personalized rehabilitation strategies, helping stroke survivors regain independence, reduce pain, and improve their overall well-being.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2217/fnl-2018-0020, Alternate LINK

Title: Botulinum Neurotoxin Type A Combined With Functional Electrical Stimulation For Upper-Limb Poststroke Spasticity With Pain

Subject: Neurology (clinical)

Journal: Future Neurology

Publisher: Future Medicine Ltd

Authors: Anahita Nikbakht, Ali Karshenas, Parisa Gazerani

Published: 2018-11-01

Everything You Need To Know

How does Botulinum neurotoxin type A (BoNTA) alleviate spasticity after a stroke?

Botulinum neurotoxin type A, commonly referred to as BoNTA, works by relaxing targeted muscles. It achieves this by blocking nerve signals, which reduces muscle stiffness or spasticity. This allows for improved movement and function in the affected areas. BoNTA is often used to manage conditions like post-stroke spasticity.

What is Functional Electrical Stimulation (FES) and how does it aid in stroke recovery?

Functional Electrical Stimulation, known as FES, utilizes mild electrical pulses to stimulate muscles. This stimulation helps improve muscle function and reduce pain. By applying electrodes to the skin over the targeted muscles, FES can encourage muscle contractions and improve overall mobility. FES is used in rehabilitation to help stroke patients regain motor control.

What are the benefits of combining Botulinum neurotoxin type A (BoNTA) injections with Functional Electrical Stimulation (FES) for stroke patients?

The combination of Botulinum neurotoxin type A (BoNTA) and Functional Electrical Stimulation (FES) aims to provide synergistic benefits for stroke patients. BoNTA helps to relax spastic muscles, while FES actively stimulates and strengthens those muscles. This combined approach can lead to improved muscle function, reduced pain, and enhanced quality of life. The sequential application of BoNTA followed by FES is crucial for maximizing therapeutic outcomes.

What did the case study reveal about combining Botulinum neurotoxin type A (BoNTA) and Functional Electrical Stimulation (FES) for stroke survivors?

A recent case study demonstrated a significant increase in a stroke patient's quality of life score after three months of combined Botulinum neurotoxin type A (BoNTA) and Functional Electrical Stimulation (FES) therapy. The patient experienced improved functionality, suggesting a valuable impact on daily life, even though pain scores didn't change drastically. This suggests that the improved muscle function has the ability to greatly improve a patients life beyond just pain scores. These results show a promising approach to stroke recovery.

What further research is needed to fully understand the potential of combined Botulinum neurotoxin type A (BoNTA) and Functional Electrical Stimulation (FES) in stroke recovery?

While the case study indicates promising results, more research is needed to fully understand the benefits of combining Botulinum neurotoxin type A (BoNTA) and Functional Electrical Stimulation (FES) for stroke recovery. Future studies should explore the long-term effects, optimal treatment protocols, and the applicability of this approach to a broader range of stroke patients with varying degrees of spasticity and pain. Additionally, comparing this combined approach to other rehabilitation techniques will help determine its overall effectiveness and place in stroke care.