AIM: The objectives of our study was to assess the efficacy of botulinum toxin type A in recalcitrant secondary Raynaud’s phenomenon with respect to complete pain relief, healing of digital ulcer, improvement in tissue oxygenation, improvement in activities of daily living and prevention of recurrence. METHODS: 20 female patients with recalcitrant secondary Raynaud’s were divided into 2 equal groups –10 in group A received upto100 units of botox in both hands (5 units/ site) and 10 in Group B received placebo injection (normal saline). RESULTS: Patients in group A had a statistically significant improvement as compared to group B in visual analogue scale for pain (p=0.02) and oxygen saturation (p=0.04). Group A had an improvement in quick Disabilities of Arm, Shoulder and Hand(DASH) score, but was not statistically significant(p=0.34). CONCLUSION: Botulinum injection rapidly reduces the pain, frequency of attacks, and reduces the disability associated with Raynaud’s phenomenon