Botulinum toxin for diabetic neuropathic pain

Abstract

This pilot study found that botulinum toxin type A significantly reduced diabetic neuropathic pain and transiently improved sleep quality. Further large-scaled study is warranted.

Botulinum toxin type A for neuropathic pain in patients with spinal cord injury

“…However, recent studies have reported that BTX‐A for the treatment of neuropathic pain can be administered subcutaneously or intradermally 9, 10, 11, 25, 26. The effects on pain may be mediated through direct effects on the sensory system 16.…”

“…In a previous case report of BTX for neuropathic pain in patients with spinal cord lesions, BTX‐A was administered subcutaneously; a subcutaneous route was chosen for this study 17. In most studies, the fractioned dosage of BTX‐A for the treatment of neuropathic pain was between 2.5 and 7.5U/cm 2 per painful surface area, and the maximum total dosage was between 100 and 200U 9, 10, 11, 25, 26, 27. In the present study, the painful surface area in patients with SCI was generally larger than that in patients with focal neuropathy such as postherpetic neuralgia and post‐traumatic neuropathy.…”

“…Considering a 5% level of significance, power of 80%, and a possible dropout rate of 10%, the total target number of subjects was calculated to be 20 for each group 10. Reductions in the VAS scores of the BTX‐A and the placebo groups at 4 and 8 weeks after the injection were assessed using Student t test or Wilcoxon rank sum test.…”

Botulinum toxin A, brain and pain

“…In the past decade, several hundreds of reports of pain relief due to BoNT/A off-label use in various clinical conditions have been published. Beneficial effects in pain have been reported in interstitial cystitis (Kuo, 2013, Russell et al, 2013, chronic arthritis (Chou et al, 2010), residual limb pain (Wu et al, 2012), different types of neuropathic pain (Ranoux et al, 2008;Zuniga et al, 2008) including diabetic neuropathy (Relja and Miletić, 2005;Yuan et al, 2009;Chen et al, 2013), masticatory pain etc. Although some double-blind, placebo controlled studies have been performed (review by Jabbari and Machado, 2011), clinical reports on BoNT/A effectiveness are dominated by studies based on a small number of patients or individual case reports.…”

Recent and Emerging Trends in Pharmacotherapy of Neuropathic Pain

“…Recent studies have shown its beneficial effects in painful diabetic neuropathy where there as a significant pain reduction during 12 week therapy as compared to placebo. [24] The findings are consistent with a positive effect of BTX-A on peripheral sensitization, but the role of a central effect has not been determined so far. One session of multiple intradermal injection of BTX-A produces long-lasting analgesia in patients with focal painful neuropathies and diabetic neuropathic pain, and is particularly well tolerated.…”