Botulinum Toxin for Neuropathic Pain and Spasticity: An Overview

Abstract

In recent years, a large body of data has surfaced reporting the therapeutic benefit of botulinum toxin injection in multiple conditions. The aim of this review is: to summarize the highest quality literature pertaining to clinical application of botulinum toxin in neuropathic pain conditions including postherpetic neuralgia, trigeminal neuralgia, diabetic polyneuropathy, post-traumatic neuralgia, carpal tunnel syndrome, complex regional pain syndrome, phantom limb and stump pain, and occipital neuralgia; to provide an overview of the clinical trials using botulinum toxin in adult spasticity; and to assign levels of evidence according to the American Academy of Neurology guidelines. In summary, there is level A evidence for established efficacy in postherpetic neuralgia and adult spasticity; level B evidence for probable efficacy in trigeminal neuralgia and post-traumatic neuralgia; level B evidence for probable lack of efficacy in carpal tunnel syndrome; level C evidence for possible efficacy in diabetic polyneuropathy; and level U (insufficient) evidence in complex regional pain syndrome, phantom limb and stump pain, and occipital neuralgia.

The Benefit of Botulinum Toxin A in the Management of Central Post Stroke Pain: A Case Report

“…It can be difficult to distinguish between other pain types following a stroke, such as painful spasticity or other musculoskeletal problems. Many patients after stroke can present with multiple pain syndromes and a definite diagnosis of CPSP is difficult [2]. Allodynia or descriptors such as a burning pain or electric shock sensation can aid the diagnosis.…”

“…Antidepressants, anticonvulsants and opiates can be tried. Non-pharmacological treatments include repetitive transcranial magnetic stimulation, deep brain stimulation and motor cortex stimulation [2].…”

Botulinum Toxin for Pain Syndromes

“…Хотя БTA преи-мущественно используется для уменьшения спастичности в условиях нейрореабилитации, в случае НПБ основопо-лагающими фармакологическими механизмами, по всей видимости, являются блокирование ноцицептивной трансдукции, снижение нейрогенного воспаления путем ингибирования нейронных веществ и нейротрансмит-теров и предупреждение периферической и центральной сенситизации. Кроме того, БTA облегчает боль и при пост-травматической невралгии, при фантомной боли в ампу-тированной конечности и при комплексном региональ-ном болевом синдроме [56][57][58].…”

“…В обзоре «Ботулинический нейротоксин в лечении нейропатической боли», опубликованном в 2014 г., были суммированы данные о применении БТА при различных нейропатических расстройствах [58]. Анализ исследова-ний применения БТА при постинсультной боли в плече показал значительное и достоверное снижение боли.…”

OnabotulinumtoxinA Nerve Blocks in the Treatment of Occipital Neuralgia

“…Studies that specifically examine the use of ONA in treating occipital neuralgia are scarce. A recent literature review discovers insufficient evidence for ONA injection treatment of occipital neuralgia, due to the existence of only two case series studies and three case reports [14]. Past studies of ONA blocks of the greater and/or lesser occipital nerves show significant decreases in pain scores [15], as well as improvement in some pain types and quality of life measures [16], but have been limited by small sample sizes.…”