Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial

Attal, Nadine; Andrade, Daniel Ciampi de; Adam, Frédéric; Ranoux, Daniéle; Teixeira, Manoel Jacobsen; Galhardoni, Ricardo; Raicher, Irina; Üçeyler, Nurcan; Sommer, Claudia; Bouhassira, Didier

doi:10.1016/s1474-4422(16)00017-x

Cited by 198 publications

(210 citation statements)

References 32 publications

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“…However evidence has shown that following treatment with Botulinum Toxin for neuropathic pain, there were no changes in total concentrations of substance P or CGRP in biopsy samples. Therefore it was been suggested that the analgesic effect could be related to central mechanisms of pain transmission [8].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2017

JNSK

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Purpose: Spasticity and pain are common complications of stroke. Pain following stroke is multi factorial and can be due to musculoskeletal problems, painful spasticity or central post stroke pain. Botulinum Toxin A is the first line pharmacotherapy in spasticity management and increasing evidence has shown benefits in neuropathic pain.Results: This case report demonstrates the benefit of Botulinum Toxin A in the management of central post-stroke pain with elbow flexor spasticity. The clinical characteristics of the pain were neuropathic and the severity was greater than expected given the degree of spasticity. The pain responded to Botulinum Toxin treatment within a few days, independently of the improvement in spasticity and the effect was continued over six cycles of treatment. Conclusion:Management of central post stroke pain is challenging due systemic side effects of oral medications. Botulinum Toxin A has increasingly being shown to benefits in neuropathic pain either through blockade of nociceptive substances or acting on central transmission of pain. Although the treatment in our case was given for spasticity management, the patient had unexpected and significant improvement in pain prior to improvement in range of movement. Given the increasing evidence in use of Botulinum Toxin A in neuropathic pain, we feel this may be a possible future treatment option for central post-stroke pain

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Section: Discussionmentioning

confidence: 99%

Untitled

2017

JNSK

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“…Although arguably not a topical treatment per se, intradermal botox has been recently shown in a randomised double-blinded controlled trial to have a sustained effect over 24 weeks when used in peripheral neuropathic pain [46]. In the palliative setting, radioactive strontium paste has been used to control pain from bony metastases [47].…”

Section: Other Topical Adjunctsmentioning

confidence: 99%

The role of topiceuticals in cancer pain

Paisley

Serpell²

2017

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review:Pain is one of the most common and feared symptoms associated with a new diagnosis of cancer and its subsequent treatment. Unfortunately, it remains undertreated in around one third of patients. It has been recently postulated that one mechanism for this could be failure to recognise neuropathic pain. One attractive option in both the case of neuropathic pain and pain associated with intolerable side effects of prescribed opioids is the use of 'topiceuticals', as a means of targeted pain relief with potentially fewer side effects. This review summarises the evidence base for the various topiceuticals available for the treatment of localised neuropathic pain. Recent findings:The recent evidence base for established treatments such as capsaicin and lignocaine is examined. A variety of novel and previously used therapies are considered. Summary:The use of topiceuticals in localised neuropathic pain associated with malignancy remain a valuable option with many advantages over systemic treatments. In addition to anecdotal reports of efficacy, there is a growing body of evidence to consider the early use of topical lignocaine and capsaicin in this context. The authors' have proposed a guideline including the use of topiceuticals to aid in the management of neuropathic pain

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“…The only reported side effect was pain during administration. In einer rezenten Publikation untersuchten Attal et al mittels einer internationalen, multizentrischen, randomisierten, placebokontrollierten Studie den repetitiven Einsatz von BoNT-A bei unterschiedlichen peripher-neuropathischen Schmerzen, darunter auch 6 Patienten mit einer Post-Zoster-Neuralgie [5]. Sie konnten zeigen, dass mit einer einmaligen Wiederholung Schmerzen über 24 Wochen reduziert werden konnten.…”

Section: Use Of Intracutaneous or Subcutaneous Botulinum Toxin For Pounclassified

“…Die Autoren konnten keine Veränderungen der Konzentrationen von Substanz P oder CGPR in den behandelten Arealen nachweisen. Sie schlussfolgerten daraus, dass sich der analgetische Effekt nicht durch eine Wirkung auf eine neurogene Inflammation erklären lässt [5].…”

Section: Use Of Intracutaneous or Subcutaneous Botulinum Toxin For Pounclassified