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Semin Neurol 2016; 36(01): 073-083
DOI: 10.1055/s-0036-1571953
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Botulinum Toxin Treatment of Neuropathic Pain

Shivam Om Mittal
1   Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Delaram Safarpour
2   Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Bahman Jabbari
3   Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
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Publication History

Publication Date:
11 February 2016 (online)

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Abstract

Neuropathic pain (NP), a common form of human pain, often poorly responds to analgesic medications. In this review the authors discuss the pathophysiology and conventional treatment of neuropathic pain and provide evidenced-based statements on the efficacy of botulinum neurotoxins (BoNTs) in this form of pain. The level of efficacy for BoNT treatment in each category of NP is defined according to the published guidelines of the American Academy of Neurology. The data indicate that BoNT treatment (most of the literature is with onabotulinumtoxinA) is effective (level A evidence) in postherpetic neuralgia and trigeminal neuralgia. It is probably effective (level B) in posttraumatic neuralgia and painful diabetic neuropathy. The data on complex regional pain syndrome, carpal tunnel syndrome, occipital neuralgia, and phantom limb pain are preliminary and await conduction of randomized, blinded clinical trials. Much remains to be learned about the most-effective dosage and technique of injection, optimum dilutions, and differences among BoNTs in the treatment of neuropathic pain.

Keywords

botulinum toxin - neuropathic pain - postherpetic neuralgia - posttraumatic neuralgia - diabetic neuropathy - trigeminal neuralgia - complex regional pain syndrome - phantom pain - carpal tunnel syndrome - occipital neuralgia
 

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