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Chapter 30 - Use of Botulinum Neurotoxin in Neuropathic Pain

Published online by Cambridge University Press:  02 November 2023

By
Szu-Kuan Yang ,
Chen-Chih Jean Chung  and
Chaur-Jong Hu
Edited by
Daniel Truong ,
Dirk Dressler ,
Mark Hallett ,
Christopher Zachary  and
Mayank Pathak
Daniel Truong
Affiliation:
University of California, Riverside
Dirk Dressler
Affiliation:
Hannover Medical School
Mark Hallett
Affiliation:
National Institutes of Health (NIH)
Christopher Zachary
Affiliation:
University of California, Irvine
Mayank Pathak
Affiliation:
Truong Neuroscience Institute
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Summary

Neuropathic pain refers to pain caused by a lesion or disease of the somatosensory nervous system. Diabetic neuropathy, postherpetic neuralgia, radiculopathy pain, trigeminal neuralgia and complex regional pain syndrome are all neuropathic pain syndromes.

Local administration of botulinum neurotoxin (BoNT)) has proven significant effects on the treatment of neuropathic pain. Abnormal muscle contractions contribute to chronic pain. Botulinum neurotoxin serotype A (BoNT-A) is well known to have an effect on inhibition of muscle contraction and this may partially explain its effect on chronic pain. In preclinical models, BoNT-A was found to effectively block the release of several pain-related neurotransmitters, including norepinephrine, substance P, glutamate and calcitonin gene-related peptide, from afferent nerve terminals and dorsal root ganglia. These pain-related neurotransmitters can stimulate depolarization of C fibers, which are responsible for propagation of chronic pain. BoNT-A also decreases local inflammation around the nerve terminal.

This chapter offers clinical description and pictorial illustration for injection of BoNT for the particular conditions of diabetic neuropathy, postherpetic neuralgia and trigeminal neuralgia.

Keywords

Botulinum neurotoxinBoNTsomatosensory nervous systemdiabetic neuropathypostherpetic neuralgiatrigeminal neuralgiacomplex regional pain
Type
Chapter
Information
Manual of Botulinum Toxin Therapy , pp. 245 - 251
Publisher: Cambridge University Press
Print publication year: 2023

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References

Baron, R (2006). Mechanisms of disease: neuropathic pain – a clinical perspective. Nat Clin Pract Neurol, 2, 95–106 http://doi.org/10.1038/ncpneuro0113Google Scholar
Cui, M, Khanijou, S, Rubino, J, Aoki, KR (2004). Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain, 107, 125-33. http://doi.org/10.1016/j.pain.2003.10.008CrossRefGoogle ScholarPubMed
Egeo, G, Fofi, L, Barbanti, P (2020). Botulinum neurotoxin for the treatment of neuropathic pain. Front Neurol, 11. http://doi.org/10.3389/fneur.2020.00716CrossRefGoogle ScholarPubMed
Ghasemi, M, Ansari, M, Basiri, K et al. (2014). The effects of intradermal botulinum toxin type A injections on pain symptoms of patients with diabetic neuropathy. J. Res Med Sci, 19, 106–11.Google ScholarPubMed
Jabbari, B, Machado, D. (2011). Treatment of refractory pain with botulinum toxins – an evidence-based review. Pain Med, 12, 1594–606. http://doi.org/10.1111/j.1526-4637.2011.01245.xCrossRefGoogle ScholarPubMed
Lakhan, SE, Velasco, DN, Tepper, D (2015). Botulinum toxin-A for painful diabetic neuropathy: a meta-analysis. Pain Med, 16, 1773–80. http://doi.org/10.1111/pme.12728Google Scholar
Morra, ME, Elgebaly, A, Elmaraezy, A et al. (2016). Therapeutic efficacy and safety of botulinum toxin A therapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials. J Headache Pain, 17, 63. http://doi.org/10.1186/s10194-016-0651-8CrossRefGoogle ScholarPubMed
Pace, MC, Mazzariello, L, Passavanti, MB et al. (2006). Neurobiology of pain. J Cell Physiol, 209, 8–12. http://doi.org/10.1002/jcp.20693CrossRefGoogle ScholarPubMed
Park, J, Chung, ME (2018). Botulinum toxin for central neuropathic pain. Toxins (Basel), 10. http://doi.org/10.3390/toxins10060224Google Scholar
Park, J, Park, HJ (2017). Botulinum toxin for the treatment of neuropathic pain. Toxins (Basel), 9. http://doi.org/10.3390/toxins9090260CrossRefGoogle ScholarPubMed
Petrenko, AB, Yamakura, T, Baba, H, Shimoji, K (2003). The role of N-methyl-D-aspartate (NMDA) receptors in pain: a review. Anesth Analg, 97(4), 1108–16. http://doi.org/10.1213/01.Ane.0000081061.12235.55Google ScholarPubMed
Piovesan, EJ, Teive, HG, Kowacs, PA et al. (2005). An open study of botulinum A toxin treatment of trigeminal neuralgia. Neurology, 65, 1306–8.Google Scholar
Van Bee, AL, Lim, PK, Gear, AJL, Pritzker, MR (2007). Management of vasospastic disorders with botulinum toxin A. Plast Reconstr Surg, 11, 217–26. http://doi.org/10.1097/01.prs.0000244860.00674.57Google Scholar
Wen, B, Wang, Y, Zhang, C, Xu, W, Fu, Z (2020). Efficacy of different interventions for the treatment of postherpetic neuralgia: a Bayesian network meta-analysis. J Int Med Res, 48, 300060520977416. http://doi.org/10.1177/0300060520977416CrossRefGoogle ScholarPubMed
Xiao, L, Mackey, S, Hui, H et al. (2010). Subcutaneous injection of botulinum toxin A is beneficial in postherpetic neuralgia. Pain Med, 11, 1827–33. http://doi.org/10.1111/j.1526-4637.2010.01003.xCrossRefGoogle ScholarPubMed
Yuan, RY, Sheu, JJ, Yu, JM et al. (2009). Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial. Neurology, 72, 147–8. http://doi.org/10.1212/01.wnl.0000345968.05959.cfCrossRefGoogle ScholarPubMed

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