An update on botulinum toxin as treatment for nerve pain
Neuropathic pain results from a dysfunction and derangement in the transmission and signal processing along the nervous system and it is a recognized disease in itself. Botulinum neurotoxin (BoNT) is derived from Clostridium botulinum has been used therapeutically for various disorders. Its spectrum as a potential treatment for neuropathic pain has grown.
The aim of this review is to discuss the pathophysiology and conventional treatment of neuropathic pain and evidenced-based statements on the efficacy of botulinum neurotoxins (BoNTs) or neuropathic pain conditions. 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.
Recent studies have suggested that BoNT is an effective (level A evidence) treatment of different clinical conditions that present with neuropathic pain, such as postherpetic neuralgia and is likely efficient for trigeminal neuralgia and post-traumatic neuralgia. BoNT could also be effective (level B evidence) as a treatment for diabetic neuropathy and posttraumatic neuralgia. It has not been proven to be an effective treatment for occipital neuralgia or complex regional pain syndrome, carpal tunnel syndrome and phantom limb pain.
This paper addresses the effect of botulinum neurotoxins in treating neuropathic pain. The use of BoNT could represent a novel therapeutic strategy in caring for neuropathic pain whenever common pharmacological tools have been ineffective. As there has been increasing interest in exploring the potential therapeutic benefit of the botulinum toxins in the management of neuropathic pain. However, much remains to be learned about the most-effective dosage and technique of injection, optimum dilutions and differences among BoNTs in the relief of neuropathic pain.