Botulinum toxin A for neuropathic pain after neck dissection: a dose-finding study.
OBJECTIVE
Botulinum toxin type A (BtxA) has been reported to be feasible in chronic neuropathic pain after neck dissection. The impact of the dose on the outcome has not been investigated yet.


METHODS
Twenty-three patients with neuropathic pain after neck dissection were selected for an open and prospective phase II trial.


METHODS
In the low-dose group (n=13), a concentration of 10 mouse units (MU)/0.1 mL saline and in the high-dose-group (n=10), a concentration of 20 MU/0.1 mL saline were injected subcutaneously. Pain and quality of life were assessed at day 0 and day 28, respectively, by visual analog scales (VAS) and European Organization for Research and Treatment of Cancer (EORTC) quality-of-life core and EORTC quality-of-life head and neck module questionnaires.


RESULTS
Patients in the low-dose group showed a significant pain reduction (VAS) from 4.3 at day 0 to 3.0 at day 28 (P<.05). The mean pain VAS values in the high-dose group did not improve significantly. No serious adverse events were observed. There were trends toward improvement in quality of life in the low-dose group.


CONCLUSIONS
BtxA in a low concentration seems to be a useful therapeutic option in chronic neuropathic pain of the neck and shoulder after neck dissection.
Wittekindt
Claus
C
Department of Otorhinolaryngology, School of Medicine, Cologne, Germany. claus.wittekindt@uni-koeln.de
Liu
Wei-Chi
WC
Preuss
Simon F
SF
Guntinas-Lichius
Orlando
O
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A