title: The role of botulinum toxin in management of pain: an evidence-based review.
abstract: OBJECTIVE
  In the present review we discuss the role of botulinum neurotoxins (BoNTs) in the management of different pain conditions, with evidence-based data on the toxins' efficacy on pain and its mechanisms.
  
  
  RESULTS
  Experimental in-vitro studies have reported promising results of a novel recombinant chimera of BoNT A and E that inhibits the calcitonin gene-related peptide exocytosis from brainstem sensory neurons. Animal studies in neuropathic pain rat models have reported an analgesic effect of BoNT A given after the neuropathic procedure and a bilateral antinociceptive effect to the unilateral noxious stimuli. There is a growing body of evidence that BoNTs are effective in myofascial pain syndrome, neuropathic pain, and joint pain. The pre-existing evidence that BoNTs are ineffective in migraine or other headache disorders has not yet been challenged. In other pain syndromes, studies published in the last review year have not contributed significantly in either demonstrating or invalidating the research that has so far proved inconclusive.
  
  
  CONCLUSIONS
  The role of BoNTs in management of pain is not yet well established. Larger studies in neuropathic pain, joint pain, and myofascial pain syndrome are needed to fully ascertain the role for BoNT therapy in those areas.
authors.affiliation: Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark. erisela@akhphd.au.dk
authors.forename: Erisela
authors.initials: E
authors.lastname: Qerama
authors.forename: Anders
authors.initials: A
authors.lastname: Fuglsang-Frederiksen
authors.forename: Troels S
authors.initials: TS
authors.lastname: Jensen
mesh_terms: D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use; D018771:Arthralgia / Q000188:drug therapy; D001905:Botulinum Toxins / Q000494:pharmacology / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006261:Headache / Q000188:drug therapy; D006801:Humans; D009209:Myofascial Pain Syndromes / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy*; D010523:Peripheral Nervous System Diseases / Q000150:complications; D016032:Randomized Controlled Trials as Topic
chemical_list: D000700:Analgesics; D001905:Botulinum Toxins