title: Botulinum Toxin-A for Painful Diabetic Neuropathy: A Meta-Analysis.
abstract: OBJECTIVE
  Painful diabetic neuropathy (PDN) is a debilitating complication of diabetes that greatly affects the quality of life of those afflicted. There are many treatment options for neuropathic pain. Recent studies show a promising analgesic effect using botulinum toxin-A (BTX-A) for neuropathic pain.
  
  
  METHODS
  This article is a meta-analysis of two studies using BTX-A in the treatment of neuropathic pain. Electronic searches of MEDLINE/PubMed, EMBASE, and Cochrane Libraries using the terms "botulinum neurotoxin" and "neuropathic pain" were conducted. Only class I and class II therapeutic trials, as classified by the American Academy of Neurology were included. The primary outcome measured was the difference in visual analogue scale (VAS) from pre-intervention and post-intervention after 1 month. Data were analyzed for biases and heterogeneity following Cochrane and PRISMA guidelines.
  
  
  RESULTS
  Two studies on PDN were analyzed in the meta-analysis showing improvement of 1.96 VAS points (95% CI, -3.09 to -0.84; Z score = 3.43, P < 0.001) following treatment with BTX-A. This corresponds to clinically significant improvement of "minimum change in pain." The adverse effects of infection at injection site was not statistically significant (P = 0.49). BTX-A may be effective for PDN.
  
  
  CONCLUSIONS
  Tests for significance, low overall risk of bias, and almost no statistical heterogeneity suggests that there is a correlation between BTX-A and improvement of pain scores in PDN. Further large-scale controlled trials are needed.
authors: Department of Bioscience, Global Neuroscience Initiative Foundation, Los Angeles, California, USA.
authors: Shaheen E
authors: SE
authors: Lakhan
authors: Department of Bioscience, Global Neuroscience Initiative Foundation, Los Angeles, California, USA.
authors: Dominic N
authors: DN
authors: Velasco
authors: Neurological Center for Pain, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors: Deborah
authors: D
authors: Tepper
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D004311:Double-Blind Method; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum Toxin; Diabetes; Neuropathic Pain; Neuropathy; Visual Analogue Scale