Botulinum Toxin for Neuropathic Pain: A Review of the Literature.
Botulinum neurotoxin (BoNT), derived from Clostridium botulinum, has been used therapeutically for focal dystonia, spasticity, and chronic migraine. Its spectrum as a potential treatment for neuropathic pain has grown. Recent opinions on the mechanism behind the antinociceptive effects of BoNT suggest that it inhibits the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. There is some evidence showing the axonal transport of BoNT, but it remains controversial. The aim of this review is to summarize the experimental and clinical evidence of the antinociceptive effects, mechanisms, and therapeutic applications of BoNT for neuropathic pain conditions, including postherpetic neuralgia, complex regional pain syndrome, and trigeminal neuralgia. The PubMed and OvidSP databases were searched from 1966 to May 2015. We assessed levels of evidence according to the American Academy of Neurology guidelines. Recent studies have suggested that BoNT injection is an effective treatment for postherpetic neuralgia and is likely efficient for trigeminal neuralgia and post-traumatic neuralgia. BoNT could also be effective as a treatment for diabetic neuropathy. It has not been proven to be an effective treatment for occipital neuralgia or complex regional pain syndrome.
Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. hazel@cmcnu.or.kr.
Hyun-Mi
HM
Oh
Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, the Catholic University of Korea, Wangsan-ro 180, Dongdaemoon-Gu, Seoul 02559, Korea. coltrane@catholic.ac.kr.
Myung Eun
ME
Chung
D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D001369:Axons / Q000378:metabolism; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004333:Drug Administration Routes; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy* / Q000378:metabolism
D000700:Analgesics; D001905:Botulinum Toxins
BoNT/A; antinociceptive; botulinum toxins; neuralgia; neuropathic pain