title: Ultrasound-Guided Nerve Block with Botulinum Toxin Type A for Intractable Neuropathic Pain.
abstract: Neuropathic pain includes postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A) has been known for its analgesic effect in various pain conditions. Nevertheless, there are no data of nerve block in PHN and PDN. Here, we report two patients successfully treated with ultrasound-guided peripheral nerve block using BoNT-A for intractable PHN and PDN. One patient had PHN on the left upper extremity and the other patient had PDN on a lower extremity. Due to side effects of drugs, escalation of the drug dose could not be made. We injected 50 Botox units (BOTOX(®), Allergan Inc., Irvine, CA, USA) into brachial plexus and lumbar plexus, respectively, under ultrasound. Their pain was significantly decreased for about 4-5 months. Ultrasound-guided nerve block with BoNT-A may be an effective analgesic modality in a chronic intractable neuropathic pain especially when conventional treatment failed to achieve adequate pain relief.
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-Daero, Seoul 137-701, Korea. momo0910@catholic.ac.kr.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Moon
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-Daero, Seoul 137-701, Korea. js031355@hanmail.net.
authors.forename: Jung Hyun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-Daero, Seoul 137-701, Korea. huejung@catholic.ac.kr.
authors.forename: Hue Jung
authors.initials: HJ
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-Daero, Seoul 137-701, Korea. jh0192@hanmail.net.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-Daero, Seoul 137-701, Korea. delita605@hotmail.com.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Kim
mesh_terms: D000368:Aged; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D009437:Neuralgia / Q000188:drug therapy*; D000069453:Ultrasonic Waves
chemical_list: D000700:Analgesics; D019274:Botulinum Toxins, Type A
keywords: botulinum toxin type A; diabetic polyneuropathy; nerve block; postherpetic neuralgia