Effect of Botulinum Toxin on Disabling Neuropathic Pain: A Case Presentation Suggesting a New Therapeutic Strategy.
This case presentation describes a 47-year-old woman who developed complex regional pain syndrome type II with severe neuropathic pain following iatrogenic transection of the tibial nerve at the ankle. The pain and disability progressively worsened over time, markedly impaired ambulation, and were not relieved despite various analgesic treatments. After injection of botulinum toxin (abobotulinumtoxinA, BoNT-A) in the leg muscles the tendons of which pass through the tarsal tunnel (together with the tibial nerve), her pain decreased and her walking capacity improved. This case suggests a new therapeutic role for botulin toxin in treating peripheral neuropathic pain caused by movement-evoked ectopic potentials.



V.
Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri, Scientific Institute of Pavia, Via Salvatore Maugeri 10, 27100 Pavia, Italy(∗). Electronic address: michelangelo.buonocore@fsm.it.
Michelangelo
M
Buonocore
Unit of Pain Medicine, Fondazione Salvatore Maugeri, Scientific Institute of Pavia, Pavia, Italy(†).
Laura
L
Demartini
Physical Medicine and Rehabilitation Unit, Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy(‡).
Silvia
S
Mandrini
Physical Medicine and Rehabilitation Unit, Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy(§).
Anna
A
Dall'Angelo
Physical Medicine and Rehabilitation Unit, Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy(‖).
Elena
E
Dalla Toffola
D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000843:Ankle Joint / Q000294:innervation; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement
D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA