title: [Use of intracutaneous or subcutaneous botulinum toxin for postherpetic neuralgia].
abstract: BACKGROUND
  Botulinum neurotoxin (BoNT), a toxin of the anaerobic spore-forming bacterium Clostridium botulinum is used as a drug for alleviating muscle spasticity. Other indications include the cosmetic application in facial muscles, hyperhidrosis and neurogenic bladder disorders. It has been approved since 2010 as the first prophylactic treatment for chronic migraine. The analgesic effect of BoNT was observed early on and is currently the subject of intensive research. Painful postherpetic neuralgia is a common complication of an infection with herpes zoster virus. Despite modern treatment algorithms and medication, satisfactory pain treatment is not achieved in all patients. The use of BoNT could represent a new treatment option.
  
  
  OBJECTIVE
  The aim of this article is to provide an overview of the current evidence for the use of BoNT for postherpetic neuralgia.
  
  
  METHODS
  We conducted a systematic literature search with the keywords "botulinum" and "neuropathic" and included original articles in which BoNT was used subcutaneously or intradermally for the treatment of postherpetic neuralgia.
  
  
  RESULTS
  The initial search yielded 212 results. After a title and abstract screening, the number was reduced to 11 relevant publications (5 case reports or series and 6 prospective studies).
  
  
  CONCLUSIONS
  The results in the currently available literature show that BoNT is an effective therapeutic option for postherpetic neuralgia. In all studies, a significant effect on the pain and also on relevant patient-oriented secondary variables, such as the quality of life and especially the quality of sleep was shown. The only reported side effect was pain during administration.
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Klinische Abteilung für Spezielle Anästhesiologie, Schmerz- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich.
authors.forename: L
authors.initials: L
authors.lastname: Halb
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Klinische Abteilung für Spezielle Anästhesiologie, Schmerz- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich.
authors.forename: B J
authors.initials: BJ
authors.lastname: Amann
authors.affiliation: Universitätsklinik für Anästhesiologie und Intensivmedizin, Klinische Abteilung für Spezielle Anästhesiologie, Schmerz- und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich. helmar.bornemann@medunigraz.at.
authors.forename: H
authors.initials: H
authors.lastname: Bornemann-Cimenti
mesh_terms: D000279:Administration, Cutaneous; D001905:Botulinum Toxins / Q000008:administration & dosage* / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007271:Injections, Intradermal; D007279:Injections, Subcutaneous; D051474:Neuralgia, Postherpetic / Q000175:diagnosis* / Q000188:drug therapy*; D010146:Pain / Q000139:chemically induced* / Q000517:prevention & control; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins
keywords: Allodynia; Herpes zoster; Hyperalgesia; Injections, subcutaneous; Neuropathic pain