Abstract
Botulinum toxin (BTX) is widely used to treat muscle spasticity by acting on motor neurons. Recently, studies of the effects of BTX on sensory nerves have been reported and several studies have been conducted to evaluate its effects on peripheral and central neuropathic pain. Central neuropathic pain includes spinal cord injury-related neuropathic pain, post-stroke shoulder pain, multiple sclerosis-related pain, and complex regional pain syndrome. This article reviews the mechanism of central neuropathic pain and assesses the effect of BTX on central neuropathic pain.
Highlights
Botulinum toxins (BTXs) are neurotoxic substances produced by Clostridium botulinum, a gram-positive anaerobic bacterium
The mechanism of central neuropathic pain has been examined according to various hypotheses, including neuronal hyperexcitability and dysfunction of the spinothalamic tract
Various preclinical and clinical studies have been published on whether BTX may be effective for central neuropathic pain
Summary
Botulinum toxins (BTXs) are neurotoxic substances produced by Clostridium botulinum, a gram-positive anaerobic bacterium. The main functional effect of BTX occurs in the neuromuscular junction, where it inhibits the release of acetylcholine from the presynaptic nerve ending, resulting in muscular and autonomic paralysis [4]. Once BTX is internalized, the light chains within the vesicles are translocated across the vesicle membrane and released into the neuronal cytoplasm. BTX causes degradation of the SNARE protein, resulting in paralysis Based on these mechanisms, BTX is clinically used to treat muscle spasticity associated with central nervous system (CNS) disorders, such as stroke, brain injury, spinal cord injury (SCI), cerebral palsy, and multiple sclerosis (MS). Preclinical and clinical studies have reported the effects of BTX on peripheral neuropathic pain and, generally, demonstrated a high level of evidence for some diseases [9]. Articles not available in English and studies conducted in children (≤18 years of age) were excluded
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