Botulinum toxin for neuropathic pain?

Abstract

Neurologists who routinely treat neuropathic pain are well aware that despite the plethora of pharmacologic agents that are purportedly effective in managing this difficult and complicated problem, the response to existing therapies is often inadequate. Neuropathic pain is often only partially responsive to conventional analgesics such as nonsteroidal anti-inflammatory drugs or opioids, which must be administered at relatively high doses, with a consequently high incidence of side effects. Fewer than 60% of patients obtain even partial relief from newer agents that have received regulatory approval for the treatment of neuropathic pain.1,2 Most of these treatments are also limited by their significant side effects. As a result, the search continues for newer treatments and additional novel therapeutic targets for what is still a largely unmet medical need. Sometimes, promising treatments arise from the application of established drugs to novel indications. A case in point is botulinum toxin. Botulinum toxin type A (BoNT/A) has been used for decades as the standard of care …