Abstract
BackgroundA large proportion of painful diabetic neuropathy cases either do not respond or are intolerant to the currently available oral and physical therapies. There is encouraging evidence from a small number of studies that those patients can improve using botulinum toxin injection. The aim of the study was to evaluate the effect of intradermal injection of botulinum toxin type A on painful diabetic neuropathy. Eight adult patients with diabetic peripheral neuropathy (DPN), confirmed by nerve conduction studies, were refractory to a minimum of two neuropathic pain treatments for 6 months or more were recruited. All cases received intradermal injection of 48 units of botulinum toxins—type A in each foot in 6×4 distribution. Follow-up was done after 8 weeks using the Neuropathic Pain Scale (NPS), Pittsburgh Sleep Quality Index (PSQI), and Overall Disability Sum Scale (ODSS).ResultsAfter 8 weeks, there was a significant change in NPS from 55.8 (7.8) to 38.5 (8.1) (p value 0.007), also there was significant improvement in ODDS from 4 (IQR, 2.25-4.75) to 2.5 (IQR, 0.5-3) (p value 0.01). However, there was no significant change in PSQI.ConclusionBotulinum toxin type A injection is a promising treatment option in Egyptian DPN adults in this study.
Highlights
A large proportion of painful diabetic neuropathy cases either do not respond or are intolerant to the currently available oral and physical therapies
Our study showed a significant change in Neuropathic Pain Scale (NPS) after 8 weeks follow-up from botulinum toxin injection, from 55.8 (7.8) to 38.5 (8.1) (p value 0.007)
Ranoux and colleagues studied the effect of botulinum toxin injection; they found significant effect on pain intensity of diabetic peripheral neuropathy from 2-12 weeks after injection, they concluded that botulinum toxin had an analgesic effect independent of the effect on muscle tone [10]
Summary
A large proportion of painful diabetic neuropathy cases either do not respond or are intolerant to the currently available oral and physical therapies. The aim of the study was to evaluate the effect of intradermal injection of botulinum toxin type A on painful diabetic neuropathy. Painful diabetic neuropathy affects about 16% of diabetic patients [5], and in another report the neuropathic pain symptoms were found among 10-30% of affected patients [3] This was frequently unreported or untreated and usually affects patient’s quality of life and sleep. The patients usually complain of lancinating pains, burning, Many symptomatic treatments are used for the relief of pain, like antidepressants, anticonvulsants, and opioids. Sometimes these medications are not effective, or the patients could not tolerate higher doses or side effects. This necessitated the trial of another option that could have prolonged effect and less side effects [7]
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