Abstract
Neuropathic pain (NP) is a common form of human pain, often poorly responsive to analgesic medications. This chapter discusses the pathophysiology and conventional treatment of common categories of neuropathic pain and reviews the literature on botulinum neurotoxin (BoNT) efficacy in neuropathic pain. The level of efficacy for BoNT treatment in each category is defined according to the published guidelines of the American Academy of Neurology. The data on type A toxin (mostly onabotulinumtoxinA, onaA) indicates efficacy in postherpetic neuralgia and probable efficacy in post-traumatic neuralgia, and painful diabetic neuropathy. Retrospective studies and anecdotal observations suggest efficacy in residual limb pain of amputees, complex regional pain syndrome, and chemotherapy-induced allodynia. Controlled studies are necessary to assess the efficacy of BoNTs in these conditions. Much remains to be learned about the most effective dosage and technique of injection, optimum dilutions, and differences among BoNTs in the treatment of neuropathic pain.
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